In an opinion piece published in the Boston Globe, the Chief of our department addresses the pandemic within the pandemic and outlines measures we must take to tackle the worsening mental health crisis in the United States. Importantly, he notes that this is not just a pandemic-driven crisis; long before the pandemic, many Americans have struggled to access mental health services.
The pandemic has clearly led to a significant increase in the number of persons suffering from depression, anxiety and stress. How will we be able to meet the needs of this growing number of patients?
“Access to care must be dramatically expanded. Legislators, insurance companies, and regulators, including boards of registration, need to respond boldly and swiftly to this crisis.”
At Mass General, when the pandemic hit, we were able to offer virtual care, providing over 230,000 outpatient visits last year and also opened a 20-bed emergency psychiatric service within the emergency department. In addition, Mass General Brigham increased the number of inpatient psychiatric beds by about 20%. Yet, the need is great, and despite these significant expansions in care, we are unable to provide timely care to all.
Dr. Fava outlines a straightforward plan:
Increase the number of trained mental health clinicians to improve access to care. There is currently a shortage of mental health providers, which is worse in rural areas and certain geographic areas of the US. Before the pandemic, it was estimated that in 2025, we will have 20%-25% fewer mental health clinicians than we need. As demand increases in the context of the pandemic, the shortage will be even more pronounced if we do not increase the number of clinicians.
Expand the number of psychiatric beds to allow for greater ability to treat the acutely ill. Currently we do not have an adequate number of inpatient psychiatric beds for the number of patients in need. Patients requiring acute inpatient care often spend days in the emergency room waiting for a psychiatric bed to open, a factor which not only compromises psychiatric care but also limits the number of beds available to care for medically ill patients.
Improve insurance reimbursements for psychiatrists and psychologies to reduce the incentive for clinicians to accept only those who can pay out of pocket. Patients with insurance often find that the panel of mental health clinicians covered by their policy is very small, and they often struggle to find an in-network clinician who is accepting new patients. Because compensation for mental health service by insurance is so low, many clinicians do not accept insurance for their services. And if they do accept insurance, the reimbursement for care provided by psychiatrists and psychologists is about 20% less than primary care providers receive for the same services.
Allow clinicians to provide virtual care across state lines to optimize mental health care. Prior to the pandemic, insurance companies limited access to virtual care. The pandemic eased some of those restrictions surrounding virtual care. Although it is clear that virtual care is effective and improves access to care, there remain barriers to providing care virtually, including not allowing clinicians to provide care across state lines.
The COVID-19 has taken a significant toll on the mental health of Americans, and our current system of psychiatric care cannot possibly manage this tremendous increase in the prevalence of psychiatric illness in our country. Dr. Fava states, “We need a bold approach, with joint efforts to help with this from all stakeholders, including legislators, insurance companies, and regulators.”
The country’s mental health crisis: A pandemic within the pandemic (The Boston Globe)
