Telehealth alone not enough to offset crushing demand for mental health services

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Worries about rising Covid-19 cases, a challenging presidential transition, and growing inequities are crushing people across the U.S.

This, coupled with the dark winter months and an unusual holiday season, is creating a rising need for mental healthcare in a country where it was already difficult to access.

“Demand was beating supply before the pandemic, before the racial trauma, before the election and before the winter,” said Dr. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness. “Now what you have is demand crushing supply.”

In August, the Centers for Disease Control and Prevention surveyed more than 5,000 people across the U.S., and found that 41% reported an adverse mental health or behavioral health condition related to Covid-19. Anxiety, depression, traumatic stress and substance use all increased.

Alarmingly, nearly a quarter of young adults, between ages 18 and 24, reported they had considered suicide in the month before the survey. Calls to the National Suicide Prevention Lifeline (1-800-273-TALK), while at normal levels in April and May, started tick up in June.  It also has a disaster distress line, which offers emotional support for Covid-19 and other disasters (1-800-985-5990). In October, call rates were 5% above the same time last year.

“I can feel it by the number of people who reach out to me looking for help for their brother or sister or daughter or niece,” Duckworth said.

Telehealth and other technologies have helped to offset these pressures, but many patients still struggle with access.

“The whole system was under strain beforehand,” he said. “It’s difficult to get what you need right now.”

 

Utilization still down

Brighton Health Plans, a third-party administrator that works with several self-insured employers in New York, saw telemedicine for mental health skyrocket. Telemedicine visits were up 3,400% for members diagnosed with bipolar disorder, major depressive disorder, schizophrenia, and other conditions. But total utilization was still down compared to last year.

When New York saw an initial spike in cases, the decline was significant — Brighton Health Plans saw a 41.2% decline in behavioral health services, chief analytics officer Urvashi Patel wrote in an email.

While we can’t say with certainty what specific challenges members had with access, our claims show that behavioral health utilization dropped during the shutdown in NY this spring. Perhaps their provider’s offices were closed or members were concerned about leaving the safety of their homes,” she wrote. “Many turned to telehealth, but many others skipped receiving care altogether. While we can’t say definitively what those lost visits mean at the individual or population level, the numbers certainly sound an alarm.”

Now, several months later, the gap is much smaller, largely driven by increased adoption of telehealth. Utilization levels are down 10% from last year.

“I do think it has dramatically improved the potential for access,” she wrote, adding that patients who don’t have many providers in their area might now be able to talk to someone hundreds of miles away. But the problem still remains: There still is a shortage across the country of behavioral health providers.

 

 Rise of digital tools 

The pandemic has also led to a rise in digital mental health services, such as text-based therapy and app-based mindfulness tools.

“That’s a pretty unregulated space, but there are some apps that people use,” Duckworth said.

Ginger, a telehealth startup that lets users access therapy via text, said it has seen utilization rates jump 170% for its coaches and 307% for therapy. It also saw a spike in activity around the election. The company has also been bringing in more providers to help.

“This has been a period of immense stress, anxiety and depression, driven by fear of Covid, family members getting Covid, uncertainty about children, schooling and how do we care for them while we’re working?,” CEO Russell Glass said. “All of those things are like a big witches’ brew of stress and pressure.”

Ginger has seen demand for coaching and therapy increase in recent months. Photo credit: Ginger

Glass said being able to provide care across state lines has been helpful, but it’s still complicated. For example, differences in state licensing rules mean that providers have to meet different requirements and register with certain states. Telemedicine interstate compacts are a proposed solution for this that many states are opting into.

Even with all of that, you still have to take the next step of being credentialed with an insurance company to be covered, Glass said.

NAMI is also advocating for Medicare to cover “audio-only” visits after the pandemic ends, to make telehealth accessible for people without a reliable internet connection. It has also been offering peer support groups to help people get support quickly.

“I think there’s a lot of momentum to try to increase access. You are paying for your health insurance. It is their job to help you find somebody,” Duckworth said.

Photo credit: Evgeny Gromov, Getty Images



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