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September 15, 2020

4 ways to manage the Covid-19 behavioral health crisis—now

Daily Briefing

    Earlier this month, a new JAMA Network Open survey made the news for its startling findings: Nearly 50% of U.S. adults report at least some signs of depression. However, while the findings were provocative enough to garner headlines, they likely didn't really surprise providers; the behavioral health needs stemming from the novel coronavirus pandemic are quickly becoming a large-scale public health crisis.

    How Covid-19 will impact behavioral health services

    There are a litany of new drivers impacting our collective psyche, including grief, fear, and loneliness amid quarantine and social distancing—factors have already led to a justified rise in distress. In fact, up to 80% of Americans report moderate to high levels of distress due to Covid-19, the disease caused by the pathogen.

    Importantly, the mental health toll is not going to subside when Covid-19 does. Instead, stress will likely be compounded by the long-term economic downturn[1] created by the pandemic.

    4 steps health systems should take now

    Health systems must take action now to address the growing behavioral health crisis—not just because of the spike in demand due to Covid-19, but also because of the potential cost to the health system. Numerous studies link untreated behavioral health conditions with higher overall costs.[2]

    But there's a problem: While the need for behavioral health care has become more urgent, the barriers to providing comprehensive behavioral health care before the pandemic still exist. For health system leaders, the challenge is making targeted investments to address urgent needs in their workforce and patient population while working with partners to drive lasting change in behavioral health services.

    In the immediate term, health systems should prioritize actions to address the dramatic increase in demand for these services among their workforce and patients already in the system:

    1. Promote available behavioral health resources at every staff meeting for the next three to six months

      Openly encouraging clinicians to tap into the support they need during this difficult time can be a powerful lever to decrease the stigma of seeking behavioral health services. Perhaps one of the most important things health system leaders can do right now is talk about available resources and take every opportunity to consistently deliver that message for the next few months.

    2. Transition current behavioral health patients to telebehavioral health services

      New opportunities in telehealth are best suited for patients with preexisting behavioral health diagnoses. These patients are enduring significant disruption to their usual psychological support system (such as in-person therapy, harm reduction resources, and group sessions such as Alcoholics Anonymous). Sudden stoppages can have major, long-term impact—especially for those with major psychological disorders, eating disorders, and substance use disorders—that might cause exacerbated symptoms, a return to alcohol or drug misuse, or higher mortality rates.

    3. Promote self-service options to patients experiencing new, low-acuity behavioral health needs; and

      Demand for services is skyrocketing, but the number of providers and reimbursement amounts are limited. So, health systems need to develop low-cost, self-service options for patients with new, low-acuity behavioral health needs. Examples include a curated webpage of resources and educational materials and help lines for navigation and immediate care.

    4. Screen and support behavioral health comorbidities to ensure high-quality, low-cost outcomes for medical and surgical patients.

      About one-third of adults with a medical condition also have some type of behavioral health disorder. Left unaddressed, patients experience lower quality outcomes and higher costs. Integrating behavioral health support with physical care can reduce costs and acute care utilization while improving clinical outcomes and adherence to care plan regimens.

    For more information on these steps and how health systems are responding to the surge in behavioral health needs, please see How Covid-19 Will Impact Behavioral Health Services: Highest-priority behavioral health moves amid Covid-19 crisis.

    [1] There was a 13% increase in suicides attributable to unemployment during the Great Recession in 2008.

    [2] There are two main reasons for higher costs among individuals with untreated behavioral health conditions: (1) they are more likely to experience physical health conditions that have their own costs, and (2) costs of acute behavioral health care may be higher than the costs of ongoing treatment.

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