Leveraging digital and policy tools to address the COVID-19 Behavioral Health Crisis

Even before the emergence and spread of COVID-19, the US was experiencing a behavioral health treatment crisis: 2018 data showed that only 43 percent of adults with mental health needs, 10 percent of individuals with substance use disorder (SUD), and seven percent of individuals with co-occurring conditions were able to receive services for their conditions.

The treatment gap is staggering, and COVID-19 is making it worse: an estimated 56 percent of adults report the pandemic has negatively impacted their mental health. Worse yet, the crisis is felt most acutely by the same health delivery systems that must deal with COVID-19 itself. Hospitals, health systems, and clinical practices—together with other first responders—are the front line. They bear the burden of their own stress and must also cope with the many patients who present with a range of mental illnesses and substance use disorders.

Digitally-enabled care models enable health systems and health plans to meet their most urgent needs in the era of COVID-19. Some solutions also help systems take advantage of favorable, albeit time-sensitive conditions, enabling them to lay the foundation for permanently expanding behavioral health services in the post-pandemic period.

Focus Area 1: Health System Employees

A pressing need for health system leaders is keeping their workforce healthy, focused, and productive during this period of extreme stress, anxiety, and trauma. The need for ongoing, easily accessible behavioral health resources for the healthcare workforce will only grow as the pandemic continues.

Solutions: Consider providing immediate, free access to behavioral health solutions for employees and their families. Also consider extending access to first responders, other healthcare workers, and other essential services workers in the community.

Many digital solutions are granting temporary access to these services and are expanding their offerings to include new, COVID-19-specific modules, resources, and/or guidance at no cost.

The following are a few digital solutions to consider:

• Recovery management tools for individuals with SUD.
• Text-based peer support groups. Organizations are using these to address loneliness and social isolation in group-based chat settings, one-on-one interactions between individuals and peer staff, and broader community applications.
• Online cognitive behavioral therapy (CBT) solutions. These tools are being used to expand access to lower-acuity behavioral health services, targeting both frontline workers and the general population.

Focus Area 2: Individuals with Acute Behavioral Health Conditions

During surge periods, the overwhelming focus is on containing and treating COVID-19; this disrupts services that are essential for individuals with severe mental illness and SUD. Maintaining continuity of care will be critical to preventing decompensation of these patients, which could drive increased rates of ED visits and admissions.

Solutions: Many digital companies are hosting virtual recovery meetings and providing access to virtual peer support groups. Additionally, shifts in federal and state policies are easing restrictions around critical services, including medication-assisted treatment (e.g., buprenorphine can now be prescribed via telephone), that can mitigate risky behavior and ensure ongoing access to treatment. The following are several solutions to consider:

• Medication-assisted therapy (MAT) via telemedicine. These solutions provide access to professionals who can prescribe and administer MAT medications, provide addiction counseling, and conduct behavioral therapy (e.g., CBT, motivational interviewing) digitally.
• Behavioral health integration. Providing screening, therapy, and psychiatric consultations across settings of care—especially primary care—will help with the increased demand.

Focus Area 3: New funding opportunities

Healthcare organizations should also look to new funding opportunities to develop digital infrastructure that expands access to critical services. Specifically, as part of the CARES Act, the FCC launched the COVID-19 Telehealth Program and extended the Connected Care Pilot Program to provide avenues for immediate funding for such implementations. Additional telehealth opportunities, including reimbursement for audio-only services and temporarily eased provider licensure requirements, have further paved the way for expansion of tele-behavioral health capabilities.

COVID-19 has brought the behavioral health crisis to the foreground and the marketplace is brimming with innovative solutions. The moment to act is now: health systems that double down on behavioral health today will emerge from the pandemic response well-positioned, having built healthier, stronger communities and workforces along the way.

_{About the Author}

_{Victor Siclovan is a Director on the Medicaid Transformation Project at AVIA where he leads work in behavioral health, chronic care, substance use disorder, and Medicaid population health strategy. Prior to AVIA, Victor spent nearly 10 years at Oliver Wyman helping large healthcare organizations navigate the transition to value-based care. He holds a BA in Economics from Northwestern.}