If the SARS outbreak 17 years ago in Asia is an accurate indicator, behavioral health care providers could see a patient surge in the coming weeks and months as the COVID-19 pandemic takes an emotional toll on people.
One-third of the people in Asia were unable to return to work full time after the SARS pandemic, six in 10 experienced fatigue, and half had difficulty sleeping.
In Hong Kong, the suicide rate spiked nearly 32 percent for two years after SARS. Hong Kong also experienced “increases in persistent depression, anxiety, panic attacks, psychomotor agitation, psychotic symptoms, delirium, and suicidality,” according to a white paper from Pine Rest Christian Mental Health Services on the potential mental health effects of the COVID-19 pandemic.
The white report pulls data from a number of sources to issue a call to action for care providers to prepare for the “aftershocks” from the pandemic and “minimize the fallout of COVID-19 on mental health in our communities.”
“The warning signs are there right now that we could in Michigan experience a significant surge in behavioral health needs that emerge out of this COVID crisis,” Pine Rest CEO Mark Eastburg told MiBiz. “We ought to be prepared as a state and a community for that in case that happens.”
The stress, anxiety and depression the pandemic triggers can come from the loss of a job or income, grief, and uncertainty about the future. At Pine Rest, “we’re experiencing a rise in many of the stressors that are known to increase risk for suicide,” Eastburg said.
As well, Michigan entered the COVID-19 crisis with existing problems related to the accessibility of mental health care.
A 2019 study conducted by Ann Arbor-based Altarum, commissioned and funded by the Michigan Health Endowment Fund, cited a serious shortage of psychiatrists and other mental health care providers in the state. Altarum detailed how 650,000 people in Michigan with a mental illness and more than 500,000 with a substance use disorder fail to receive any treatment.
“We’re already stretched thin as a state in behavioral health and this is going to stretch us even more,” Eastburg said. “We really need to step up right now.”
Pine Rest’s intent with the white paper was “to get us as a state to begin thinking about and get our creative clinical and policy minds working on this question: How do we improve access to behavioral health if we do see a surge?” Eastburg said.
Among the suggestions is “improving access to mental health care through awareness, affordability, and technology” such as telehealth platforms.
“We in Michigan need to continue to scale up teletherapy and telepsychiatry, let Michiganders and gatekeepers know the availability of these care options and how to find them, and keep in place financial incentives such as waivers for co-pays for these services,” according to the white paper.
Action on expanding telehealth in behavioral health care has been moving forward on a number of fronts. Many mental health care providers have transitioned to telehealth platforms to connect with patients during the COVID-19 pandemic and state-issued stay-at-home orders.
Early on, therapists at Pine Rest adapted to conducting outpatient sessions through a telehealth platform. Prior to the pandemic, Pine Rest therapists held about 100 telehealth sessions a week. They are now conducting about 6,000 weekly sessions, Eastburg said.
Patients have adapted well to the change, according to Eastburg.
“Some of the patients we’re seeing initially were a little skeptical, but as they get used to it a little bit, people have accepted it and they’re returning for follow-up visits. It seemed to work well,” he said. “We’re been pleasantly surprised that people have really adopted it because it’s a great tool in this crisis.”
In April, the Michigan Health Endowment awarded nearly $3 million in grants to 60 organizations statewide to expand telehealth services. The funding will help the organizations to implement telemedicine procedures, set up billing, train or add staff, educate patients, and acquire licenses and equipment needed to comply with federal privacy requirements.
Grand Rapids-based Hope Network was among 15 West Michigan care providers to receive funding from the endowment to offer more telehealth services. Hope Network used the $50,000 to quickly expand and ramp up telehealth for multiple services, including substance abuse treatment, CEO Phil Weaver told MiBiz.
“I really believe that this will be the turning point in using telehealth more strategically than what has been available before,” Weaver said.
Hope Network serves more than 1,000 clients weekly through an array of programs. Many of its clients previously served in face-to-face meetings are now using telehealth, Weaver said.
So far, Hope Network has seen a small increase in inquiries from people who are having issues that “may not be a serious mental health condition, but it’s serious enough to them that they make a call to somebody,” Weaver said. He’s concerned about what may occur in the summer and fall.
Higher incidences rates of substance abuse and post-traumatic stress disorder are among the problems that Weaver expects. Care providers will need to partner even more to respond, he said.
“I think six months from today we’re going to see a massive uptick in both substance abuse and other mental health conditions,” he said. “There’s going to be post-traumatic stress coming out of this pandemic. All of our jobs in the community that are in health care is to try to figure out, ‘OK, how do we start to be proactive in addressing that together?’
“It’s going to change how we think and do business. I am hopeful that we take this opportunity to make those changes and improve health care for our community.”
Changing status quo
The greater use of telehealth services, albeit mandated by the stay-at-home order, is one example of change that’s already occurring to improve access. That’s illustrated by the Michigan Health Endowment grants to Hope Network and others, plus action by Blue Cross Blue Shield of Michigan.
The state’s largest health insurer has begun to develop telehealth programs with care providers to allow certain patients with substance abuse disorder to detoxify and undergo treatment at home.
Through the effort, Blue Cross Blue Shield of Michigan’s program “meets people where they live” and can bring their families more into their treatment, said Dr. William Beecroft, medical director for behavioral health at Blue Cross Blue Shield.
“We may find this approach could change the status quo for substance use disorder treatment in the future,” Beecroft said.
As well, 18 community mental health organizations across Michigan were recently chosen to receive federal grants totaling $54.4 million to expand services to people with mental illnesses or substance use disorders, according to a recent announcement from U.S. Sen. Debbie Stabenow, D-Michigan.
In Kent County, community mental health agency Network 180 received nearly $2 million. Network 180 plans to partner with Cherry Health to provide primary care and telehealth for Suboxone treatment. The organization also will work with Arbor Circle, Hope Network, InterAct and Pine Rest for case management, treatment, psychiatric rehabilitation, social support services and recovery.
The federal funding for the Certified Community Behavioral Health Clinic “allows us to serve anyone in need of mental health or substance use disorder services regardless of ability to pay or insurance type,” Network 180 COO Beverly Ryskamp said in a statement on the agency’s website. “Before the grant we were only able to serve individuals coming into our Access Center who have Medicaid or no health insurance.”
Similar grants were received by West Michigan-based agencies in Battle Creek, Lansing, Muskegon, Kalamazoo and Ludington, according to Stabenow. The funding “provides a major boost in services to individuals in our state during this difficult time,” Stabenow said in a statement.
In addition to increasing capacity and scaling up the use of telehealth, the Pine Rest white paper suggested that providers “prepare our existing behavioral health workforce for caring for a surge of trauma-related needs, and in evidence-based suicide prevention interventions.”
Therapists at Pine Rest, for instance, aim to “sharpen up their skills in working with people who have been traumatized, identifying suicide risks and addressing risk factors,” Eastburg said.
The therapists are honing their skills at “all the good things good therapy training prepares you for, but you want to be especially astute because we might be seeing more situations like that where it’s important those skills be really sharp,” he said.
Employers also play a role in preparing for the emotional effects the pandemic could have on employees, Eastburg said. He urges employers to examine their employee assistance program (EAP), if they have one, and to remind employees what they have available.
“It really is a good time right now for companies to reach out to the EAP and find out what those benefits are, figure out how to communicate with your employees, and let people know this is available,” he said. “The minimal step you can do is mobilize that resource if you have it.”