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Rethinking Behavioral Healthcare After the Pandemic

April 20, 2020

Many businesses will one day reflect on how they existed before and after the pandemic. Disasters bring wide-ranging consequences, though not based entirely on their direct or immediate impact. Behavioral healthcare will be changed for three reasons: Deficiencies have been exposed, new ways of functioning will become established, and disruption from any source creates an opportunity for change.

These changes are likely to not just impact the internal operations of our field, but also how we are perceived by others. There will be enduring attention paid to the psychological impact of this pandemic. This attention could potentially refocus and invigorate our field. Yet this depends on our leadership. Crisis, as we know, is a time of danger and opportunity.

New vision

Many experts will begin to think about the growing incidence of depression and anxiety. There will be discussion of which diagnostic categories are most prevalent in the wake of this ongoing tragedy. Interventions from medication to psychotherapy will be considered and modified. This focus is too limited unless the goal is to view everyone as a potential patient.

Do we want to normalize or pathologize reactions to the pandemic? Let’s start by assuming many with existing behavioral health conditions will experience exacerbation. New disorders may multiply. Yet the focus for a universal disaster should be commonality and the non-pathological nature of our responses. Many will know loss and grief personally, while everyone will grieve the loss of what once was familiar.

Our field should focus on both health and illness in normal times, but in times of crisis it is especially important to emphasize how we can facilitate health, and more specifically, resiliency and wellbeing. We need to broadcast how people find the resiliency to cope with trauma and adversity. We need to recall the lessons of positive psychology when disaster is most apparent and widespread.

The pandemic is a stressor for all, but especially those on the front lines. Many will develop PTSD, but we have little ability to predict which ones. At some point we must shift to stories of coping. War stories are to be expected at first, but we soon need to hear profiles in resiliency for people of all ages. Let’s avoid vague medical predictions of stress reactions progressing biologically to psychiatric disorders.

The secondary role of the diagnostic manual bears mention. Our focus needs to be on health promotion and disease prevention, more than the treatment of clinical disorders. This focus has long been lacking in healthcare, and as behavior is the essence of health and prevention, our field is the answer to this deficiency. We should embrace leadership on this and become a beacon for health and wellbeing.

New services

The past decade has been an incubation period for virtual healthcare services, and suddenly we need them to reach full maturity to address pervasive needs. Behavioral healthcare services are well-suited for telehealth modalities. For example, many companies now provide interactive modules with web and mobile access that emulate a session of cognitive behavioral therapy for depression or anxiety.

Many studies have found these services to be comparable in clinical outcomes to in-person therapy, and so we have probably reached a tipping point. Services delivered via phone, video or internet device will likely become normal. The remaining barrier to widespread virtual coaching is state licensure restrictions for clinicians, but the impetus for legislative change has presumably arrived.

The introduction of new services and new modalities poses a threat to the status quo. Clinicians have asked in recent years if telehealth would end their office practices. This will not happen because needs have long surpassed supply, and the expanded focus on health promotion and disease prevention necessitates new service providers with new skills.

New team

When the focus is health and wellbeing rather than treating a diagnosis, it is possible to train smart and caring non-professionals to staff new telehealth delivery systems. The need for behavioral health services outstrips the supply of professionals, and so we must think beyond licensed clinicians. The time is right to create new teams devoted to behavior change that feature non-licensed coaches.

These coaches can focus on health promotion and disease prevention, the pathway to lowering national healthcare costs and improving population health. They can work under the supervision of licensed professionals who can focus their services on people with clinical disorders. The pandemic will devastate families, and the demand for accessible, low cost supportive services will be huge.

Behavioral healthcare delivery is ready to be transformed into a multidimensional system with professional and para-professional providers working with people in person and remotely. They will also promote digital platforms for assessment and interactive sessions at no cost to the consumer. The behavior change team is oriented toward the positive psychology goals of wellness and wellbeing.

Wellness might be thought of as physical wellbeing, and the primary areas of focus include nutrition, movement, and avoidance of tobacco and other toxic substances. Emotional wellbeing stems from many capabilities, including coping and resiliency skills, the management of life transitions, satisfaction with interpersonal relationships, and recovery from trauma.

New identity

This is a time for industry leaders to be focused externally and not just on the internal issues discussed to this point. We can teach the public that our field not only helps people in the throes of major depression or disabling anxiety, but we also help individuals build resiliency skills in the face of major stressors, adopt healthier lifestyles, and develop coping skills that promote a greater sense of thriving.

The pandemic may be a burden for years to come as it constrains our behavior, damages our economic security, and adds to our grief. We can surpass all expectations for our field by combining traditional services with telehealth services and promoting a focus on health and wellbeing, not just the remediation of disorders. This dangerous time is an opportunity for our field to raise its profile.

All this requires leadership to transform the delivery of services and communicate a new message to the public. We need executives with credibility managing traditional behavioral healthcare services to address this natural restructuring of our field. We have been preparing for these changes for many reasons, but now millions of Americans are ready to understand and experience them.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

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