Healthcare Policies and Pandemics: How COVID-19 Complicated Access to Care

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By: Olivia Sinicropi

The word “accessibility” can bring to mind different things. It could mean the ability to gain assistance in your education, or find a job where you can do your best work, or live in a place that takes your needs into account. And in the early days of the COVID-19 pandemic, every system that depends on accessibility was put to the test.

As we headed into a once-in-a-hundred-years health crisis, nearly 30 million people were without health insurance. It became clearer to millions every day: knowing that the healthcare system is out there and having the means to access it are two very different things. Like many other parts of life, the virus widened gaps in what kind of care was and wasn’t accessible for millions of people across the country – just as the need for mental health care exploded.

In 2020, the Centers for Disease Control and Prevention (CDC) published data showing that, across the country, people were facing worsening mental health, increased substance use, and rising suicidal ideations. More than 40% of people reported at least one adverse mental or behavioral health condition because of the pandemic, including symptoms of anxiety or depression, symptoms of a trauma- and stressor-related disorder (TSRD), and having started or increased their substance use to cope with stress or emotions. More than 1 in 10 individuals who responded to the survey reported that they had seriously considered suicide in the 30 days before completing the survey.

Is it any surprise why? Like we talked about in our past two blogs (which you can check out here and here), COVID completely changed the way we were living our lives. From our relationships with the people around us to our relationships with our minds, COVID has been a totally unique experience for almost everyone in the world. All of a sudden, millions of Americans were dealing with stresses they – and their healthcare providers – weren’t prepared for.

This all had the makings of a boom in business for the mental health field but, like most things related to COVID, it’s not quite that simple.

It’s true that there was an increase in people addressing their mental health and accessing care for it. In 2019, about 50 million adults were receiving some kind of mental health care (including counseling, therapy, and prescription medication). In 2020, though, with all of the added stresses of COVID, not to mention the election, racial unrest, and the murder hornets that never seemed to come, that number only increased to about 52 million.

That’s not a number to write off. We love to see an extra two million people taking charge of their mental health. But it’s also a sign that, in times of particular mental distress, either everyone who was facing increased mental health issues had already been getting help in 2019 . . . or something wasn’t working quite right in 2020.

As the virus spread and began to take over the country, hospitals everywhere were suddenly in the uncomfortable position of not having enough space. Not for COVID patients, not for heart attack victims, not for people who’d been in car crashes, and not for their psychiatric departments. Last June, 99% of Maryland’s state-run psychiatric care beds were occupied, and hospitals weren’t much better, with some patients stuck in emergency departments and medical units (a trend known as “boarding”) for weeks. Dr. Jacob Venter, Chief of Child and Adolescent Psychiatry at Cambridge Health Alliance, described the situation as, “a crisis on top of a crisis. The pandemic has really exacerbated everything, made everything a lot worse.”

In outpatient mental health offices, the problem was slightly more complicated.

In 2019, only 21% of psychologists were providing telehealth services for their clients; a few months under COVID-19, and it was now 96%, as either mental health professionals or clients/patients suddenly became unable to meet in person. Zoom’s stock price famously skyrocketed in 2020, from $73 in January to its peak of $559 in October (at the time of writing it’s still much higher than pre-pandemic numbers, at $111 per share).

And even though Zoom’s stock started to fall as the vaccine rolled out, many people are just fine staying virtual. Last week, a report from KFF found that one in three mental health visits are still through telehealth, and an overwhelming 93% of clinicians plan to continue offering telehealth services.

And it is true: when there was a need to follow stay at home protocols, the transition to online appointments met the demand. Accessibility during the pandemic improved for many clients, especially clients in rural communities, when telehealth services began to gain traction. Not only were people able to continue their care from the safety of their own home, but others were able to start working with therapists located too far away to normally travel to and, in some communities, without the risk of being seen entering a mental health office and facing social stigma.

But up against a tidal wave of increasing anxiety and depression, telehealth services were sometimes a band-aid solution toward making mental health care more accessible for everyone who needed it. Almost 70% of psychologists with a waitlist reported that it had grown longer since the start of the pandemic, and more than 40% couldn’t even keep up with the demand. About half said that they felt burned out.

Some new therapists couldn’t even get to work. Between working remotely, understaffed and underpaid offices, and an influx of applicants, licensing agencies that allow clinicians to legally practice have seen increased delays. It usually takes a few weeks to a few months to become fully licensed and start seeing clients; since the pandemic, some social workers have reported waiting for more than a year and a half.

Deborah Baker, Director of Legal and Regulatory Policy at the American Psychological Association, said, “If we don’t have efficient, consistent processing of these licensing applications, it’s just snowballing the overwhelming need. This is more than just an administrative issue, this really is a public health issue.”

Clients and patients weren’t faring much better. In 2020, 8 million adults with a mental illness reported that they couldn’t even access care because of the cost. In 2021, that number grew to 8.8 million (or, about the populations of Wyoming, Vermont, Alaska, North Dakota, South Dakota, Delaware, Montana, Rhode Island, and D.C. combined).

A major component that’s remained true throughout the pandemic, and still remains true, is difficulty in finding providers who accept government-funded programs like Medicare and Medicaid. These programs provide coverage for well over 100 million people, but the current healthcare system often leaves them out. Providers most commonly point to low reimbursement as the main reason they choose not to accept patients insured by Medicaid or Medicare.

The Centers for Medicare and Medicaid Services (CMS) noted that many Medicare and Medicaid/CHIP recipients were, like many uninsured Americans, simply going without care altogether in 2020. They noted a 22% decline in the number of mental health services utilized by adults compared to the same time period in 2019. Children were accessing care even less, with a 34% decline from 2019 to 2020.

It begs the question: does a health crisis really end if only a handful of the problems it involved are solved? Even as more people are vaccinated and case numbers/positivity rates continue to go down, the problems COVID exposed and the disparities it exacerbated aren’t yet. “Access” is just an idea if people can’t afford to access care, or therapists are too overworked to access care from, or licensure offices are too understaffed to create a path to access.

Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO, lamented that “While the pandemic has generated interest in and concern for mental health, it has also revealed historical under-investment in mental health services. Countries must act urgently to ensure that mental health support is available to all.”

Individuals looking for mental health and substance use support can contact our office at 410-337-7772, or by clicking here, for more information on our clinicians, the issues we treat, and the insurances we accept to make your care as accessible as possible for you.


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