COVID-19: Four Approaches to Addressing Behavioral Health Impact
Much of the initial focus on addressing the COVID-19 pandemic has been on preventing the spread of the disease and creating capacity (e.g., workforce, ventilators, ICU beds, PPE). However, it is also essential for healthcare organizations to consider the behavioral health (mental illness and substance use disorder)[i] impact of COVID-19. In fact, the increased demand for behavioral health services could greatly exceed that for medical services.[ii]
Provider planning efforts should address the need to maintain services for individuals in recovery, receiving medically managed detoxification, in residential treatment programs, and on psychotropic medications. Up to 30 percent of the population may be at risk for developing behavioral health conditions,[iii] including an increased suicide risk from the impact of economic instability, particularly unemployment.[iv] Additionally, providers must be prepared to support the mental and emotional health of their own workforce as the current crisis introduces unprecedented stress upon caregivers.
Below, we outline several approaches that healthcare organizations can take to address the behavioral health impact of the pandemic. We also provide a list of helpful resources to support staff, providers and patients in coping with this crisis.
Given the complexity of the problem, a “one-size fits all” approach will not suffice. Strategies should be customized based upon the current behavioral health resources available and an assessment of the needs of high-risk groups (e.g., those with a history of behavioral health conditions, older and disabled individuals, and children).
Most patients seek care from their primary care physician for their behavioral health conditions.[vi]
The psychologic impact of the COVID-19 pandemic will create an even greater demand on primary care providers for behavioral healthcare. Integrating behavioral health and primary care through models such as collaborative care can leverage limited behavioral health resources through a team-based approach centered around supporting the primary care provider.[vii]
Telemental health is an effective mechanism for providing behavioral healthcare, including integrated models such as collaborative care. TMH supports the practice of social distancing[viii] and has been shown to be effective.[iv] Recently instituted regulations by government and private payors are removing many of the traditional barriers to utilizing this technology.[x]
Human connection is necessary for maintaining psychologic well-being. Social distancing poses a particular risk for individuals with anxiety, depression and other behavioral health conditions in which connection with other individuals (friends, family, caregivers) is critical.[xiii]
Coping guidance is important for both patients and healthcare workers.
The COVID-19 infection poses a significant risk of depleting our healthcare workforce. It is important that we attend to the significant stress healthcare workers face due to concerns about maintaining their own safety and health, exposing family members and other patients, and covering staff shortages due to illness or isolation/quarantine restrictions. In addition, caregivers will benefit from having tools to support their patients who share many of the same concerns.
Concerns about contracting the COVID-19 infection and the far-reaching measures being taken to mitigate the spread of disease has disrupted our lives and is already exacting a psychologic toll on our communities. Health systems can play an important role in mitigating this impact. Planning efforts should consider how best to leverage or re-direct existing behavioral health resources, particularly for the highest risk individuals, and should be coordinated with community-based strategies and providers.
i We are using the terminology adopted by the American College of Physicians in a 2015 policy paper for behavioral healthcare "...to encompass care for patients around mental health, and substance abuse conditions, health behavior change, life stresses and crises, as well as stress-related physical symptoms.” Crowley RA, Kirschner N. The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into Primary Care: An American College of Physicians Position Paper. Ann Intern Med. 2015;163:298–9.
iii Bonanno GA, Brewin CR, Kaniasty K, Greca AM. Weighing the Costs of Disaster: Consequences, Risks, and Resilience in Individuals, Families, and Communities. Psychol Sci Public Interest. 2010 Jan;11(1):1-49. doi: 10.1177/1529100610387086.
iv Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemployment: a longitudinal analysis covering 63
countries, 2000-11. Lancet Psychiatry. 2015 Mar;2(3):239-45. doi: 10.1016/S2215-0366(14)00118-7. Epub 2015 Feb 25.
vi Crowley RA, Kirschner N. The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into Primary Care: An American College of Physicians Position Paper. Ann Intern Med. 2015;163:298–9.
vii Dissemination of integrated care within adult primary care settings: The Collaborative Care Model. American Psychiatric Association Academy of Psychosomatic Medicine. https://www.integration.samhsa.gov/integrated-care-models/APA-APM-Dissemination-Integrated-Care-Report.pdf
viii Best Practices for Telehealth during the COVID-19 Public Health Emergency. National Center for Behavioral Health. https://www.thenationalcouncil.org/wp-content/uploads/2020/03/Telehealth_Best_Practices.pdf
ix Lori Raney, David Bergman, John Torous, and Michael Hasselberg, “Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment”, Current Psychiatry Reports 19 (2017): 86.
xii SAMHSA. Taking Care of Your Behavioral Health: Tips for social distancing, quarantine, and isolation during an infectious disease outbreak. https://www.samhsa.gov/sites/default/files/tips-social-distancing-quarantine-isolation-031620.pdf
xiii Hari.J. Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions. Bloomsbury USA; First Edition edition (January 23, 2018).
xiv NIOSH Fact Sheet: The Buddy System. https://www.cdc.gov/vhf/ebola/pdf/buddy-system.pdf
xv World Health Organization: Psychological First Aid: Guide for Field Workers. https://apps.who.int/iris/bitstream/handle/10665/44615/9789241548205_eng.pdf;jsessionid=89CC64EAC5D1AD56D14DB0435A7D8A7F?sequence=1