Could COVID-19 Force Health Systems to Reprioritize Mental Health?
The operations of hospitals and health systems are being tested in unprecedented ways due to the COVID-19 pandemic. Organizations are facing structural, financial and even regulatory challenges as they attempt to navigate not only the current landscape, but as they prepare for a new healthcare reality in a post-pandemic world. This new reality will require a renewed focus on mental health treatment as an integrated component of care due to the potential impact on patient volume as well as acuity. These factors, if not addressed proactively, can result in even more overburdened hospital staff and workflows.
An Existing Challenge
Prior to the pandemic, hospital emergency rooms were already experiencing challenges related to the volume of mental health needs being presented, as well as a shortage of resources required to be able to efficiently treat those patients. According to a 2018 Medscape article, individuals with mental health diagnoses presented in the ED 25% more times than other patients, spent longer time in the emergency room and had higher morbidity and mortality rates. Statistics also reflected an increase in ED visits for people diagnosed with mental health and substance use disorders, particularly individuals with anxiety, depression and psychoses. Despite the significant need, the demand far outpaced the number of available psychiatrists, with the National Council of Behavioral Health estimating a shortage between 6,100 and 15,600 by 2025, and that emergency departments would be particularly impacted by the lack of psychiatric services.
All of this was before COVID-19 struck the nation.
A Pain Multiplied
COVID-19 has negatively affected the mental health of individuals already suffering from existing disorders, and preliminary studies show that this impact is likely to increase because of social isolation, anxiety due to financial uncertainty and even substance use. An April 2020 KFF Health Tracking Poll revealed that 45% of adults feel that worry and stress related to the novel coronavirus has had a negative impact on their mental health, which is an increase from 32% in early March. The immense burden related to mental health treatment previously borne by hospital emergency rooms will increase, but the impact will be even more significant due to potential depletion of resources related to the pandemic.
The current hospital-based psychiatric system is primarily crisis-oriented and reactive, which addresses a clear need but does not provide the earlier intervention required in the effective management of a sicker population. Additionally, limited reimbursement and availability of psychiatric providers will require hospitals to identify efficient and innovative options to manage these patients effectively, while operating within the new post COVID-19 reality.
Innovative Approaches to a New Normal
Some potential innovative solutions that hospitals and health systems can use to address this emerging need include meaningful care partnerships with local mental health treatment providers. These partnerships can include a range of associations including subcontracting of treatment services, referral-based systems or even co-location options to promote more cohesive care transitions. Concrete data sharing agreements that clearly define rules of engagement between the health system and community provider will help to ensure the security and accuracy of patient information.
Another option includes utilization of telehealth technology for point-of-care coordination with community-based mental health treatment providers. Due to the advent of COVID-19, many community-based providers have not only already instituted systems to support telehealth, but they are actively seeking ways to better align with other providers in order to support individuals who have the most need. By creating connections using telehealth technology, health systems can leverage an existing network of community linkages, which can help to relieve the pressure on the ED and deliver faster access to care. Organizations should consider options that do not inflict additional financial burden on the hospital, and are formalized with the appropriate data-sharing and collaborative agreements.
The need for mental health services in our country will only continue to increase, and hospitals will still bear the primary burden for care. By proactively engaging community-based treatment providers for innovative care partnerships, hospitals will be better positioned to address the exacerbating impact of the pandemic on patients’ mental health while maintaining operational efficiency.
Melissa Fox is the Chief Operating Officer of Acenda Integrated Health, a multi-specialty organization serving 10 counties in New Jersey across over 55 locations. Fox has led innovations in healthcare operations including Federally Qualified Health Centers, Healthcare for the Homeless, Behavioral Health, Home Care and Hospice
