Ian Kobernick
Ian Kobernick
March 26, 2020

What COVID-19 and Social Distancing Mean for Mental Health

Ian Kobernick
Ian Kobernick

COVID-19 is creating immense challenges for our nation’s health systems. Essentially overnight, these systems are making new plans to transfer patients, keep providers and staff safe, expand for surge capacity, find new equipment and much, much more.

As health systems rightfully focus on addressing the threat of the virus, they also must find new ways to treat patients with related conditions. Patients may especially require mental health support as COVID-19 will have significant psychological impacts on everyone. Fear and anxiety about disease are common and often overwhelming, causing strong emotions in adults and children across the world. For example, after the Great Depression, suicide rates spiked from 17.0 per 100,000 people in 1929 to 21.3 per 100,000 people in 1932 — an increase of nearly 25 percent in three years.

While the Great Depression hopefully turns out to be an extreme example compared to what is happening today, institutions, physicians and health systems are reacting in creative ways to treat these patients.

An example of what’s being done today

An excellent example of evolving our approach in practice comes from Massachusetts, where Governor Charlie Baker established an executive order to address insurance concerns around virtual care. The Telehealth Order makes insurers cover telemedicine in hopes of preventing people from overloading hospitals that are preparing to treat COVID-19 patients. This measure expands people’s ability to access mental health services in a pressing time of crisis. It also allows hospitals to continue to prepare for the possibility of exponential capacity increases as the virus continues to affect more individuals. We’re already seeing other states take similar steps in this challenging moment.

Telehealth considerations for providers and health systems

In a new reality where health systems need to keep non-critical patients out of the ED and traditional medical settings, and isolation is a strategy to stop a pandemic, health organizations need to embrace new models to deliver care to mental health patients. Fortunately, tools like telehealth have been in practice already, but it may be time to advance those significantly and establish them as new models moving forward.

Here are key definitions and baselines to help people understand what’s currently possible with telehealth:

  • Standard of care: At its core, the expectation is that any telehealth instance should not compromise or understate the established standard of care
  • HIPAA: In the current COVID-19 environment, the US Department of Health and Human Services offers enforcement discretion, stipulating providers act in good faith
  • Reimbursement: The restrictions around telehealth guidelines, as it relates to the geography of patient and reimbursement, continues to soften as in-person care is limited during this time of crisis. One of the main obstacles for providers is to make sure the services they offer are eligible for appropriate reimbursement. CMS and other payors are covering telehealth at the same rate as in-person visits. Some health plans are waiving co-pays on telehealth services during this period to make it more accessible for its patients.
  • Quality of care delivery: It is important that telehealth care delivery is a sufficient alternative for in-person visits. Telehealth can be viewed as unfamiliar and requires adapting to change which can be difficult for all, but especially the older patient population.

Telehealth considerations for patients

Telehealth helps individuals receive care without leaving their homes (critically important at the moment). Even in health organizations not fully equipped for this technology shift, providers could offer patients opportunities for Facetime therapy sessions and Skype calls in lieu of in-person counseling visits.

Here are key realities about telehealth every patient should be aware of:

  • Access to care: With relaxed guidelines, patients can access mental health care at their home, or if they are geographically in a different state from their provider.
  • Communications: Patients are now allowed to schedule telehealth sessions via platforms like Skype and Zoom, which offer a certain level of security.
  • New provider relationships: With recent changes to guidelines, patients can establish a new provider relationship without the need for an initial in-person appointment. This is particularly important in response to COVID-19.

Steps we all can take for our mental well-being

While the practice of “social distancing” will help curb the spread of COVID-19, it also increases isolation and loneliness for essentially everyone, especially our most vulnerable populations. Knowing that, there are routine steps we call can take to help, including:

  • Stay connected: Make a point to virtually connect with others. Reach out and talk to people you trust about your concerns and how you are feeling. Existing virtual networks can help create a sense of community, but be wary of information overload
  • Prioritize personal wellness: Even in the most extreme lockdown situations, individuals can still get outside to exercise. It’s also important to remember to breathe and live in the moment. Play board games, practice journaling and reactivate old hobbies that may help ease stress
  • Set a schedule: While working remotely, structure your day and schedule time for breaks, meals and to unwind at the end of a workday
  • Explore your options: Several organizations have resources available to help support you during this time. Your employer, healthcare provider or community resource center may offer access to professionals who can offer guidance and be available for you if you need to discuss your situation

As COVID-19 spreads as a pandemic, it is pushing us all into a future we can’t fully predict. There is no playbook for the months ahead. However, we know people will be isolated, we know non-critical patients should stay out of health facilities, and we know mental health challenges will be prevalent — this creates a recipe where telehealth can help providers, patients and peers connect, ensure care delivery and get through this tough moment together.