Not only can the virus have direct neuropsychiatric effects, but the necessary public health measures we are taking to stem the spread, inconsistent messaging, and the pervasive uncertainty about the present and the future are contributing to unprecedented mental health problems. We have seen that delaying healthcare can have disastrous effects—from burst appendices to cancer being detected at later stages adversely affecting survival. The same can occur with a delay of mental health services. Depression, anxiety, eating disorders can all worsen when care is postponed.
To some extent, people’s concerns about seeking face-to-face healthcare during the pandemic have been offset by allowances for telehealth services during the Public Health Emergency. Medicare and TRICARE have greatly expanded telehealth coverage during the pandemic.
This loosening of restrictions has had the unanticipated benefit of allowing mental health practitioners to reach individuals whom we couldn’t reach before. It has had positive impact on access for rural individuals and whose who live far or are unable to travel to specialist services.
We conducted a nationwide survey of over 500 individuals with eating disorders. Early in the pandemic, 45% of symptomatic individuals were not receiving treatment for their eating disorder. In August, that number was reduced to 38%—still too high, but trending in the right direction.
Equal access to telehealth and tele-mental health services should be a permanent change, but it is at risk of being rolled back. Commercial insurers stand at the ready to eliminate support for health care at home. Two very important bills are circulating through Congress now that will extend provisions for health care at home.
House Bill (H.R. 6644) the Health Care at Home Act of 2020, a bipartisan bill introduced by physician Representatives Kim Shrier, MD (D-WA-8) and Phil Roe, MD (R-TN-1), would ensure that all medically necessary benefits in commercial and ACA plans are covered via telehealth, including mental health for the duration of the Public Health Emergency. In addition, it would ensure that telehealth services are covered at the same rate as in-person services, including audio-only visits. Although this bill only covers an extension during the Public Health Emergency, it is a first step toward what should be permanent provisions.
The partner Senate act (Tele-Mental Health Improvement Act S. 3792), also a bipartisan effort introduced by Senators Tina Smith (D-MN) and Lisa Murkowski (R-AK), requires commercial plans to cover mental health and substance use disorder services provided through tele-mental health at the same reimbursement rates as what would have been received for the same services provided in person; prohibits health plans from imposing additional barriers on access to tele-mental health; and directs health plans to inform enrollees on how they can access mental health and substance use disorders services via tele-mental health. The Senate act also requires the Department of Health and Human Services to issue a report on the impact of telehealth parity measures on the use of tele-mental health and in-person services.
Not much good has come of this pandemic, but it has accelerated the acceptance of telehealth services, and in some cases, even broken down the age-old barrier of providing treatment across state lines. In order to meet the mental health needs of our population, these innovations should become permanent fixtures of our healthcare system. Reach out to your Representative or Senator to help them understand the importance of these provisions for those in need of mental health care in our country.