The impact of COVID-19 altered the way behavioral healthcare operates and sets objectives. Many Americans were out of work, uninsured, and/or dealing with a new or existing behavioral health disorder, such as depression, anxiety, or substance abuse. The demand for mental health services did not match the resources available, causing those issues to worsen throughout the pandemic. In this blog post, we will discuss new trends in behavioral health and how it shapes the future of primary care.
Shortage of Professionals
With shutdowns in order, people were not scheduling primary care visits or elective procedures, damaging hospitals’ revenue, and independent practices forced organizations to lay off staff. While you can delay a routine checkup, teeth cleaning, facelift, and other non-essential appointments, mental health is something that patients need continuously addressed. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the U.S. needs about 4.5 million additional behavioral health professionals to care for the current population with mental illness and substance abuse issues. On top of that, nearly 60% of the roughly 30,000 board-certified psychiatrists in the U.S. are age 55 or older, meaning many of them will be retiring soon.1 If you are currently a student in the healthcare field or considering it a possible major, look into psychiatry—the industry needs you.
Of the ones that didn’t get fired or are considering retirement, a large percentage of the remaining are at least considering quitting due to physician burnout. When healthcare organizations cut staff, the existing ones had to work extra shifts, limiting their sleep and social schedules. This issue, however, was affecting physicians even before COVID-19’s relevancy. In fact, 42% of physicians reported feeling burned out, and 79% said their burnout began before the pandemic, according to Medscape’s 2021 Physician Burnout report published early this year.2 Read more about burnout in one of our recent blog posts.
Even if there were a sufficient amount of professionals to treat behavioral health, many patients do not have the funds to afford the care. One study revealed that 43% of working-age adults are considered “under insured”—a number that has been growing since 2010 due to changes in employer-sponsored health plans. Among adults who reported any medical bill or debt problem, 37% said they exhausted all their savings to pay their bills, 40% reported receiving a lower credit rating because of medical debt, and 26% said medical bills left them unable to pay for necessities such as food, water, rent, or heat.1
Although most company-sponsored health plans cover mental health services now, people are still not getting sufficient treatment. The 2008 Mental Health Parity and Addiction Equity Act, Affordable Care Act, and state mental health parity laws require specific health care plans to provide mental and physical health benefits. However, insurers are still finding ways to make receiving behavioral healthcare difficult for payers. When insurance companies have an “inadequate network,” it forces plan members to:
- Wait for long periods before getting treatment
- Travel great distances to see an in-network provider
- See a professional outside of their network at a high out-of-pocket cost
Health insurance companies also often use restrictive criteria and standards to limit coverage for care as well. These standards make it extremely difficult to get treatment covered unless the plan member is severely ill.3
The pandemic brought to light something called the Social Determinants of Health (SDoH), which experts define as the conditions into which people are born, grow, live, study, work, and age that shape a person’s health. This can be categorized into five essential areas:
- Neighborhood and built environment
- Economic stability
- Social and community context
- Health and health care
This helps researchers break down aspects of healthcare by race, age, geographic location, etc. For example, a recent study showed that there are significant health differences in COVID-19 between different races. Compared to Whites, the likelihood of COVID-related deaths for Blacks is 37% higher, Asians 53% higher, Native Americans and Alaskan Natives 26% higher, and Hispanics 16% higher.1
There are several ways to address these issues, starting with awareness. The patient’s health record doesn’t tell their whole story—care providers must be mindful of their daily schedule, financial situation, living arrangements, and more when prescribing medications/treatments. Even if two people share the same medical condition, one person’s work might not work for the other based on these social determinants. Head to our previous blog post to learn more about the 5 A’s of addressing the SDoH: Awareness, Adjustment, Assistance, Alignment, Advocacy.
Telemedicine and telecare were in full swing before COVID-19, but their adoption rate has accelerated greatly as a result. Shifting to virtual care was not an easy task for physicians, but if they wanted to reach their patients and keep their practice in business, it was the only option. According to Healthcare Dive, 48% of providers used it for the first time because of the pandemic.4
Though a difficult change for patients at first, they embraced the opportunity with open arms. According to a recent survey, 78% of patients reported they were at least ‘somewhat satisfied with their telehealth experience—42% were ‘extremely satisfied,’ and only 6% were ‘not satisfied’ or ‘extremely dissatisfied.’ 5 Telehealth is the best way to address the SDoH as it removes all barriers to care—eliminating wait times and travel, decreasing cost, and improving accessibility. Providers love it as well. Through virtual visits, they see inside their patient’s home, allowing them to learn more about their surroundings. With wearables and mobile apps, they can continuously monitor their patients’ vitals, ensuring patient safety.
This was especially efficacious for behavioral health patients, as 33% of all appointments were conducted virtually between November 2020 and February 2021, after COVID-19’s peak.1 While physically meeting with a psychologist/ counselor serves as an escape for some; others feel more comfortable communicating from their own home.
Although we are still rebounding from the hardships brought upon us by COVID, as behavioral health awareness increases in our country, the greater the access to services will become. A lot of work needs to be done, but by addressing the barriers to care, recruiting more professionals into the field, improving cost efficiency, and utilizing technology to start, we can enhance behavioral healthcare for all Americans.
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- “Trends in Behavioral Health” Otsuka American Pharmaceutical Inc., July 2021.
- Bean, Mackenzie. “5 Stats on Physician Burnout in 2020.” Becker’s Hospital Review, 25 Jan. 2021, beckershospitalreview.com/hospital-physician-relationships/5-stats-on-physician-burnout-in-2020.html
- Bogusz, Guin Becker. “Health Insurers Still Don’t Adequately Cover Mental Health Treatment.” NAMI, 13 Mar. 2020, https://www.nami.org/Blogs/NAMI-Blog/March-2020/Health-Insurers-Still-Don-t-Adequately-Cover-Mental-Health-Treatment
- “The Ripple of Telehealth Adoption during COVID-19.” Healthcare Dive, American Medical Association, 19 Oct. 2020, https://www.healthcaredive.com/spons/the-ripple-of-telehealth-adoption-during-covid-19/586900/
- Charleson, Kimberly. “Telehealth Statistics and Trends: A 2021 Report.” The Checkup, 12 Aug. 2021, https://www.singlecare.com/blog/news/telehealth-statistics/