In addition to ravaging our physical health, the unrelenting global pandemic has negatively affected the mental health of Americans in ways we probably won’t fully comprehend for years to come.
Covid-19 has driven increases in mental health-related emergency room visits, suspected suicide attempts, and reported cases of depression and anxiety among all age groups, particularly children. According to a U.S. Census Bureau survey, 42% of Americans have experienced symptoms of anxiety and depression over the past two years, up 11% from the previous year. The continued escalation of mental health needs has placed undue stress on service providers.
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Health experts like Dr. Fauci predict an eventual transition to “endemic” with the potential for a return to normal life – and that’s welcome news. But Americans will continue to struggle with mental health issues long after the pandemic subsides and will need access to mental health services, perhaps more than ever before.
Unfortunately, the state of the U.S. healthcare system means that many may continue to find it difficult to access behavioral healthcare.
Mental health professionals face a range of endless challenges to delivering care and managing their practices, including restrictive state laws, onerous certification and licensing regulations, intensive and expensive education requirements, and historically low reimbursements from some insurance companies. Collectively, these challenges have led to frustration and burnout among veteran therapists, causing a dearth of available providers.
To alleviate shortages and ensure that all who need services have access to them, the entirety of the mental health ecosystem needs to evolve. Insurance providers, legislators, advocacy groups and providers must adopt a more innovative approach in the following four key areas to meet the expected outsized demand for mental health support post-Covid.
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1. Education and mentorship
Among the biggest hurdles for the next generation of mental health professionals is continued education and mentorship. The industry must ensure that therapists have access to educational opportunities needed to practice with patients during their supervision. They also need mentors, resources and tools to help them continually learn, develop specialty practice areas and hone their crafts.
In addition to multiple years of expensive schooling, aspiring therapists must clock up to 2,000 hours of practice and supervised experience before they can practice independently. Until recently, this was extremely complicated and costly for businesses or private practices to create and run, leaving hospitals and agency settings as the best options to obtain the required hours.
2. Technology
Behavioral services are deeply interpersonal and rely on human connectivity and the strength of relationships between people. That does not mean there isn’t an important place for technology.
Therapists, whether young or experienced, need to enthusiastically embrace technology for organizing data, clinical risk management, capturing treatment outcomes, managing administrative tasks, and handling all things for which the human touch is not required. Technology is key to enable clinician collaboration and facilitate communication between providers as that remains a significant barrier to comprehensive care
A tech-enabled industry transformation will help patients more easily connect with the right providers and generate the data-driven insights related to impact and outcomes that can spur insurance carriers to raise reimbursement rates.
3. Insurance
Historically, the relationship between many insurance providers and the mental health industry has been adversarial.
Reimbursements were woefully low and the therapists who didn’t partner with insurance companies regularly faced administrative red tape and payment delays, which crushed some smaller practices. As a result, they were disincentivized to work with insurers, leaving patients with mental health benefits that they couldn’t use. And practitioners who did accept insurance spent as much time engaged in paperwork as they did with their patients.
With insurance payers as part of the solution and outcome-based care complementing fee-based services, therapists and payers can work hand in hand to ensure members have access to the behavioral health services they need – a win-win for all parties involved.
4. Regulations
Even with demand for mental health services soaring, regulations governing industry practices remain onerously prohibitive.
State laws and certification requirements restrict providers to working only in states where they are licensed. As the pandemic took hold, some states enacted emergency provisions that temporarily allowed therapists to provide telehealth services across state lines to ensure continuity of treatment. But the restrictions are now returning, and that is unfortunate.
Securing a state license is yet another costly, cumbersome process. As a result, patients located in different states from their providers may have to forgo a trusted relationship.
Establishing a single licensing structure where therapists can provide services across multiple states would provide patients with more options for care. Existing therapeutic relationships could be preserved, and providers would be able to expand their respective practices.
We are on the cusp of a full-blown mental health crisis in this country. There’s never been a more important time to address the challenges and implement the remedies that enable current providers to continue serving patients in need while paving the way for new clinicians to enter the field.
The adoption of more flexible and innovative approaches to education, regulation and compensation are needed to systematically benefit the entire professional mental health community and the individuals who rely on them during this critical time.
Photo: Pornpak Khunatorn/Getty Images
Christine Carville is Co-founder and Chief Clinical Officer of Resilience Lab, practicing psychotherapist and behavioral care innovator. After a decade in entrepreneurship which included health & wellness publishing, she returned to school to train as a clinical social worker to help people address the root causes of their suffering and pain patterns. It was personal family issues of addiction and mental illness and a 12 year journey working in the New York City public healthcare system that steeped Carville in the problems in U.S. behavioral care delivery.
