The most coveted toy on holiday wish lists may change each season, but the long waitlists and lack of mental health providers that accept insurance are unfortunate constants for Americans.
The number of people wanting and seeking mental health services during the COVID-19 pandemic has grown: Mental health helplines saw a 35% increase in call volumes during the pandemic’s early weeks, and the share of people reporting symptoms of anxiety or depression increased from an estimated 10.8% in 2019 to approximately 30% during the pandemic.
This is not surprising, given that people have been grappling with life stressors like the loss of work, routines and loved ones. The uncertainty of what the “new normal” will be like – and when the pandemic will be over – also have contributed to emotional distress.
At the same time, nearly two years since COVID-19 infection rates surged and the world was sent into rolling lockdowns, the long-term impact of infection on patients is playing out. These individuals, called long-haulers, are experiencing ongoing physical, cognitive and emotional problems – such as depression, anxiety and post-traumatic stress disorder – weeks after they were first infected with COVID-19.
I am a rehabilitation psychologist who treats people recently diagnosed with COVID-19 as well as long-haulers. My patients have reported panic attacks, feeling afraid that their physical symptoms will worsen and feeling constantly worried that they will never get better or that they are dying. They have difficulty returning to work and managing activities of daily living such as bathing, cooking and keeping track of their finances.
I worked with one young mother with no history of mental health concerns who reported experiencing visual and auditory hallucinations that understandably terrified her and prevented her from caring for her toddler. Another COVID-19 patient, a man in his 60s, reported tremendous guilt because he survived being in the hospital, whereas his father passed away after a short stay.
The mental health symptoms experienced by long-haulers are not unique to them. These same symptoms are often experienced by survivors of other critical illnesses that result in admission to intensive care units and demand treatments such as intubation.
While impairment rates vary, significant shares of people discharged from an ICU experience what’s known as post-intensive care syndrome, or PICS. In addition to fatigue and overall physical deconditioning, this syndrome encompasses symptoms such as depression, anxiety and post-traumatic stress disorder, as well as difficulty with memory, attention, concentration and overall thinking. Untreated, PICS can result in the inability to return to work and care for oneself, and ICU admission itself is associated with higher risk for hospital readmission.
Just as these symptoms are not new, waitlists and a lack of resources for mental health care also are not new. What is new are both the acknowledgement of and heavy spotlight on the lack of mental health resources available to people amid a surge of survivors of critical illness.
And what is necessary is to strategize to meet the needs of long-haulers and the needs of many other patients who are hospitalized with a life-threatening illness during COVID-19 and beyond. It is critical to rebuild the health care system to include and support mental health treatment. Health care providers, administrators, organizations and policymakers need to consider a number of long- and short-term solutions.
As President Joe Biden works to gather support for the estimated $1.75 million Build Back Better social policy package that includes provisions expanding health care, it is critical to acknowledge the importance of continuing to preserve and expand telehealth mental health services.
Recently, the Centers for Medicare & Medicaid Services announced a permanent expansion of telehealth services for mental health issues. Other insurance payers need to follow this example and adopt lasting telehealth policies. Additionally, reimbursement for services should be equitable across all insurance payers and modes of teletherapy, whether by telephone or video.
Meanwhile, research shows telehealth services are efficient and equitable to in-person services. For populations and communities who have difficulty obtaining transportation or traversing outside of the home, this access is a lifeline. And by providing the flexibility of telehealth services, providers broaden access to mental health care and provide patients and clinicians the option to decide what makes the most sense for their treatment goals.
In order to expand mental health services, states also should work swiftly to join the Psychology Interjurisdictional Compact, or PSYPACT – an interstate compact that allows psychologists to see patients who live in member states across state lines. This would allow patients who do not have access to care due to their location or need for a psychologist specialized in PICS to receive treatment.
I work at an institution, for example, that services many residents who live in neighboring states. But even though the state I practice in is a member of PSYPACT, three of our neighboring states are not. This means some patients must drive across state lines so I can provide treatment. I recently worked with a COVID long-hauler who, with the assistance of a friend, drove four hours round-trip for treatment. She lived in a rural area and was desperate for care. We collaborated on a treatment plan to minimize the frequency of her travel, but this would not have been necessary if she lived in a PSYPACT state.
To reduce stigma, assess for psychological distress, and to provide education to patients and other providers regarding signs and symptoms of emotional changes, it also is essential to integrate psychologists and other mental health care providers into primary care and specialist clinics where COVID long-haulers and other survivors of critical illness inevitably will have follow-up visits. Health care providers can no longer work in silos, and must move toward interdisciplinary care in medicine, particularly as COVID continues.
Perhaps most importantly, we need more mental health providers, particularly those who are trained in rehabilitation and health psychology – specialties that focus on evaluating and treating psychological distress in individuals who’ve experienced acute or chronic illness and injury. These psychologists are also uniquely trained to work on these interdisciplinary teams.
The COVID-19 pandemic has highlighted a number of disparities and inequities across the world, including a lack of access to mental health treatment in the U.S. If this problem is not fixed, there will be another pandemic of survivors of critical illness who are struggling physically and emotionally.
This impacts everyone. An analysis last year estimated that the U.S. economy would lose some $16 trillion due to the COVID-19 pandemic, with mental health impairment accounting for more than $1.5 billion of this total.
These suggestions do not encompass all the solutions available to restructure mental health care access. Nor do they include cost consequences such as the funding to pay for increased training, the development of interdisciplinary clinics and the costs of mental health treatment.
Doing nothing, however, is not a choice.