Tuesday, May 19, 2020

COVID-19 is the Tipping Point for Mental Healthcare in America: How the Coronavirus Finally Shed Light on our Broken System 

Dana Udall, PhDChief Clinical Officer, Ginger.io


In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

As the COVID-19 pandemic continues, one thing has become clear: we’re in for a long ride. The coronavirus outbreak will have a lasting impact that our country we’ll be addressing for years to come.

Over the past weeks, the pandemic has shed light on a wide range of inadequacies in our U.S. healthcare system - from hospital beds and PPE, to a well-resourced workforce of frontline clinicians to combat the virus itself. In many cases, the problems that are coming to light are problems we’ve had all along, but appear more obvious today because of our current crisis. And as tens of millions of Americans deal with the mounting anxiety that comes with uncertainty--as well as the depression that can accompany social isolation--it’s clear that mental healthcare in our country is among those problems.  

Increased Distress

Our system was already reeling from the strain of rising suicide rates, growing numbers of people reporting at least one major depressive episode, and tens of millions suffering from anxiety. And just as health disparities related to COVID-19 have had a disproportionate impact on communities of color, mental health disparities have created barriers for racial and ethnic minorities, who are less likely to have access to high quality treatment. 

Though social distancing is crucial for containing the spread of the coronavirus, we are starting to see a dramatic increase in mental health needs--both in those already seeking mental health services, as well the general population. We can think of this in two ways: those without previous mental health symptoms are developing them, and those with existing diagnoses are likely getting worse. For many, initial qualms about social distancing have evolved into grief about being displaced from family and friends, or losing loved ones to the virus itself. Financial stress has evolved into job loss and despondency about when things will get better. While the peak in the bell curve of COVID-19 cases may be in sight, the mental health peak has yet to come -- and when it does, it will likely have a long tail. 

Gaps in the System

Unfortunately, most individuals who are suffering will not have the chance to successfully obtain mental support, due to large gaps in the U.S. healthcare system which existed long before the onset of COVID-19:  

  • Lack of access: 50% of U.S. counties don’t have access to a single mental health provider within the county, and wait times exceed 4 weeks on average.
  • Poor quality: 70% of Americans with behavioral health conditions are not getting effective mental healthcare. 
  • Fewer providers entering the field: Estimates pre-COVID-19 showed that by 2025, the gap for mental health providers was estimated to be 250,000.  

The COVID-19 pandemic is both exposing and exacerbating these challenges. We are now seeing many of the country’s therapists and psychiatrists closing their doors. Most have not been trained to provide telehealth services, which means they may not feel comfortable transitioning from brick-and-mortar practice to online office. Those who have made the shift to provide online care are likely booked out weeks or months in advance. 

Short and Long-term Solutions

With a supply-and-demand imbalance that has only grown more pronounced during COVID-19, we need both short-term and long-term solutions. 

In the short term, mental health providers should seek training on how to provide telehealth services, and invest in hardware and software that will enable them to do so. The barrier to entry has come down, and clinicians don’t need to be IT experts to migrate their practices online. To address healthcare disparities in the long-run, graduate training programs should develop robust curricula around telehealth services, so that incoming students are trained and mentored on best practice from the beginning of their career.

We know there is a huge appetite for such novel approaches. In a recent survey, 70% of people who used a technology-based mental health service for the first time did so to deal with COVID-19 stress, with 48% of them trying it because their regular counselor had moved to online sessions. 

While the transition can feel foreign to many clinicians, virtual care, supported by the right technology infrastructure, can provide an incredibly powerful platform to better balance workload, reduce administrative burden, and support providers to practice at the top of their licenses. I know, because I've made the transition myself. 

But moving care online is not enough in itself. To provide services to those who need it most--and those with fewest resources--we need to expand our idea of what mental health support looks like. New modalities that focus on prevention can be effectively leveraged to meet the needs of a broad population. Behavioral health coaching, particularly when paired with clinical services in a telehealth setting, is key in distributing care across groups. Coaches can help people face tough situations and learn skills like mindfulness, which is a highly effective tool for self-management.

The government also plays an important role here. The telehealth industry has historically suffered due to complex regulation around cross-state licensing and reimbursement, which has significantly impeded widespread adoption by consumers and clinicians. Fortunately, as a result of COVID-19, we’ve seen positive developments at both the state and federal level, which have reduced some of these barriers. Though we’re headed in the right direction, these changes shouldn’t be temporary. State and federal partnerships should foster continued innovation in telehealth, and further push to dismantle systems which prevent people from accessing much needed care. Both our patients and providers have never needed this more. 

Our already overburdened mental health system has been easily broken by COVID-19. The coronavirus pandemic is causing new mental health problems, but--more importantly--exposing the problems our system has had all along. Upgrading our tools, training, and infrastructure will be essential to providing sustainable care for those who need it most. Though these upgrades have been a long time coming, there’s no time like the present to take action. 

About Dana Udall: 

Dana Udall is the Chief Clinical Officer at Ginger, an on-demand mental health company

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