Policy, Health Services

Report: Providers cut mental health staff, even as demand increased during the pandemic

As demand for behavioral health services increased during the pandemic, many organizations providing these services cancelled or rescheduled appointments, or laid off staff, according to a report by the U.S. Government Accountability Office. 

Even as demand for mental health services increased during the pandemic, some provider groups cut staff or trimmed programs, according to a report released Friday by the U.S. Government Accountability Office (GAO).

The U.S. had already faced the opioid crisis and challenges in access to mental healthcare before Covid-19. Now, more groups are working to track the “crisis within a crisis,” as reports of anxiety, depression and substance use have increased.

More than a third of adults reported symptoms of anxiety of depression in the last year, according to a series of weekly surveys conducted by the Centers for Disease Control and Prevention. At the worst point, in mid-November, 43% of adults had these symptoms, compared to roughly 11% of adults in 2019 in a similar survey conducted by the CDC.

By another measure, the Substance Abuse and Mental Health Services Administration (SAMHSA) found that opioid deaths in some parts of the U.S. were as much as 25% to 50% higher than in 2019, according to a report released in September of last year.

Despite the clear and overwhelming need for mental healthcare services, during the last year, many providers trimmed staff or programs, according to the GAO report.

Specifically, the government watchdog cited a survey conducted last fall by the National Council for Behavioral Health, which found that 27% of 343 behavioral healthcare organizations they polled reported laying off employees, and 45% reported closing some programs. A whopping 65% of them said they had to cancel, reschedule or turn away patients between June and August, and at the same time, 52% saw an increase in demand for their services.

Companies have tried to offset this with telehealth visits, or investments in digital health companies that provide self directed mental health exercises and coaching. But it’s still not enough to offset the crushing demand that some experts are reporting.

In particular, access has been the most challenging for people who needed in-person care, such as an inpatient stay.

For example, the Virginia Hospital and Healthcare Association told the GAO that some of its members had to reduce the number of available beds by blocking off rooms to meet social distancing requirements for inpatinets. Some hospitals in the state also reported challenges in getting insurance companies to cover inpatient stays for patients with combined physical and behavioral health diagnoses.

Hospitals in other states reported similar difficulties, especially in getting inpatient behavioral health services covered by Medicaid.One hospital system in Oregon told the GAO that behavioral health inpatient claims were routinely denied.

Although the GAO collected several other similar anecdotes, there’s little complaint data to show that insurers deny behavioral health claims more than physical health conditions. This might be because most people aren’t aware of mental health parity laws that require insurers to cover mental health conditions the same as physical health conditions, or might have privacy concerns with submitting a complaint.

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