What Behavioral Health Can Do Now to Respond to COVID-19

Behavioral health systems should prepare now for what may be our new normal.

Posted Mar 26, 2020

Muhammad Irfan/Pexels
Source: Muhammad Irfan/Pexels

Communities are rapidly ramping up social distancing policies in response to the COVID-19 pandemic. Reducing physical contact (#physicaldistancing) between those who are infected and those who are not infected is a necessary step to “flatten the curve” to prevent our healthcare system from collapse.

Bars, restaurants, gyms, and places of worship are closing their doors to foot traffic. Mass gatherings are cancelled and employees across the U.S. have been asked to work from home when possible. Every school is closed in all but three states and parents are navigating how to teach their kids in between work emails and conference calls. In some cases residents have even been asked to “shelter in place” (California, New York and Chicago). These responses appropriately reflect the gravity of the situation, with more than one country demonstrating for the U.S. the catastrophic consequences of not taking appropriate steps to slow the spread of COVID-19.

Daily life for Americans has changed in ways that are hard to fully grasp, particularly given the uncertainty of how things will unfold in the coming weeks and months. Disorientation and isolation, combined with looming increases in joblessness, are likely to create a building wave of psychological distress. Behavioral health systems need to prepare for when this swell breaks shore.

Though many public service agencies are currently stretched thin by the COVID-19 crisis, a few actions taken now by behavioral health authorities can pay off later as this pandemic matures:

Reinforce crisis response services. In the context of physical distancing measures, crisis lines may be more important now than ever before. Behavioral health systems should consider staffing up call lines for 24-hour access. New protocols for validating provider lists may also be needed to account for service provider absenteeism related to COVID-19, ensuring that callers aren’t given dead-end referrals.

Facilitate telehealth. Regulatory, coverage and reimbursement issues related to telehealth for individual and group therapy should be addressed. In addition, leaders should recognize that telehealth may not work for everyone, and accommodations should be made, for example, for those who may lack access to videoconferencing or may be hearing impaired.

Ensure access to medications. The DEA recently released guidance that relaxed the in-person medical exam requirement and allowed audiovisual consultations for initial controlled substances prescriptions. Limits dictated by the state on the quantity of prescription refills and the number of times a prescription can be refilled should be relaxed to allow for a 30- to 90-day supply. In addition to early refills, the American Pharmacist Association advocated for home delivery options and removing prior authorizations.

Address the needs of marginalized populations. Great strides have been made in addressing the needs of those with opioid use disorder. Some medications for opioid use disorder inequitably required daily in-person dosing at an opioid treatment facility. New SAMHSA guidance allows for opioid treatment programs to prescribe 14-28 days of take-home medication, depending on whether the patient is stable. Behavioral health systems should also consider the COVID-19-related needs for individuals served by harm reduction programs, homeless individuals, and other marginalized groups who faced life-threatening challenges before this pandemic and will likely continue to face them after.

The transition to online learning may be particularly difficult for low-income youth.  Meeting educational milestones is an important protective factor among youth for the development of behavioral health issues. Low-income youth and those with individualized education plans are at risk for disproportionate educational delays from the transition to online learning due to lack of internet access, further exacerbated by potential increased exposure to food insecurity and neighborhood violence. Behavioral health systems should consider how to partner with schools to consider how to provide trauma-responsive youth programming remotely.

Be a source of timely, relevant information. Communication is key in a time of crisis. Inadequate information exacerbates the negative psychological toll of isolation. Behavioral health authorities need to publicly acknowledge the new challenges providers are facing, communicate plans to address questions, and disseminate guidance on recent changes in regulations.

Behavioral health authorities can also craft fact sheets that would be helpful for providers and the general public. For example, given that many Americans are feeling the loss of their typical coping mechanisms, authorities could provide a resource page or brief communications with culturally appropriate ideas for outdoor activities to replace gym work outs, online options for worship, or recipes for video conferencing a friend over lunch. All communications should recognize the common experience of anxiety and make clear that help is available. Finally, behavioral health authorities should also remember that providers themselves may be in distress and need support during this time.

Statistical modeling suggests that physical distancing measures may need to persist beyond the next few weeks. Relaxing isolation protocols for longer than brief periods of time risks the rebound of transmission and our hospitals being overrun. Even if treatments for coronavirus become available, delivery of those drugs will not happen overnight. This suggests that public services may need to prepare for this potential new reality and its ramifications.

Responding to COVID-19 has further exposed the vulnerabilities in our health systems, behavioral health included. This could be an opportunity for behavioral health systems to take a hard look at ineffective policies and make improvements that will help individuals now and in the future. While a comprehensive plan should be developed for behavioral health, there are some things that behavioral health authorities can do now to prepare for what may be a longer-than-expected period of physical distancing measures.