As mid-summer rapidly approaches, it is important to take stock of where behavioral healthcare currently stands on our COVID-19 response, as well as how the field is likely to change during the next several months.
The current context is quite relevant. The early summer rush to “reopen” now is bearing fruit in terms of COVID-19 spikes in a majority of states, especially those that did not fully embrace social distancing or mask use. This has necessitated step-backs by governors, including mandated mask use, virtual school openings in the fall, and re-closure of restaurants and bars. Clearly, these developments have major implications for behavioral healthcare.
It also is very clear that COVID-19 and related abatement procedures have had a very significant impact upon the psychological health of all Americans. Stress, anxiety, depression and outreach for behavioral health services have all increased during the past three months. These trends also can be expected to continue and even accelerate in succeeding months.
Here are a few key areas where related developments are occurring in behavioral healthcare:
In-person reopening. Many behavioral healthcare entities are on the cusp of reopening their in-person practices. Pressure to do so comes from the recognition that some persons with more severe behavioral health disorders are doing more poorly in virtual care. A second factor is revenue; many of our providers have experienced significant revenue reductions with the conversion to virtual care. Overall, that loss may be as much as one-quarter since the end of March.
Primary consideration in reopening ought to be given to the current status of the pandemic in the surrounding community. Almost as important are the fall opening plans of local school systems, as they juggle virtuality against in-person classes. The activities of the schools are a very good bellwether regarding the safety of in-person operations in the local area.
Insurance dynamics. The dramatic dislocations in the labor force related to business closures as a result of the pandemic are now beginning to cause major changes in health insurance coverage. Of specific interest to behavioral healthcare, the Medicaid program is growing rapidly. These new enrollees can be expected to have a very different understanding of care access and acceptability. Further, they will have very little knowledge of how the public behavioral healthcare system actually operates.
It will be important to monitor these insurance dynamics in the local community. States will have a vested interest in reducing Medicaid benefits or provider reimbursements as the rolls continue to row. Further, better outreach likely will be required to help new enrollees understand the importance of behavioral healthcare and how to access it. The stress of the pandemic, coupled with stay-at-home orders and increased social isolation and loneliness, has led many persons to develop new cases of behavioral healthcare conditions not present earlier.
Staff turnover. The pandemic has accentuated human resource trends and problems already present six months to one year ago. These include retirement of the baby boomers, accession of the Gen Xers into leadership positions, and continuing churn of the millennials. The net result is that it now is more difficult to hire. Fewer candidates are willing to leave their current positions; many have fear of exposure to the virus; and, in some local areas, no candidates are available.
Factors to consider in recruiting include promotion from within, especially based upon performance in the COVID-19 period, job sharing of staff with other local organizations, and much more effective use of peers. Moreover, beyond traditional telehealth care, which involves a provider and consumer in synchronous interaction, new virtual tools and apps are available, which can be used asynchronously by consumers to reduce demand upon staff time. Hence, it also will be important to develop a digital formulary of these tools to ease current staff shortages. Overall, some have estimated behavioral healthcare staff shortages as large as 90,000 to 150,000 over the next two to three years.
Behavioral healthcare will survive the COVID-19 pandemic. The success with which this will be done will depend upon our capacity to continue to be adaptable to a rapidly changing environment, while also remaining true to the major values and human goals that motivate entire behavioral healthcare endeavor.