Coronavirus reveals everything that’s wrong with our mental health care system

By now you’ve probably read at least one article about how to manage anxiety related to the coronavirus. Many of them contain useful tips: avoid the 24-7 news cycle, reframe negative thoughts, practice mindfulness, and connect with loved ones. 

These coping skills will undoubtedly help many weather coronavirus anxiety, particularly if everything else in their life is going well. 

But COVID-19, the official term for the disease caused by the virus, is forcing people to isolate, distance, and quarantine themselves, all of which can exacerbate stress, anxiety, and sadness. For those already dealing with mental illness, financial and relationship strain, unreliable support from family and friends, and limited access to physical and mental health care, reminders about coping skills are stop-gaps that can’t fix a larger problem: a broken system that often leaves people one emergency away from a mental health care crisis. 

Coronavirus anxiety is showing up at Crisis Text Line, where users of the free mental health support service are mentioning words like scared, terrified, overwhelmed, panicking, and paranoid to describe their feelings. One-third of the service’s conversations are normally about anxiety; that increased to more than 40 percent in March. Volume for the online therapy service Talkspace has risen by 25 percent since mid-February. 

The helpline operated by the National Alliance on Mental Illness (NAMI) is seeing a similar trend and recently took a call from someone so alarmed by the impact of coronavirus on their income that they expressed suicidal thoughts. The nonprofit has since posted an 11-page document that outlines coronavirus information and resources, including where to get mental health help if you’ve been quarantined and how to access care without insurance or regular doctor. 

There’s no question that people are seeking help, but the nation’s mental health care system is woefully unprepared to meet that need. Of the 60 million people with mental health conditions, nearly half go without any treatment. In 2018, one in four Americans reported choosing between paying for mental health care and purchasing household essentials, according to a survey of 5,000 Americans, commissioned by the National Council for Behavioral Health and Cohen Veterans Network. People reported long waits to see therapists, high costs, and poor insurance coverage. 

Mental health care is inaccessible to millions of people who are left to suffer in silence or rely on a patchwork of free services. 

Though helplines and pay-based telemental health services can make a life-saving difference right now, we need a much more aggressive response as coronavirus anxiety spikes. 

Joe Parks, a psychiatrist and medical director at the National Council for Behavioral Health, says many changes could happen through regulatory measures. 

The rules for delivering mental health treatment via phone or video, for example, vary significantly depending on who’s paying and where the patient lives. Medicare, government insurance for seniors and people with disabilities, will only cover telemedicine in high-need areas, like rural locations experiencing a provider shortage. Medicaid, state-based insurance for low-income people, children, and others who qualify, may not reimburse telemental health treatment in certain states. And some private insurers may cover remote therapy while others don’t. 

Parks says that the federal government should consider temporary changes to their own policies and encourage insurance companies to do the same so that patients can receive mental health care from afar. This solution could deliver treatment safely and efficiently at a time when neither patients or therapists will be eager to see each other. 

Similarly, federal regulations require face-to-face visits to prescribe medications often used to treat anxiety. But with coronavirus, the rules of self-isolating, social distancing, and quarantine mean a patient in severe distress might find it difficult to get a prescription that relieves their symptoms. Parks says that’s another regulation the government could temporarily relax. 

Neil Leibowitz, a psychiatrist and chief medical officer of Talkspace, says insurers could accept out-of-network claims for all members. Even when insurance plans offer coverage for therapy, it’s difficult to find therapists who accept those plans because of low reimbursement rates. As a result, patients end up paying out of pocket. They may delay appointments, particularly when facing economic uncertainty, or abandon the idea of starting therapy altogether. 

Leibowitz also suggests temporarily waiving interstate licensure requirements, which would allow therapists to give care across state lines. In other words, a New York resident who wants to take advantage of telemental health can only interact with a therapist licensed by the state of New York. Leibowitz says relaxing this rule would lower barriers to access, particularly for people in states where provider shortages are high.  

“If we have a huge surge today, we’re going to struggle.” 

“We’re going to want as much as capacity as we can have,” says Leibowitz. “If we have a huge surge today, we’re going to struggle.” 

People who experience mental illness may be at higher risk of contracting coronavirus, says Dawn Brown, director of NAMI’s HelpLine. Smokers, who may use nicotine to cope with mental health conditions, are prone to worse COVID-19 outcomes. Mental illness is disproportionately experienced by people who are homeless, and that population is at greater risk of developing COVID-19 because they may live in close quarters and lack medical care. Incarcerated people, who also experience high rates of mental illness, are vulnerable thanks to a lack of resources to stop widespread infection. 

Efforts to prevent and treat coronavirus must take into account people’s physical and mental health, particularly in high-risk groups where specialized treatment for mental illness is critical. 

Brown says the federal government should respond to coronavirus anxiety by making long-term, substantial investments in the country’s mental health care system with the aim of lowering barriers to care and providing equitable access to all.

“My hope would be that this is a huge wake up call to America that we have serious deficiencies in our health and mental health systems,” says Brown. “It will shine a glaring spotlight on them as this thing evolves.” 

If you want to talk to someone or are experiencing suicidal thoughts, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 6:00 p.m. ET, or email info@nami.org. Here is a list of international resources.  

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