How a rise in untreated mental illness symptoms and a lack of federal funding are creating the perfect storm.
For months the country has been living at a distance, working from home, steering clear of crowds, anything to avoid catching COVID-19. This sudden shift in behavior, coupled with economic uncertainty, has left many experiencing a host of less discernible symptoms that, if left untreated, could cause a whole new crisis on the heels of COVID-19.
One clinician sees these effects first hand in her practice and warns that this is part of a nationwide problem. Suzan Song, MD, PhD, MPH, director of the Division of Child, Adolescent and Family Psychiatry, notes that COVID-19 has exacerbated mental health symptoms that were once manageable.
“In my psychiatry practice, some of my college-aged patients who were previously able to manage their depression and anxiety are crippled in paralyzing fear of going outside, or depressed about the loss of their year and uncertain of their future,” Song, who also serves as associate professor of psychiatry and behavioral sciences at the George Washington University (GW) School of Medicine and Health Sciences, writes in an April 17 USA Today contributed article titled “Flatten the Mental Health Curve by Fixing Our Broken System.”
“Early on in the pandemic my health care worker patients can't sleep, spending most waking hours consumed by the vicarious trauma of managing the pandemic,” she writes. “My older patients have voiced thoughts of suicide, as they do not want to be a burden on family or the health system should they test positive for COVID-19.”
Even before the COVID-19 pandemic, 1 in 5 American adults experienced mental illness. Yet fewer than half of those received treatment. Since March, nearly half of Americans say that COVID-19 has affected their mental health, according to a recent poll by the Kaiser Family Foundation. Furthermore, there has been a 34% jump in prescriptions for anti-anxiety medications and a 19% increase in prescriptions for antidepressants. If that’s not alarming enough, an emergency hotline run by the Substance Abuse and Mental Health Services Administration registered a more than 1,000% increase in calls for April 2020 compared with the same time last year. An article in the April issue of JAMA Internal Medicine warned of a looming mental health epidemic due to COVID-19.
For patients who need mental health care or just need to speak with someone about a problem, explains Song, it’s not quite the same as getting an appointment for a physical ailment. Access to mental health providers and high costs of care are just some of the challenges people face when seeking mental health services. According to the National Council of Behavioral Health, almost half (42%) of Americans view cost or poor insurance coverage as the main barrier to accessing care.
“Despite federal laws that require mental health and medical services to be comparable, mental health care continues to lack the same reimbursements as care for physical health,” she says. “For example, one insurance company has covered only what was considered a crisis, but not needed treatment before or after the crisis resolves. This is the pandemic equivalent of only covering COVID-19 patients while they are on ventilators, but not the medical care before or after they are in acute respiratory failure.”
Low reimbursement rates among insurers have lead many psychiatrists to only accept self-pay. Additionally, a mental health office visit with a therapist is five times as likely to be out-of-network when compared to a non-mental health office visit. Together, this makes finding mental health care both difficult and expensive, a problem in need of reform.
Song believes there are multiple solutions that can offer mental health care for less. Prevention and recovery maintenance are inexpensive approaches that reinforce family and community support. Resiliency training, she adds, should be encouraged in both the clinic and the community. This training would help people as they deal with milestones such as graduating from school, becoming a parent, losing a job, retiring, and living through a pandemic.
Telehealth is another option that shows promise. The restrictions on telehealth have been lifted through the CARES Act allowing greater flexibility for patients, expanded reach for physicians, and Medicare and major insurer coverage of virtual office visits. Tele-psychiatry visits at The GW Medical Faculty Associates have been well received with over 90% of their patients opting for virtual visits over coming into the practice in person.
While nationally this has allowed greater access to mental health services, it remains to be seen if these restrictions on telehealth will return.
Song argues that more work is needed on the federal level to curb the problems surrounding access to care, something the CARES Act has fallen short of. Of the $2 trillion in the pandemic relief spending package passed by Congress in March, only $425 million was earmarked for mental health. In April, more than a dozen mental-health organizations called on Congress to allocate $38.5 billion in emergency funding to protect existing treatment programs, plus an additional $10 billion for pandemic response.
As Congress works on another relief package, Song believes more emphasis should be placed on broad mental health funding to expand established federal programs and services for low-income individuals and vulnerable populations. Furthermore, she says, insurers should continue to evaluate their coverage for mental health services. Mental health should be viewed on an equal playing field with physical conditions, both with an emphasis on prevention. Changing licensing requirements to allow mental health providers to offer tele-psych services across state lines is yet another solution Song believes could to have an impact on care.
While debates continue in Congress and in state legislatures across the nation, Song notes that we can start the reforms now in our communities and in our businesses.
“As we move forward, we must continue to combat the social and personal stigma against seeking mental health care,” she says. “A cross-disciplinary collaboration and involving business, technology, entertainment and medicine can help do so through public education and social awareness. People trained in basic first aid should also be trained in Mental Health First Aid. Employers can innovate and change workforce policies to highlight the importance of mental health, showing that mental health problems are as common and critical as medical problems. This could enhance not only well-being but also productivity.”