The COVID-19 pandemic has laid bare the dire need for broad and affordable access to mental healthcare and resources. The isolation of the last few months, fear of illness, record unemployment and countless other stressors in 2020 are contributing to increased anxiety, depression, overdoses and suicides across the country.
In Texas, the dearth of mental health services existed well before the pandemic. More than three million adults in Texas are living with a mental illness, and 61 percent of those who needed treatment did not receive any. Not only are mental illnesses often treatable and manageable, it increases quality of life and saves money for patients, healthcare organizations. and the state. So if these numbers reflect the state of mental healthcare in Texas before the events of 2020, the dire circumstances now mean we must openly address not only the access to care and resources, but the fact that so many of us are dealing with mental illness quietly.
Recent statistics from Dallas-based Meadows Mental Health Policy Institute (MMHPI) show that COVID-19 unemployment will cause an increase in suicide and drug overdoses, especially if treatment availability and resources remain at pre-pandemic levels. For every five-percentage point increase in unemployment, projections show there could be an additional 4,000 suicides (300 in Texas) and 5,000 drug overdose deaths across the country.
A solution to curb these unnecessary deaths would be universal access to collaborative care behavioral health model and medication-assisted treatment (MAT) for opioid users. MMHPI’s modeling shows that if Texas had universal access to collaborative care to treat major depression that the number of suicide deaths could reduce between 725 and 1,100 per year and nationally, 14,500 deaths could be prevented.
The collaborative care model is a care team led by a primary care physician and includes mental health care managers, psychiatrists, and other mental health specialists which implements a measurement-guided tailored care plan that relies on accountability and evidence-based care. Studies have shown this model improves outcomes, controls costs and helps patients living in both rural and urban settings.
Medication-assisted treatment uses medications in combination with counseling to treat drug addiction, particularly opioid addiction. Using MAT helps patients stay in recovery, reduce the risk of overdose and maintain employment and relationships. MAT is often misunderstood because it continues to provide drugs to patients, but in combination with counseling it is shown to reduce drug use and relapse.
Unfortunately, the use of collaborative care models and MAT in treating mental illness and substance abuse is not very widespread across the country. The current system of mental health care does not include preventative measures like screening are used to prevent physical illness. Care must either be initiated by the person recognizing they need help, finding a provider and being able to afford care, or it is started through a crisis situation where a person ends up in an emergency room or there is a law enforcement intervention. Crisis care often does not result in long-term management of a condition, like it might with diabetes.
These numbers show just what access to healthcare can do to stop preventable deaths. When healthcare leadership and policy makers consider whether or not we need more mental health care facilities and resources, we must remember that these statistics are not just numbers, but family members and loved ones who deserve the same level of care as if they had any other chronic disease.
One aspect of mental health care treatment that has improved because of the pandemic is access to telehealth services. Availability increased in Texas and across the country due to governments and insurance companies changing regulations and reimbursement rates to make it more affordable for patients and health care organizations. Therapy, both individual and group sessions, check-ins and more can be conducted safely via telehealth, and help isolated individuals who don’t have access to usual support systems because of pandemic-related issues. Because telehealth can help successfully implement comprehensive care plans for mental health, the expansion of telehealth due to the pandemic can help to accelerate the model’s availability.
While the pandemic has highlighted the widespread prevalence of mental illness, the spotlight on the increasing cases has helped to reduce the stigma that has prevented people from seeking care. Teletherapy allows not only for easy and affordable access to treatment, but also treatment that can be conducted in the environment of the patient’s choosing. The success of virtual care should be a clear indicator to policy makers that more resources is a good thing and can lead to preventing unnecessary hospitalizations and deaths. Yet as the pandemic and its shockwaves continue to radiate throughout the country, it’s important to build on these strides, particularly for marginalized populations. How can we use the pandemic as a moment to call for lasting social changes for mental health?
Alison Leonard is a key leader for CannonDesign’s Dallas Health Practice with deep experience and focus on mental and behavioral health. Committed to evidence-based design and passionate about reducing stigma around mental health issues, Alison directly influences projects in Dallas, Texas and nationwide.