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An imperfect perfect storm: The effects of deferred behavioral health care

We’re seeing light at the end of the tunnel as Americans start to get the COVID-19 vaccine. With it comes the hope that we can return to a life we once knew – a life of engaging with people – at work, at play and beyond.

Along with the renewed hope is a challenge for healthcare in general and behavioral health in particular: the effects of deferred care due to the pandemic. A recent survey revealed that 40 percent of individuals stated they canceled upcoming appointments, and an additional 12 percent stated they need care but haven’t scheduled an appointment. The situation complicates as we know that the pandemic has negatively affected individuals’ mental health and wellbeing. In another survey, 53 percent of American adults reported their mental health has been negatively affected due to COVID-19-related worry and stress.

In brief, we have a healthcare perfect storm: more people needing care who haven’t been getting it. The time is now for all healthcare players to work together to figure out how to stem the tide of deferred care.

The impact on the healthcare system

The effect of deferred care on the healthcare system is just becoming apparent, predicts McKinsey Consulting in a September 2020 article. Not only did the pandemic interrupt treatment for people with existing behavioral health challenges, it also has put more people at risk for developing behavioral health conditions, such as depression and substance use disorder (SUD). In fact, the article posits that approximately 35 million people could develop a behavioral health condition because of the pandemic.

This surge of behavioral health need will affect the healthcare system for many years. It will, of course, affect the quality of life for individuals needing behavioral health care, but some research indicates it will also increase costs: people with behavioral health challenges have approximately four times the healthcare spend of people without behavioral health conditions, according to the article.

It’s important to point out that medical care costs increase when someone has a behavioral health need. For example, individuals with no behavioral health condition incur approximately $2,400 in annual physical healthcare costs. Someone who has major depression spends on average $10,400 per year, with $1,800 of that on behavioral health care. For someone who has SUD, the average annual spend is $15,100, with only $1,700 of it for behavioral health services.

We can meet pent-up demand

As we prepare for the increased need, Beacon Health Options offers lessons learned during the pandemic to ensure access to care. The following Beacon efforts would apply to a post-pandemic world as well:

  • Be proactive in identifying at-risk people through data analytics. Identifying at-risk people helps to connect these individuals to care before their conditions can escalate. To do so, Beacon invested in additional screening tools and made approximately 13,000 outreach calls.
  • Promote telehealth and other virtual means of care. Not only did Beacon lift administrative requirements around telehealth, we also helped providers by offering many telehealth trainings. It turns out that there was an 80 times higher use of telehealth services among Beacon members in 2020 versus 2019.
  • Increase the use of peer specialists. In addition to their normal duties, we trained peers to do outreach calls to at-risk members. We also trained them to facilitate online support groups. As the world shifts to a more virtual approach to healthcare, activities such as online support groups are likely to remain relevant.
  • Pay attention to social determinants of health (SDoH). During our outreach calls, Beacon learned that 28 percent of people contacted had SDoH needs. Among other SDoH initiatives, we conducted provider-facing trainings on identifying and responding to SDoH and implemented an SDoH assessment tool.

These suggestions are a start. Beacon calls upon all stakeholders to determine what they can do at their organizations to ensure that people get care during these times when they need it more than ever.


22 Comments. Leave new

this is very insightful

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i am so appreciative of this article reminding us that in our profession the long term effects will be significant. I work mainly with small children and have seen an increase in depressive symptoms and feelings of agitation.

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Mental healthcare workers—counselors, psychologists, etc—need to be a priority to be vaccined. Right now I’m hearing potential clients say they only want to see a counselor in person. This is a risk for us and for our other clients. We ARE frontline workers, and I can’t seem to get an appointment before the end of March.

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Tabitha Kuehne
February 12, 2021 3:50 pm

I’m an independent psychotherapist and random people have been vaccinated and I haven’t. I wish there were a way to show up on the radar.

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Debbie Burmeister
February 10, 2021 5:00 pm

An additional challenge is an increased demand for in person sessions and the limitations on vaccines for mental health providers not associated with large agencies or hospitals. Appropriately 2/3 of my clients (children, teens & adults) prefer in person sessions to telehealth.

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Lynne Sheban, Ph.D.
February 10, 2021 5:01 pm

I’m finding the opposite. Not only is everyone keeping appointments because it is easier with telehealth, but the demand for care is so high that every practitioner that I know is booked, if not overbooked. It is painful when I have to tell referrals that I cannot fit them in at this time.

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Cynthia Wells Grey
February 11, 2021 12:39 pm

I am experiencing the same scenario as Lynne Sheban. Most of my clients that were in therapy with me at the start of the pandemic have continued virtually. My former clients are returning. Rarely does someone cancel and most find Telehealth more time efficient. I have only added a very few referrals. I feel less of a potential liability (clients being exposed to the virus in my office or building) by seeing them virtually. I feel safer as well.

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This is true for me as well. I’ve never gotten so many inquiries for appointments and now I see people for different counties and states via telehealth. And I see some people who are not tech savvy and/or just old fashioned and want to come in person. So I’ve held that space throughout (with safety measures). Strange times indeed.

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Good article. I am hopeful the resources for persons dealing with the dramatic social, emotional changes caused by the pandemic will be available post crisis as well know there will be a great deal of need for many months, next couple years to come.

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Telehealth has made mental health services available to people who could not otherwise attend counseling services due to schedule demands, childcare and remote learning, no transportation and, or need for social distancing. I hope telehealth will continue to be available after the pandemic crisis subsides. Thank you!

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Teletherapy has been a godsend during the pandemic, both for me and my clients. Not only safer due to COVID related concerns, but I have found that sessions are just as effective (or more effective), my no-show rate is significantly lower, and I am able to be more available to my clients. If I return to in-office therapy it will only be on a limited basis. I really enjoy using teletherapy and my clients do too!

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Yes, I totally agree!!! Although, I would think we all agree seeing people in person is what we do best. However, these are not regular times we have to adjust and ALL of us benefit. Everyone seems to be happy to have the accessibility during such a difficult time. I am grateful insurance has adjusted to allow us the opportunity to do telahealth!!

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I agree with you, Sara Corry.

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Mostly women/mothers find an additional
Virtual session , after a day with remote learning and their own professional computer intensive work
Just too much
Sometimes a telephone can substitute for a missed session
And usually later at night
Have to re adjust to the environmental impacts
Also have be more understanding for a missed session

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Beverly Parker-Dennis
February 10, 2021 11:57 pm

Thank you, for this article . I have experienced a variation of these issues with the diverse clients during this Covid-19. I will be grateful for when I can open my office again to provide in person sessions. The articles I read are able to help with keeping a sense of community.

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As a private practice LPC, and trauma and grief specialist, I am acutely aware of the need to normalize people’s responses to the stressors and ongoing life threatening nature of the pandemic. I have been from the beginning. Our work is not just about the standard presenting problems, of depression, anger and anxiety, but also about the cultural and global context of the problems clients are able to identify. In the same way that I have worked with media and community organizations in the past to be able to provide psychoeducational opportunities to people impacted by 9/11, the Boston Marathon Bombing, the Sandy Hook school shootings, and many other traumatic incidents, I have been using telehealth and other virtual platforms to offer information that helps normalize and create understanding of what we are all experiencing and how to develop and sustain resilience in the face of the pandemic. I have also found that a significant number of mental health professional colleagues are maxed out and developing clear signs of compassion fatigue, which leads them to call for help. We need to be aware of the the frontline response nature of our roles as mental health professionals and provide supports, where and when we can, to keep ourselves healthy and able to keep responding to the overwhelming need for our services. Thank you Beacon, for all of your support from the beginning of the pandemic a year ago, until now. It is appreciated, even when I don’t have the hours in the day to participate in the webinars.

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Telehealth has proven not only more convenient for clients, but so far 7 different clients of mine have contracted COVID. Had I been seeing them in my office, not only would I likely have gotten sick, I would have spread this horrid virus(es) to my other clients.

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Constance Wildey, LCSW
February 11, 2021 4:05 am

This article addressed issues that we are all dealing with. I am doing a mixture of in-person and telephonic sessions. I agree with the person who mentioned the difficulty getting schedule for vacine. I still prefer the face-to-face sessions, but appreciate the flexibility to meet some client’s preference for virtual sessions.

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Dr Myrna B Alexander
February 11, 2021 4:19 am

Found this article helpful and interesting, as it helps to be aware of major trends both for myself as practitioner as well as to assure clients they are not alone.

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Great ideas that empower both the providers and the patients..

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Social isolation due to Covid has dramatically increased anxiety and depression, with many otherwise healthy people experiencing what can be diagnosed as an adjustment disorder. If left untreated this situation can lead to substance abuse, interpersonal and family stress, and a host of related issues. This is not even counting the serious effects the pandemic has had on those who already had a mental health diagnosis before the crisis. Insurance companies have been both smart and beneficient to eliminate copay and deductible requirements for mental health services.

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Karen Livingston
February 17, 2021 3:24 am

Thank you! I found this article helpful as it spoke to the some of the real issues of behavioral health during the pandemic. Most of my clients were willing to switch to tele-health and when I asked them their preference between seeing me in a mask or full face through a screen voted for full face with a screen. Since most of my clients are have a significant trauma history, it has been important to pay attention to and mitigate the traumatic impact of the pandemic itself and the ways in which it triggers earlier experiences and responses.
I greatly appreciated other provider’s responses and their acknowledgement of the ways in which we have been impacted through our work during the pandemic. The need is so great during the pandemic that it has, at times, been a challenge to practice “good enough” self care, pay attention to the ways in which I am also impacted by the pandemic, and have reasonable expectations of myself during an unreasonable time.

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