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Pandemic Calls for Population Behavioral Health Strategy

October 30, 2020
Ron Manderscheid
By Ron Manderscheid, President and CEO, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

This week, the Population Health Alliance held its annual Innovation Summit and Capitol Caucus. This year’s theme was enticing: “Emerging Population Health Management Strategies in Our New Era of Health Care.” A detailed agenda is available on the alliance’s website.

The central question asked throughout the Summit was how population health management can be adapted to respond to the COVID-19 pandemic. More specifically, two questions were addressed: What changes are required in population management as a result of changes in actual care practices, e.g., virtual care? What contributions can population management make to resolve the personal health effects of the pandemic and its mitigation efforts?

I was honored to be invited to present a plenary talk on “Addressing a Behavioral Health Pandemic within the COVID-19 Pandemic.” Here are some key messages from the session:

On an ongoing basis, behavioral health conditions affect about 25% of adults and 20% of children/adolescents each year. As a result of COVID-19 and its mitigation efforts, these numbers for adults have climbed to at least 40%, based upon a CDC survey, and are expected to go even higher. Comparable data are not available for children/adolescents. However, reports from the field suggest that rates have climbed precipitously for them.

Prior to COVID-19, only about 50% of adults and 25% of children/adolescents with behavioral health conditions actually received any behavioral care. Further, almost 80% of this care was provided through primary care. There is very little reason to believe that behavioral care capacity has changed since the inception of the COVID-19 pandemic. Thus, virtually no capacity exists to serve new behavioral care clients who have been affected by the COVID-19 pandemic.

Thus, the COVID-19 pandemic is generating a behavioral health pandemic. Because behavioral care has lacked capacity to serve the population in need prior to the COVID-19 pandemic, it is very clear that it cannot meet the new demand generated by the behavioral health pandemic. As a consequence, a very serious problem rapidly is becoming a crisis.

What can be done? The behavioral care field needs to implement a population behavioral care strategy to address the social and physical determinants of health that are generating the behavioral health pandemic. This strategy follows the principle that it always is better to prevent a problem than to treat it. 

Let’s examine a few examples. Population behavioral care will need to intervene with population groups rather than individual clients to prevent and ameliorate the trauma and stress, anxiety and depression, and even suicide contemplation that have resulted from COVID-19 and its mitigation efforts. The field knows how to do this. It simply needs to be done for population groups rather than individual persons.

Tools are available to facilitate this work. They range from mindfulness and wellbeing regimens, to online apps to address stress, to more traditional group interventions. Peers and colleagues from public health can join in this effort.

Population health management also can play a very important role in this process. It can subdivide populations into subgroups that have had differential exposure to adverse social and physical determinants of health. This will permit population behavioral care to better direct interventions toward those who need them most. 

I hope that we can discuss these strategies in the behavioral care field and take positive steps to implement them. Otherwise, our pandemic within a pandemic will only grow worse in the next 12 to 18 months.                                             

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