COVID-19 drives flexibility in mental health therapy

BIG PICTURE: Rhonda Cox is executive vice president and population health officer at Vaya Health. Photo courtesy of Vaya

After nearly a year of little to no social contact, the pandemic is taking its toll on most everyone.

“Humans are social animals,” says Rhonda Cox, executive vice president of Vaya Health, the regional agency that manages services for publicly funded mental health, substance abuse and developmental disabilities care. “We were not designed to endure this kind of stress for months and months.”

And though the ongoing manufacture and distribution of vaccines mean there’s light at the end of the tunnel, it will still take many months to get everybody vaccinated.

In the meantime, the pandemic that’s raged for the last 10 months has sparked concerns about everything from illness and death to job security and one’s ability to pay for necessities. The political turmoil of recent months has only heightened the uncertainty and stress.

“It’s not dramatically higher, but emergency hospital admissions for mental illness and substance abuse are rising,” notes Cox.

But COVID-19 has also brought changes in mental health care that, at least temporarily, have improved access to services for people who lack reliable transportation.

“It will depend on insurance companies and public officials whether we can make permanent changes for the better,” cautions Dominique Huneycutt, a clinical psychologist at the Mountain Area Health Education Center.

According to the Kaiser Family Foundation, which tracks health issues, people were already reporting markedly higher levels of stress, anxiety and depression between March, when the virus forced people to social distance, and last summer. Between May and July, the number of survey respondents self-reporting symptoms of anxiety disorder rose from 29.6% to 35.2%; of depressive disorder, from 24.7% to 28.4%. The Centers for Disease Control and Prevention reported similar trends.

“We’re also seeing increased levels of substance abuse because of the stress of COVID and lack of ability to access social supports,” says Cox. “And people with developmental disabilities who are nonverbal or less verbal are having increased problems, because they can’t express themselves. Human beings just aren’t designed to be isolated in perpetuity.”

Good news, bad news

Still, not everyone responds to this enforced isolation in the same way. Extroverts, who are typically energized by social contact, may struggle with it more than introverts who, even under more normal conditions, need time alone to recharge. And by forcing most folks to slow down and avoid unnecessary exposures, the pandemic is actually helping overbooked, overworked Americans pare down their schedules, says Cox.

In fact, notes Huneycutt, MAHEC actually “saw a reduction in the number of calls early on, but the acuity has increased. More recently, we’ve seen an uptick in suicide contemplation, attempts and completions. People are dealing with a lot.”

Mental health care, though, has never been as accessible as other types of treatment, and despite some improvement due to the Affordable Care Act, that’s still the case. Until recently, for example, online therapy sessions weren’t generally covered by insurance. “But it is necessary now, since it’s so much higher risk to see people in person,” says Cox.

And once the pandemic is finally gone, Huneycutt hopes insurance companies and Medicaid will continue to reimburse telehealth sessions at the same rate as in-person treatment, because online services help people in rural areas where there’s little or no public transportation to access care. It’s also easier for working people to find time for appointments, since they don’t have to factor in the travel time.

Online appointments also offer greater flexibility that helps providers keep pace with the increased number of people needing care. Like their patients, therapists can work from home, saving time and reducing the need for more office space to handle expanded caseloads.

“Is it perfect?” asks Huneycutt. “No. I’ve had parents start their children’s sessions while they’re out shopping. The child is walking around, doing therapy in public. … It’s also exhausting for us, because our brains are on a screen where we can’t see the nonverbal cues we need. And some people still really do need to be seen in person.”

Meanwhile, working from home poses the same challenges for mental health providers as it does for everyone else, she adds. “I can’t eliminate distractions: It’s a different set of boundaries.”

As to whether online therapy is as effective as in-person appointments, Huneycutt believes that only time will tell. “We need data to know how this is working,” she maintains. “And collecting data takes some time.”

Multiple concerns

But COVID-19 is not the only challenge people are facing these days, notes Cox. Other key stressors include worries about finances, political upheaval, potential or actual job loss, an inability to work off stress at the gym, and prolonged separation from family and friends.

In addition, many people who are dealing with financial uncertainty or who have lost job-related health insurance are postponing seeking care. So by the time they do get help, their depression and anxiety are likely to be worse.

“Human beings need contact with others, and when things become overwhelming, they need care,” stresses Cox.

And though Huneycutt believes that the current situation “has presented us with some ability to offer better care,” she worries that unless the expanded access continues once the pandemic is over, providers will be hard-pressed to handle the increased number of cases of post-traumatic stress disorder they’re bound to see.

Besides, even though vaccines are now being administered, the pandemic-induced isolation isn’t likely to end anytime soon. A Kaiser Family Foundation survey in December found that half of adult respondents believed the worst was yet to come.

Nonetheless, says Cox, we still have ways to combat stress. “If you’re feeling overwhelmed, humor can reset your emotional tank,” she points out. “Hope is another huge factor: The vaccine is coming; this will pass.”

And in the bigger picture, argues Huneycutt, “We have a chance to learn from this, to collect data and learn what works in different circumstances, using new methods. We can do a lot — we really can, if we make informed decisions.”


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