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The COVID-19 pandemic sparked an influx of demand for mental health care. People struggled with depression, anxiety, social isolation, and fearful conditions brought on by the pandemic. In 2020, more than one in three Americans reported the pandemic having a serious, negative impact on their mental health. As COVID has lingered, so too have high anxieties.
This has increased the pressure on the already strained mental and behavioral care field. Simply put, there is a supply-demand imbalance. There is limited availability for patients to find treatment from licensed professionals. Access is at the heart of the problem: more than one-third of Americans live in areas that lack adequate access to mental health professionals.
Telebehavioral care—when direct clinician-to-patient care is delivered online—has helped reduce these treatment gaps. The pandemic has shown that when widespread adoption is possible, telebehavioral care brings immense value for both increasing patient access and supporting healthcare professionals through virtual collaborative care.
Telebehavioral Care in Homes, Hospitals, and Primary Care Offices
Telehealth has been a vital resource for people across the country, especially for those who have needed mental health support that’s covered by their insurance provider. Telebehavioral health has been a lifeline for patients everywhere, including underserved patients – like the thousands of children living in rural and urban communities who don’t have access to a child psychiatrist.
The expansion of mental telehealth provides a bridge between those who are seeking help and those who are available to provide help. Insurers like Aetna are doubling down on evidence-based telebehavioral health by providing mental health services to members in all 50 states. An expansion like this benefits patients at home by helping them schedule time with a licensed psychiatrist, therapist, counselor, or psychologist in as soon as two days. Telebehavioral care has also provided support for healthcare professionals and hospitals nationwide.
When mental health providers aren’t available and people are experiencing a mental health crisis, patients often turn to the only remaining available resource: the emergency department. To alleviate this pressure, recently hospitals in rural communities like Sidney Health Center in Montana and VCU Tappahannock in Virginia have increased their on-demand telepsychiatry services for patients and support for onsite staff. Meanwhile, United Physicians, an independent physician organization of 2,000 providers in Detroit, has already made it halfway to its treatment goals in just three months in part due to virtual collaborative care.
Telebehavioral Care: A Solution to Find and Deliver Mental Health Help
The increased availability and access to at-home behavioral care was made possible by laws and regulations that were temporarily changed or adapted to accommodate widespread telebehavioral health treatment. This increased legal flexibility also stretched to clinicians as many states temporarily removed the requirement that forced mental health providers to be licensed in the same state where their patients reside. Bill proposals in states like New Jersey are important for giving patients and doctors the incredibly valuable tool of telehealth for good.
The rising demand for mental health professionals isn’t predicted to go away any time soon. Array is a covered insurance benefit for 87 million people and counting, proving insurers are responding to the increased need for mental health services by expanding telebehavioral care as a covered benefit for their members.
By: Geoffrey Boyce
Telehealth’s adoption has skyrocketed over the course of the pandemic. Although telehealth was a lifeline for many and filled in the gaps in our healthcare system, you cannot help but wonder where do we go from here? Despite its accelerated adoption, will telehealth have the same staying power after the public health emergency ends? The evidence and anecdotes point to a resounding ‘yes,’ especially when it comes to behavioral care.
Over the past 13 years in the industry, I’ve witnessed firsthand how telehealth has transformed the delivery of behavioral care. Research has long proven that telebehavioral care is just as effective as in-person care and checks out with higher retention rates. The COVID-19 crisis created an opportunity for telehealth to demonstrate its value without some of the traditional challenges that once limited its widespread adoption.
In early 2020, many laws and regulations were either temporarily instituted or suspended to promote, encourage, and legalize virtual treatment for behavioral health conditions. HIPAA flexibilities, 1135 waivers, and interstate allowances rolled out so that people could continue with their behavioral care provider, or pick up a new one, amid worsening mental health conditions nationwide. Even the DEA temporarily lifted multi-state registrations and the Ryan Haight Act fell under an exemption, which allowed psychiatrists and other prescribers to issue controlled substance medications without the usual requirement of seeing them in person – critical for both child psychiatry and addiction medicine.
The temporary telehealth allowances focused on making sure that patients could be seen at home. That is why industry groups, such as the American Telemedicine Association, are advocating at the federal and state levels to keep and expand these laws. Nearly 75% of providers say that no or low reimbursements would hinder them from offering telehealth after the pandemic if the current expansions do not remain.
Yet as waivers expire, and we emerge from home with a new location-agnostic reality, we must realize that telebehavioral care’s place has to be where the patient is — everywhere. Telebehavioral care’s place is in the home, the hospital, the PCP’s office, the community clinic and more. To truly serve patients’ mental health needs, telehealth regulation must support care across the now-expanded continuum.
The story of one New Jersey mother illustrates the need for expanded access to telebehavioral care. Despite having at-home virtual care and medication for her adolescent son struggling with autism spectrum disorder and suicidal tendencies, this mother ended up in an emergency department to save her son from suicide twice.
The first time, she and her son waited for days in an emergency bed for her son to be seen by a social worker, not a psychiatrist — a common occurrence as hospitals shoulder the burden of the nationwide mental health crisis amid a shortage of behavioral care professionals. On the mother-son pair’s second visit, the hospital had implemented a telepsychiatry program that allowed her son to be seen in just a matter of hours by a psychiatrist who evaluated him and sent him home with a concrete treatment plan and next steps.
The second visit was made possible by legislation that allowed for the psychiatrist to see the patient virtually along with the appropriate authority to make the right placement decision, while also requiring reimbursement for that care. These hospital EDs are just one setting in need of behavioral care support. Data shows that one out of every four primary care visits in the U.S. are for mental health conditions. FQHCs regularly serve populations with higher incidences of behavioral care needs. In short, pro-telehealth legislation does not just expand patients’ access to behavioral care clinicians, it expands other providers’ access too.
Telehealth is a lifeline for so many of the patients that are often left behind by our healthcare system. It is crucial to extend the telehealth-friendly regulations well after the COVID-19 crisis has passed so that there can be broader, timelier, and more convenient access to the scarce resource of behavioral care. Ensuring that physicians, psychiatrists, clinics, hospitals, and other healthcare providers offering telehealth continue to be paid and allowed to practice virtually is one of the ways that our industry protects telehealth’s future and secures a permanent place for the vitally important behavioral care Americans need — wherever and however they need it.
Geoffrey Boyce
CEO, Array Behavioral Care
Geoffrey Boyce is the CEO of Array Behavioral Care, the leading telepsychiatry service provider in the United States with a mission to transform access to quality behavioral care. Boyce is a leader in telemedicine advocacy, education, and reform initiatives. He serves as a national voice promoting telemedicine and telepsychiatry and regularly interacts with state and local healthcare regulators and administrators. In 2017, he received the Industry Leader Award from the American Telemedicine Association and is currently an active participant in several ATA Special Interest Groups and Workgroups including: the Telemental Health SIG and the controlled substances prescribing and telehealth workgroup. He also serves on the advisory board of directors for the Mid-Atlantic Telehealth Resource Center (MATRC). In 2018, he was appointed to the New Jersey Telehealth Review Commission. Boyce frequently speaks about the potential of telemedicine and the best practices for establishing new programs.
This week kicks off the American Telemedicine Association’s first Telehealth Awareness Week. The theme of the virtual event is “Telehealth is Health” — a sentiment that rings true now more than ever.
Telehealth adoption has skyrocketed over the past year-plus and will undoubtedly become a permanent fixture in healthcare. In a March 2021 survey of Americans, 61% of people had tried a telehealth appointment. And between 2019 and 2020, provider visits nationwide delivered via telehealth jumped from 0.3% to 23.6%. Interestingly, the care specialty that grew in telehealth adoption the most, according to a McKinsey & Company report, was psychiatry.
During the COVID-19 crisis, a larger average share of adults spoke up about needing help with their mental health: 4 in 10 adults reported anxiety or depressive disorder, an increase from 1 in 10 in the year prior. While the COVID-19 pandemic has compounded an underlying national mental health crisis, it surfaced another significant challenge: a shortage of mental health specialists who are available to provide care. Behavioral health clinicians can only meet 27% of patient needs across the U.S.
This “perfect storm” of limited supply and increased demand has placed a substantial and untenable strain on mental health clinicians. However, it’s not only therapists, psychologists and psychiatrists who are shouldering the toll of the high demand for mental healthcare. Primary care providers (PCPs) are feeling it too.
As a confidant and trusted advisor, PCPs are frequently the first point of contact when patients seek mental health help. Serving as the “medical home” for a patient, PCPs play an important role in addressing both physical and mental health care needs by bringing in behavioral care specialists. But with the rising needs among patients and short supply among professionals, finding the right specialist for a patient is challenging.
Two-thirds of primary care physicians report having trouble getting psychiatric services for patients. It can take several weeks or months for a patient to be seen by a local mental healthcare professional. Relying on referrals to in-person professionals presents a challenge as patients often sit on long waitlists and symptoms worsen. Additionally, it also contributes to keeping mental and physical health siloed, which goes against the numerous studies that have shown that outcomes improve when the two are aligned.
Fortunately, there is a way to achieve holistic, coordinated care: telehealth.
At the intersection of primary care and behavioral health services is the perfect opportunity for telebehavioral care. As an effective alternative to referrals for in-person care, PCPs can refer a patient to a virtual behavioral health provider. In comparison to a referral to a local behavioral health specialist, a patient can see a virtual behavioral health specialist much sooner — in hours or days instead of weeks or months. The remote modality also eliminates geographical barriers, delivering patients a wider selection of mental health providers tailored to their mental health challenges.
Beyond improving referral follow-through and care coordination, many PCPs are bringing telebehavioral care in-house through collaborative care models. Breaking traditional siloes, the collaborative care approach integrates a behavioral health care manager at the practice level to identify and treat patients with mental health challenges. Bringing these professionals in via telehealth widens access not only for the PCPs but also for patients, as the care managers can virtually tap into a wider array of specialists, such as psychiatrists or professionals with condition-specific skills. Telebehavioral care models have been proven to reduce symptoms, and ultimately help improve overall patient health, by providing PCPs with the support needed and addressing the gap between high demand and low supply in the nation’s mental health crisis.
The benefits of telehealth at this point can’t be denied. But the benefits of telebehavioral health can’t be ignored. As we all settle into the new normal of healthcare, we must ensure that telehealth’s place in behavioral care is championed. It expands access. It helps our PCPs. It works for patients. And it’s absolutely critical to overcoming our nation’s mental health crisis in the era of COVID-19 and beyond.
Mental health plays a central role in our overall health and wellbeing. It affects the decisions we make and impacts how we show up at home, in social settings, and even at work. So, when an employee or someone in their home begins to experience mental health challenges, they benefit from knowing their employer genuinely cares about their mental, not just physical, health and wellbeing.
Yet historically, employers and even the government have not held mental health at the same status as physical health. Evidence of that is plentiful, including that in 2020 there remained no dedicated mental health category for Schedule A federal reporting that self-funded employers must perform. Those services most often fall under the “Health (other than dental or vision)” bucket, while dental and vision each have their own categories. If our teeth and eyes can receive special attention, shouldn’t our minds?
As we enter “The Great Resignation” fueled by pandemic stress, self-funded employers are in a unique position to recognize their employees’ mental health needs, differentiate themselves, and improve their businesses by investing in practical, accessible mental health treatments for their teams. It’s not just good for business; it’s the right thing to do.
The impact of the mental health crisis on employees and their families
We are a nation living in a behavioral health crisis. Each year nearly 25% of adults suffer from a diagnosable behavioral health condition such as depression or substance abuse, according to the National Institute of Mental Health (NIMH). Though cases were on the rise before 2020, the COVID-19 pandemic pushed the issue to the forefront. An August 2020 survey by the CDC revealed 40% of adults reported they had struggled with behavioral health or substance use in the previous 30 days. Sadly, the growing number of mental health challenges is expected to linger post-pandemic.
For employers, this means a significant number of employees, or their dependents, will experience challenges. Perhaps they already are. And when an employee is struggling with their mental health, it negatively affects their performance, productivity, engagement, hindering them from bringing their best self to work. The issue is only magnified if employees feel their employers aren’t prepared to help.
The costs of mental health in the workplace
Uncared for behavioral health conditions affect, first and foremost, the individual suffering. And their individual challenges have a financial impact on their employer too. One study of Quest Diagnostics revealed that in the course of a year, the six most common mental health conditions cost the company $12 million, their largest health cost by far compared to other physical conditions, largely for inpatient stays and emergency visits. This means that for the nearly 6,000 employees that visited a care facility, their mental states deteriorated to the point that emergency treatment was necessary. But the costs of these employees’ struggles started to tally long before they sought treatment.
Just looking at depression alone, employers lose 200 million workdays each year at a staggering cost of $17 to $44 billion. At a more granular level, the average employee suffering from depression misses nearly five workdays and experiences 11.5 days of reduced productivity in a three-month period.
Extrapolate that to a full year, across a large workforce, across multiple mental health conditions, and it’s clear that the impact is profound.
As behavioral health needs spike, every employer has both the responsibility and the power to provide the support their teams desperately need.
Utilizing virtual mental health care options
Empowering employees to care for their mental health can recoup some of the losses that come along with prevalent mental illness. But it can also be a differentiator for employers to help attract, engage, and retain talent, particularly in today’s tumultuous environment. Recent reports reveal that 40% of employees are considering changing jobs in 2021, and 25% are actively planning a change. The greener pastures that employees are in search of are better pay, richer benefits, and better work-life balance.
These desires indicate that employees are stressed and looking for employers to support their wellbeing, not just their work product. Fortunately, employers are acting and investing in corporate wellness programs, which include mental health benefits, to care for their teams. In fact, 53% of employers surveyed by the National Alliance of Healthcare Purchaser Coalitions said they are now offering special emotional and mental health programs in response to the pandemic.
As workspaces become more remote, there’s an opportunity for employers to increase access to in-network mental health services through telehealth. Telebehavioral health care frees employees to connect with specialists who can evaluate, diagnose, and treat behavioral health disorders from anywhere without the need to take time off from work to fit into tight appointment windows, travel long distances for appointments, or arrange for childcare. So, they can work from home and also receive care from home too. Plus, with in-network providers that offer specialized care, employers can open the door to scarce resources, such as child and adolescent psychiatry, for employees and their dependents.
Employers have the resources at the ready to help employees through these tough times and help their organizations stand out as employees seek better situations. All they have to do is implement the right benefits and educate employees on their options to begin the path to better wellbeing.
By adopting high-quality, telebehavioral health care, employers can protect the emotional wellbeing of those who are suffering, and in turn, increase productivity, reduce absenteeism, and build a more positive workplace culture. Telebehavioral care is not only good for employees and businesses; it’s a vital approach to address and start resolving America’s mental health crisis.
It has been a year like no other and that’s particularly true for the telemental health and telepsychiatry industries.
Unfortunately, mental health need has spiked during COVID-19, which has brought on the removal, at least temporarily, of nearly every barrier that previously limited telehealth.
While telehealth advocates have preached that telehealth is health, in 2020, we saw that come to fruition, particularly within the behavioral health space. You’d be hard pressed to find a behavioral health clinician today who has not held a remote session. So, what does this mean for the future?
As we look into the year to come, here are six trends we predict to see in 2021.
We are ready for permanent action. The telepsychiatry industry predicts and respectfully calls for regulators to make it happen. Here’s the short list:
About the Author: Olivia Boyce, MPH is the chair of the American Telemedicine Association’s Telemental Health Special Interest Group and a Vice President at Array, the leading national telepsychiatry organization and a long time telehealth advocate.
About Array
Array Behavioral Care (formerly InSight + Regroup) is the leading and largest telepsychiatry service provider in the country with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care from hospital to home with its OnDemand Care, Scheduled Care and AtHome Care divisions. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.
Healthcare systems and individual hospitals can evaluate their very own metrics against industry data to evaluate cost and revenue implications of an investment in on-demand telepsychiatry.
(October 22, 2020) – Array has launched a customized capability using a value calculator to help hospitals and healthcare systems evaluate costs associated with their current process for managing behavioral health patient demand against savings and revenue opportunities.
The unique tool responds to a long-standing need for hospital administration to quantify the expected return on investment of behavioral health coverage via on-demand telepsychiatry. This new capability comes at a critical time as the industry faces unexpected operational and financial challenges. Many facilities are seeing a rise in demand for mental health services, while a simultaneous drop in ED visits in the wake of COVID-19 is presenting financial strain.
For hospitals and healthcare systems considering on-demand telepsychiatry to meet growing patient need for mental health services, implementing a financially sustainable and scalable program is essential:
On-demand telepsychiatry can have a positive financial ripple effect that extends well beyond emergency departments, including reduced reliance on scarce inpatient psychiatric resources, reduced inpatient psychiatric admissions, improved emergency department throughput and increased capacity for med-surg admissions. It allows healthcare systems to allocate resources to populations with heightened need and acuity to reduce strain on clinicians and improve operational metrics.
Array's value calculator uses proprietary logic based on more than two decades of experience implementing programs and delivering telepsychiatry services within hospitals and health systems. Customizable to organizations of all sizes, the tool uses validated data, clinical research and demonstrated outcomes to help organizations determine the financial impact of on-demand telepsychiatry applied to their specific use case. It takes into account actual direct and indirect costs using current behavioral health demand within the facility in order to quantify specific areas of cost savings and highlight untapped revenue opportunities.
Using key data on current behavioral resources and gaps, such as patient length of stay, bed capacity and existing clinical coverage, hospitals and health systems can:
“We understand the key role on-demand telepsychiatry can play in helping hospitals deliver financially sustainable care, but it has typically been challenging for leadership to quantify its impact at a detailed level,” says David Cohn, Chief Growth Officer at Array. “Now, this capability allows us to collaborate with healthcare organizations and give them a fresh, detailed view of their current cost exposure and expected operational outcomes and financial returns from on-demand telepsychiatry programming.”
Request a Customized ROI Assessment Now
Array Behavioral Care (formerly InSight + Regroup) is the leading and largest telepsychiatry service provider in the country with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care from hospital to home with its OnDemand Care, Scheduled Care and AtHome Care divisions. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.
More clinicians are choosing to work in telehealth than ever before. As the industry matures and more competitors enter the market, clinicians have more options in where they chose to work. What makes them choose one provider organization over another?
Telepsychiatry is changing the way mental health services are being delivered. Telepsychiatry not only transforms access to care for patients, but it also offers clinicians unparalleled job flexibility and opportunities for growth.
The clinician network at Array continues to grow rapidly as we regularly add new psychiatrists and other behavioral health professionals to our team. In the past 6 months, more than 200 clinicians and 18 supporting administrative members have joined our team. In addition to these new hires, we have numerous existing clinicians who have been with our organization for many years.
These new and seasoned clinicians alike share what initially attracted them to Array and why they chose to stay:
Work-Life Balance
Array prioritizes the well-being of clinicians and administrative team – the mental health of our patients starts with us. Aside from the flexibility that comes with working from home and choosing your own schedule, we’ve established a wellness committee and clinician engagement team who continuously promote healthy work-life practices and on-going education.
Longtime Array clinician, Julie Lu, a psychiatric NP who has worked with us for several years explains why she enjoys working in telepsychiatry.
“What I like most about practicing telepsychiatry is that it feels like I’ve found more time in the day; I no longer have to fight traffic during a long commute. That time is now better used talking to patients and my clinic staff. The technology has allowed me to reach across the distance and make connections with patients who might otherwise still be on a wait-list to be seen by a psychiatric provider.”
Focus on Clinical Care
Array has an unmatched internal technical and administrative infrastructure backing its clinicians. We offer around-the-clock clinical, operational and technical support designed to help clinicians with their delivery of care every step of the way. Clinicians enjoy support from a large responsive team so they can focus on what they do best – providing patient care.
“Array offers reliable support via admin staff, care navigation team and user-friendly systems. Thank you, Array for allowing me to put 100% of my energy into providing therapy.” - Kelly Wood, LCSW
Being Part of a Team
Collaboration is a cornerstone of our organization. Through collaboration, Array clinicians develop strong professional relationships with their partner site as well as with their telepsychiatry peers and administrative support staff. Clinicians are not providing care “on an island” by themselves; our clinicians can find reassurance in having systems in place that makes it easy to communicate with colleagues and collaborate with necessary personnel in order to deliver the highest-level care.
When community health clinics across the country had to close or temporarily suspend services during the coronavirus crisis, one of our partners, the Fauquier Free Clinic in rural Virginia, in collaboration with our clinician, Dr. Azpiri, was able to quickly convert from facility-based to home-based virtual care so their patients could continue to receive much-needed mental health services.
“I am so grateful that patients have been so receptive to this new approach. They have been so welcoming and inviting and flexible, which is a big reason we’ve been able to pivot so quickly and successfully to in-home virtual care. Delivering care directly to patients in their homes gives me a glimpse inside their private worlds, without being overly intrusive. I can assess environmental cues such as the orderliness and cleanliness of their surroundings, appearance, food needs, etc. This allows me to really see how they are doing physically, emotionally and mentally and determine if additional support is needed.” – Alicia Azpiri, MD
Expanding Organization
Following the recent merger between InSight Telepsychiatry and Regroup Telehealth in December 2019, even more clinicians have inquired about clinical opportunities with our newly combined organization. The merger created a larger, more comprehensive nationwide team that allows us to grow more quickly and strategically. With a bigger footprint and opportunities in various settings across the continuum of care, we are able to offer clinicians different options for where and how they practice. Clinicians also benefit from, our collective partnerships, expertise, leadership and resources; together we are truly transforming access to care.
Clinician Choice in Care Setting
Array is the only telebehavioral health care organization that offers clinicians the flexibility to select among multiple models, serve multiple organizations and work with multiple patient populations. Clinicians have the opportunity to choose from a myriad of settings such as emergency departments, hospital medical/surgical floors, inpatient units, mobile crisis programs, crisis centers, residential programs, primary care clinics, community health centers, tribal programs, correctional facilities or direct-to-consumer. Given the multitude of options available, we work with each clinician from the start to figure out the best care setting for them. We discuss their individual needs and preferences as well as the needs of the organization to ensure long-term success. We have found that uniquely matching our clinicians and partners and maintaining a strong line of communication has enhanced clinician satisfaction.
“I have been a psychiatrist with Array for 2 years. It has been a phenomenal work experience. I enjoy rotating my days between an outpatient clinic, a correctional facility and a commercial insurance/home setting. It keeps my clinical work interesting and my skills sharp.” - Betsy O’Brien, MD
Work for an Established Reputable Organization
Array is the pioneering leader in telepsychiatry. For the past two decades, our mission has remained the same – to transform access to quality behavioral health care. Clinicians appreciate the stability and reassurance of working for an established and rapidly growing organization that has the technical, clinical and operational support to make them successful. Clinicians can engage with telepsychiatry peers, learn from behavioral health thought leaders and clinical experts.
“The collaboration between professionals, flexible hours, and ability to work with a company whose values and standards are in alignment with mine are some of the reasons why I continue to choose Array as an employer. I enjoy working in telehealth; it's a rewarding and humbling experience to be invited into a patient’s home once a week for online therapy and have the opportunity to observe and help them when their most vulnerable.” – Robert Cleveland, LCSW
Array uses the Net Promoter Score (NPS) metric that assesses clinicians’ experience with our organization by asking them how likely they are to recommend us to a friend or colleague. The final aggregate NPS score can range from as low as –100 to as high as 100. With the most recent clinician NPS scores for the two organizations averaging 55, it’s clear that clinicians like working at Array. We are committed to fostering the best clinician experience possible to ensure they can deliver the best in class care.
What do you look for in a telebehavioral health employer? We’d love to hear from you. Visit this link to either share your ideas or to discuss the various telepsychiatry opportunities available at Array.
This year has seen remarkable changes across every element of the healthcare landscape. From the unforeseen curve ball thrown at a vulnerable U.S. healthcare system to the rapid, necessary adoption of telehealth across all care settings, 2020 is nothing like we’ve dealt with before.
With all this change comes a need to be introspective and understand how we can prepare for the days, weeks, months and years ahead. Array maintains partnerships with hospitals and health systems across the nation under unique circumstances to ensure access to timely psychiatric assessments.
To help give us a clearer picture of what hospitals have experienced and may continue to endure related to mental health patients, Array SVP & Medical Director, Dr. Mark Alter, gives his thoughts on the current hospital-based telepsychiatry landscape.
How has the coronavirus impacted hospital behavioral health services/programs?
The earliest phase of COVID-19 (March and April) saw a significant dip in the utilization of hospital-based behavioral health services and programs. This was in large part due to patients trying to avoid physical spaces with high risks of infection. Then, we saw a spike in mental health visits in hospitals as community-based programs where individuals typically sought treatment temporarily closed or switched to telehealth-only appointments. These types of programs are often inaccessible to the most vulnerable populations such as those experiencing homelessness and require them to end up in the emergency department.
Now, as COVID impacts lives in numerous ways, the need for behavioral health care is still present and is in fact increasing. The National Alliance on Mental Illness estimated that by 2021, 1 in 3 Americans will have a mental health or substance use issue. As an organization that works with its partners to scale and adjust services to meet these challenges, we are expanding our work into non-traditional on-demand settings and developing models to improve our ability to provide our services in areas and communities most in need.
One thing that has changed is our operational process and on-demand platform used by our hospital partners to request an assessment. When an emergency department, inpatient psych unit or medical floor requests a patient evaluation, they may denote the patient in question has tested positive for COVID-19. Doing this allows for our telepsychiatry clinician to adjust their messaging and ensure the appropriate amount sensitivity around the subject. Additionally, this makes the telepsychiatry clinician aware that onsite staff may require more time preparing PPE before setting up the virtual encounter in the presence of the patient.
What does the future of behavioral health look like for hospitals?
Prior to this pandemic, the need for telepsychiatry was fueled by a limited, poorly dispersed number of quality behavioral health clinicians across the country as well as an increasing demand for services by patients in need of care. The nature of this virus complicated those already difficult challenges. Even with available care resources or a manageable demand, this virus halted many in-person encounters and has forced us to adopt virtual interaction. Whether newly implemented programs or refining and sustaining ongoing programs, healthcare professionals are realizing the efficacy of telebehavioral health encounters and we will likely see continued use of these solutions even when in-person assessments are possible.
Has there been an increase in mental/behavioral health presentations in emergency departments or changes in disposition decisions?
While stressors such as the duration of quarantine, inadequate supplies, lack of information, frustration, boredom and fear of infection exist, these have not necessarily meant an increase in mental health-related presentations in hospitals. In response to the pandemic, hospitals and health systems have had no choice but to reallocate their resources. Changes like the need to limit inpatient psych unit rooms to just one bed did decrease overall bed availability. This did not mean that behavioral health programs they had previously implemented shut down. Our telepsychiatry clinicians continue to constantly monitor the evolving circumstances of the partner facility, adjust their processes and consider the community resources that they can leverage when making dispositions.
Though behavioral health visit volume was down initially, we have seen a steady return to pre-first spike volumes of mental health-related visits across many of our hospital partners. This could be in part due to patients in crisis or in urgent need of care feeling more comfortable utilizing hospital resources now that many have managed to safely adapt their operations in response to the virus. Stepping inside a hospital may not pose an exorbitant amount of infection risk as it may have posed just a few months ago. 81% of hospital leaders stated in recent Array poll that they believe the volume of mental health-related visits will increase over the next 6 months.
Hospitals and health systems need to continue to examine their disposition processes and adjust according to the availability of other resources in their community. If resources like intensive outpatient programs (IOP) and primary care providers (PCP) close or offer limited access, telebehavioral health may be able to bridge those gaps in many instances.
It is vital to support the mental health of your team right now. Healthcare workers and administrators are bravely bearing the burden of this collective trauma and the impact on their own well being now and into the future cannot be ignored.
Creating meaningful support for healthcare employees should be top priority.
What could or should that look like? We've put our heads together with HR teams at several large health systems to brainstorm the key elements of a solid program to support healthcare-industry employees.
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Suggested Structure & Logistics
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Suggested Structure & Logistics
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The COVID-19 pandemic is creating an unprecedented set of global circumstances that are profoundly changing the lives of people everywhere. Among many challenges that we now face, it’s evident that COVID-19 is creating – and in some cases, exacerbating – mental health issues among many groups.
Research shows that 47% of individuals who were ordered to shelter in place have reported negative mental health effects. This is likely due to the fact that what we’re facing currently is global, systemic trauma. As clinical psychologist Sharon Greenfield recently told Reuters, “We’re all a little disoriented. Our brains aren’t quite sure whether we’re being exposed to a traumatic trigger or not.”
While many people around the globe are feeling some of the negative effects of grief and trauma, those who work in healthcare are especially at risk. Healthcare workers – like nurses, doctors and EMTs – are on the front line of the coronavirus fight. As a result, they’re witnessing trauma occur daily as they perform their jobs.
Healthcare Workers’ Mental Health During COVID-19
If you’re a healthcare worker, research shows you’re more likely to show symptoms of mental health disorders because of the very real stress of managing the pandemic.
Dr. Lorna M Breen, an ER physician in New York, recently died of suicide after the trauma of witnessing COVID-19 firsthand. Research from China shows a considerable amount of Chinese healthcare workers are experiencing symptoms of depression, anxiety, insomnia and distress. These were especially prevalent in women, nurses, those who reside in Wuhan where the outbreak originated, and frontline healthcare workers.
The fallout of this trauma also takes a toll on the spouses and families of healthcare workers. Roughly half (51%) of people who live with a healthcare worker said worry and stress about the coronavirus has had a negative impact on their health. Additionally, many healthcare workers report being afraid to go home, because they have sick or immunocompromised family or housemates and they fear accidentally infecting these individuals.
Weathering the Storm, Together
While the pandemic continues to unfold, it’s imperative to prepare to address the long-term impact of COVID-19 to help healthcare workers transition, cope and heal from the trauma they’re enduring. One key resource will be perceived social support; feeling interconnected tends to help protect against post-traumatic stress disorder (PTSD). Self-care is also highly recommended.
While acts of self-care are important, however, many healthcare professionals will need additional support if they’re experiencing mental health issues such as anxiety or PTSD. Hospitals and healthcare systems can help by offering emergency transportation and housing options, which can mitigate the stress healthcare workers feel about infecting those around them. Perhaps most importantly, these organizations can help provide counseling services and support groups to these workers. Access to mental health resources and professionals is crucial to helping healthcare workers cope and heal from the events surrounding COVID-19.
One tool that hospitals and healthcare systems may consider implementing to support healthcare workers is telepsychiatry. Becker’s Hospital Review reported that in 2019 alone, over 100 hospitals had implemented virtual care technology to enable telehealth services for a variety of specialties. Now that telehealth laws are changing quickly in many states to accommodate stay-at-home orders and coronavirus measures, telepsychiatry is emerging as a flexible, no-contact option to connect healthcare workers and others with the services they need.
Countless healthcare workers are fighting to protect our well-being during the pandemic, and these professionals will need their own well-being supported as the immediate crisis fades. Telepsychiatry can help break down barriers to deliver care when and where it’s needed most, giving these frontline heroes access to vital mental health services in the days and months ahead.
If you are in crisis, call the National Suicide Prevention Lifeline, a free, 24-hour hotline at 1.800.273.8255. If your issue is an emergency, call 911 or go to your nearest emergency room.
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