Breaking the Barriers to Behavioral Health Access

Nearly half of all adults in the United States say that the COVID-19 pandemic has negatively affected their mental health because they are worried and feeling stress, according to a study by the Kaiser Family Foundation (KFF).

The KFF study showed that 47% of people who lived in states with stay-at-home orders reported negative effects on their mental health, with 21% saying they were feeling major effects. In contrast, 37% of those who were not sheltering-in-place reported feeling negative effects on their mental health, with only 13% describing those effects as major.

Left untreated, stress and worry about family and friends, financial pressures and social isolation can have the following effects, according to the federal Centers for Disease Control and Prevention (CDC): 

• Increases in mental health issues
• Greater use of tobacco, alcohol, and drugs
• Difficulty concentrating
• Less sleep or changing sleep patterns
• Worsening chronic health problems

It is clear that there is a growing need for mental health services in this country as we continue to deal with the COVID-19 pandemic and the economic upheaval that came with it. For many Americans, particularly those in rural areas, access to behavioral health services is limited due to provider shortages and social stigma.

Behavioral Health Access Grows During COVID-19

A May 2020 survey by the Blue Cross Blue Shield Association (BCBSA) shows that 75% of Americans who have behavioral health conditions have been able to continue their therapy during the COVID-19 pandemic by using telemedicine services. Only 16% of adults who responded to the survey reported that they had delayed mental health treatments because of the pandemic.

The same BCBSA study showed that the use of telemedicine to deliver behavioral health services has increased by 60% since the summer of 2019, with more than half of that growth coming since the COVID-19 pandemic began. 

One reason for the growth in telehealth services occurred in March 2020, when the Centers for Medicare and Medicaid Services (CMS) issued waivers that expanded payments for telehealth visits, including behavioral health services. Private insurers, such as Blue Cross and Blue Shield plans, soon followed suit. Prior to that, CMS and many private insurance plans would only cover those services for in-person visits.

While the waivers CMS issued are only temporary for the duration of the pandemic, CMS administrator Seema Verna says she believes the changes will continue after the coronavirus crisis is over.

“I can’t imagine going back. People recognize the value of this, so it seems like it would not be a good thing to force our beneficiaries to go back to in-person visits,” Verna told STAT, a website that covers the pharmaceutical and healthcare industries. 

At the same time, 64% of employers believe that the coronavirus pandemic will have a moderate to large impact on the wellbeing of their employees, according to a survey by Willis Towers Watson, a business advisory group. Many of those employers are taking steps to protect their employees, with 45% expanding their wellbeing programs and 47% enhancing the health care benefits they provide.

Use of Telemedicine Increases Dramatically

Spending for mental health care was already on the rise before the COVID-19 pandemic arrived. According to Open Minds, total US spending for behavioral health treatment reached $225 billion in 2019, an increase of 52% since 2009. 

Open Minds also said that the residential and inpatient treatment settings declined over the same period of time, while outpatient and virtual services increased. The use of telemedicine for both behavioral health and acute care medicine was already growing but that trend has accelerated significantly since the COVID-19 pandemic reached the United States.

According to a report from Fair Health, a non-profit organization that tracks healthcare insurance claims, telehealth claims increased 121% nationwide from February 2019 to February 2020, before the pandemic arrived. A month later, the number of claims for telehealth visits increased but 4,347% nationally over the previous year, and by 15,503% in the northeast United States. 

Telemedicine Increases Behavioral Health Access In Rural America

A research study published in the American Journal of Preventive Medicine concluded that behavioral health services are less available in rural areas of the United States than in more densely populated metropolitan areas. In fact, the study said, of the 1,339 counties in the US with populations less than 10,000 people, 80% do not have one psychiatrist, 61% do not have a psychologist, and 91% do not have at least one psychiatric nurse practitioner.

That lack of providers has made it very difficult for residents of rural counties to get the behavioral health care they need. Traveling to the nearest behavioral health practitioner might require a drive of several hours, or an overnight stay. 

In addition to the travel difficulties, there is often a great stigma associated with mental health care in rural areas. “One of the things that’s a barrier to treatment and mental health, especially in small rural communities, is the stigma of going to the mental health center,” Timothy Allen, MD recently told TechRepublic. 

Residents of rural areas may not believe mental health care is necessary because they have had so little exposure to it. They are not accustomed to talking about mental health, and the small towns in rural counties do not provide opportunity for anonymity.

Allen, a physician and an associate professor of psychiatry at the University of Kentucky College of Medicine in Lexington, Kentucky, said telehealth can help overcome issues of distance and stigma that can prevent rural residents from seeking behavioral health care.

For example, the University of Kentucky has partnered with a community health provider that operates six medical clinics in rural eastern Kentucky. In that partnership, psychiatrist residents at the university can see patients at the clinics via telehealth.

“Now people don’t have to drive to the next county or two counties over,” Allen told TechRepublic, adding that telehealth also removes the stigma of mental health services. “That goes away with this process because you’re just going to your family doctor, and nobody knows that you’re seeing the psychiatrist.”

How to Optimize Behavioral Health Access

Providers who offer behavioral health services via telehealth should do all they can to make the process as easy and convenient as possible for patients to pursue the care they need. Providers should, for example, offer:

• Online scheduling so patients can book appointments any time that is convenient for them, without having to call during busy business hours
• The ability to search for providers who accept their health insurance plan so they can stay in-network and avoid unnecessary financial expense.
• Send electronic reminders to patients to help communicate appointment details and reduce patient no-shows

That’s why healthcare providers such as LifeBridge Health partner with DocASAP. The DocASAP platform will help patients find the right, in-network provider for their needs and then schedule an appointment with that provider online.

“We look forward to seeing how this new technology can help our patients connect and coordinate with their care providers,” said Matthew Poffenroth, M.D., chief clinical officer for LifeBridge Health. Lifebridge Health is one of the largest health services providers to residents of the Greater Baltimore, Maryland region.