Summary - Ensuring Access to Behavioral Health
COVID-19 has heightened the behavioral health (BH) needs of both of patients and the providers who care for them, necessitating a national response to ensure expanded and ongoing access to care. This session of the Fitzhugh Mullan Institute for Health Workforce Equity’s webinar series, Emergency Health Workforce Policies to Address COVID-19, co-hosted by the Beyond Flexner Alliance, discusses the changing BH policy landscape, the BH needs of providers, and how health systems can adapt to meet the BH needs of the public and health care providers moving forward. Moderator Dr. Isabel Chen is joined by two experts with the National Council for Behavioral Health, Dr. Joe Parks and Dr. Amelia Roeschlein.
Policies to facilitate access to BH services in the wake of COVID-19 are being enacted at a rapid pace (minute 03:40), reports Dr. Parks. Federal changes enacted by CMS include loosening restrictions on eligible telehealth services and modalities and allowing for the provision of services across state lines. HIPPA requirements are also being relaxed, as are prescribing restrictions for substance use disorders, which now temporarily allow for increased take-home dosing. States, meanwhile, are using the 1135 emergency declaration waiver process to enact a variety of policy changes that protect and facilitate access to BH services during the current national public health crisis.
Dr. Parks cautions that these policy changes, while welcomed by the mental and behavioral health professionals who have long advocated for them, do not come without challenges (minute 06:20). Telehealth has the potential to increase access to services, but it often relies upon patients having access to smart phones, enough data plans, and internet, posing an access barrier for many, especially those in rural settings. And even for those with access to the necessary technology and services, navigating telehealth platforms can be a challenge.
Behavioral health service barriers also exist on the provider side. Many agencies do not have the needed equipment to go mobile, and the cost to secure it can be prohibitive. Behavioral health providers may also need training to adapt their services, like group therapy, for telehealth. Dr. Parks notes that financial and training resources are available to help providers navigate these challenges, and that many of them are now available through The National Council for Behavioral Health’s coronavirus resources library (minute 07:35).
Financial assistance is an especially urgent need given the scale of the COVID-19’s financial impact on BH providers (minute 12:25). Dr. Parks cites a recent survey conducted by the National Council for Behavioral Health finding that two-thirds of the 600 organizations surveyed do not have enough money to stay in business more than three months. He warns that if payers don’t act quickly, there will not be enough behavioral health providers left during the latter stages of the pandemic and beyond, emphasizing the need for retainer payments which will allow providers and treatment centers to keep their doors open and prevent a permanent loss of BH service capacity.
This financial strain is just one of many added pressures health care providers face during the current crisis. Dr. Roeschlein points out that COVID-19 has exacerbated the stress already inherent in health care providers’ work and shed new light on the BH needs of the health workforce (minute 18:50). She asserts that now more than ever, providers need to be encouraged to engage in the self-care and stress management practices they teach to their patients, noting that much like when on a flight, providers should be reminded to put their masks on first during times of crisis. By tending to their own BH needs, Dr. Roeschlein points out, senior-level providers are also modeling vulnerability, authenticity, and healthy self-care strategies for their trainees, thus contributing to the resiliency of the next generation of healers. A variety of innovative, on demand tools like health care worker self-care cards and resilience apps are emerging, giving providers immediate access to mental and behavioral health support (minute 22:35).
Drs. Parks and Roeschlein agree that despite the current crisis, the path forward presents an opportunity to better prepare for the future BH needs of the public and health care providers, stressing that pre-COVID-19 practice guidelines and policies should not ultimately define future strategies (minute 26:10). Health systems need to be flexible and adapt based on an assessment of patients’ needs and what is both feasible and sustainable for the provider, recognizing that providers cannot always give all of themselves. Moving forward, Dr. Roeschlein says health systems should focus on creating safe and compassionate work environments that promote the psychological and social safety of their staff and clients (minute 24:00). Health systems can work toward this by providing resources like ongoing resilience and compassion satisfaction training, implementing trauma-informed supervision, and prioritizing collaboration and mutuality in staffing dynamics.
Dr. Parks concludes the webinar with two parting messages (minute 28:00). First, he emphasizes that not all stress leads to trauma; it can instead lead to strength, resiliency, and newfound skills. “The one thing that victims and heroes have in common is that both have been wounded,” he states. “We could end up heroes instead of victims.” Secondly, Dr. Parks challenges people to critically assess their fears and the amount of time they spend focusing on the pandemic, explaining that just as you don’t want someone recovering from a chronic disease to become all about their illness, we shouldn’t become just about the COVID-19 crisis. He notes that a balance exists in the moment-to-moment decisions we will make in response to the crisis, saying that if there is something you can do to help the situation, do it, but once you’ve done everything you can, you must get on with living your life.
Policies to facilitate access to BH services in the wake of COVID-19 are being enacted at a rapid pace (minute 03:40), reports Dr. Parks. Federal changes enacted by CMS include loosening restrictions on eligible telehealth services and modalities and allowing for the provision of services across state lines. HIPPA requirements are also being relaxed, as are prescribing restrictions for substance use disorders, which now temporarily allow for increased take-home dosing. States, meanwhile, are using the 1135 emergency declaration waiver process to enact a variety of policy changes that protect and facilitate access to BH services during the current national public health crisis.
Dr. Parks cautions that these policy changes, while welcomed by the mental and behavioral health professionals who have long advocated for them, do not come without challenges (minute 06:20). Telehealth has the potential to increase access to services, but it often relies upon patients having access to smart phones, enough data plans, and internet, posing an access barrier for many, especially those in rural settings. And even for those with access to the necessary technology and services, navigating telehealth platforms can be a challenge.
Behavioral health service barriers also exist on the provider side. Many agencies do not have the needed equipment to go mobile, and the cost to secure it can be prohibitive. Behavioral health providers may also need training to adapt their services, like group therapy, for telehealth. Dr. Parks notes that financial and training resources are available to help providers navigate these challenges, and that many of them are now available through The National Council for Behavioral Health’s coronavirus resources library (minute 07:35).
Financial assistance is an especially urgent need given the scale of the COVID-19’s financial impact on BH providers (minute 12:25). Dr. Parks cites a recent survey conducted by the National Council for Behavioral Health finding that two-thirds of the 600 organizations surveyed do not have enough money to stay in business more than three months. He warns that if payers don’t act quickly, there will not be enough behavioral health providers left during the latter stages of the pandemic and beyond, emphasizing the need for retainer payments which will allow providers and treatment centers to keep their doors open and prevent a permanent loss of BH service capacity.
This financial strain is just one of many added pressures health care providers face during the current crisis. Dr. Roeschlein points out that COVID-19 has exacerbated the stress already inherent in health care providers’ work and shed new light on the BH needs of the health workforce (minute 18:50). She asserts that now more than ever, providers need to be encouraged to engage in the self-care and stress management practices they teach to their patients, noting that much like when on a flight, providers should be reminded to put their masks on first during times of crisis. By tending to their own BH needs, Dr. Roeschlein points out, senior-level providers are also modeling vulnerability, authenticity, and healthy self-care strategies for their trainees, thus contributing to the resiliency of the next generation of healers. A variety of innovative, on demand tools like health care worker self-care cards and resilience apps are emerging, giving providers immediate access to mental and behavioral health support (minute 22:35).
Drs. Parks and Roeschlein agree that despite the current crisis, the path forward presents an opportunity to better prepare for the future BH needs of the public and health care providers, stressing that pre-COVID-19 practice guidelines and policies should not ultimately define future strategies (minute 26:10). Health systems need to be flexible and adapt based on an assessment of patients’ needs and what is both feasible and sustainable for the provider, recognizing that providers cannot always give all of themselves. Moving forward, Dr. Roeschlein says health systems should focus on creating safe and compassionate work environments that promote the psychological and social safety of their staff and clients (minute 24:00). Health systems can work toward this by providing resources like ongoing resilience and compassion satisfaction training, implementing trauma-informed supervision, and prioritizing collaboration and mutuality in staffing dynamics.
Dr. Parks concludes the webinar with two parting messages (minute 28:00). First, he emphasizes that not all stress leads to trauma; it can instead lead to strength, resiliency, and newfound skills. “The one thing that victims and heroes have in common is that both have been wounded,” he states. “We could end up heroes instead of victims.” Secondly, Dr. Parks challenges people to critically assess their fears and the amount of time they spend focusing on the pandemic, explaining that just as you don’t want someone recovering from a chronic disease to become all about their illness, we shouldn’t become just about the COVID-19 crisis. He notes that a balance exists in the moment-to-moment decisions we will make in response to the crisis, saying that if there is something you can do to help the situation, do it, but once you’ve done everything you can, you must get on with living your life.