In the spring of 2020, when COVID-19 transmission became prevalent in the United States, Americans started experiencing high levels of isolation, economic uncertainty and anxiety. In January 2021, the American Psychological Association's Stress in America survey found that adults were experiencing the highest levels of stress since the early days of the pandemic.
Becker's Hospital Review recently spoke with two experts from Amwell about a second crisis that has grown worse during the pandemic — the growing demand for behavioral healthcare services. Lindsay Henderson, PsyD, director of psychological services, and Miles Kramer, LCSW, CCHP, vice president of Amwell psychiatric care, shared insights into the country’s current behavioral health crisis and discussed how telepsychiatry and teletherapy can support both patients and providers throughout the entire patient journey.
As behavioral health needs surge, the healthcare system is struggling to keep up
In late February and March of 2020, the upheaval associated with the onset of the COVID-19 pandemic was traumatic, frightening and life altering. Almost a year later, the acute stressors associated with the pandemic have evolved into a chronic burden.
"Dealing with the pandemic is like running a marathon, but not knowing where the finish line is," Dr. Henderson said. "There's only so long that people can sustain the adrenaline and hypervigilance associated with the stress. I am seeing a lot of long-term fatigue among patients and providers. Chronic stress is persistent, and it presents as low-grade depression and anxiety for many people."
In conjunction with the increase in chronic stress, the demand for behavioral healthcare has increased dramatically. Not only are people confronting new mental health issues, but many individuals previously diagnosed with mental health conditions have lost access to care due to pandemic-related restrictions. For people with serious and persistent mental illnesses, care plans often include day treatment programs, intensive outpatient programs or participation in supported employment. All of those programs include people congregating. As a result, many programs have been stopped to prevent transmission of COVID-19.
"When people lose their support system and they can’t access their usual providers, they end up in emergency departments that are already inundated with COVID-19 patients," Mr. Kramer said.
Exploding demand for services is only one aspect of the current behavioral health crisis. The second issue is the behavioral health system itself. Nationwide there is a shortage of mental health professionals and the system for behavioral care is fragmented and inefficient.
"People are shocked to learn that most hospitals don’t offer any psychiatric care at all," Mr. Kramer said. "Statistics suggest that over half of American counties have zero psychiatrists, and over the last few years an additional 10 percent of psychiatrists have retired or aged out of the profession."
When individuals experience a behavioral health emergency, they usually turn to their local hospital emergency room. Yet most emergency departments don't have access to behavioral health resources. As a result, patients linger in the ER awaiting appropriate care while caregivers struggle to keep up with the steady flow of COVID-19 cases and traditional emergency patients.
Telehealth is transforming behavioral health for both patients and health systems
To overcome the current challenges of delivering professional psychiatric care, Amwell is using technology to bring providers and patients together, regardless of their physical location. The company has developed both hospital and in-home telehealth solutions to address behavioral health needs across the complete patient journey. This powerful model bridges the gaps in care that have historically plagued the system.
For hospitals, & healthcare facilities, Amwell Psychiatric Care, a newly announced offering from Amwell, builds additional psychiatric capacity, providing hospitals and health systems with on-demand and scheduled telepsychiatry services. "Our customers depend on us to make rapid decisions about psychiatric dispositions and get patients to places where they will receive help," Mr. Kramer said. "When an ER patient needs behavioral health services, we are usually able to arrange a telehealth consult with a psychiatrist within a half hour."
Hospital partners recognize and appreciate Amwell’s commitment to provider quality. APC physicians are part of a physician led organization that has obtained Joint Commission accreditation. In addition, Amwell vets and supervises all network providers using Joint Commission quality standards. These are the same standards adopted by the majority of American hospitals.
Once patients improve and return home, they may transfer to Amwell’s in-home teletherapy services which provides support to help maintain their mental health. Amwell also offers its teletherapy and telepsychology services via an app so patients in all 50 states can benefit from increased access to behavioral health services. Many health plans also partner with Amwell to provide virtual behavioral health services to their members, under their own brands.
Ultimately, in-home teletherapy services streamline and eliminate many of the barriers that prevent people from entering traditional brick-and-mortar mental health treatment. "Our mission is to democratize healthcare and make it more accessible," Dr. Henderson said. "Patients log onto our system via the website portal or mobile app. They can review our network of therapists, psychologists and psychiatrists in their state. Patients also have access to information about providers' interests and training. They can self-schedule an online, video-based treatment appointment. In some cases, same-day appointments are available."
Behavioral health professionals also appreciate the benefits of telehealth
Amwell’s approach to behavioral health improves providers' quality of life. Telehealth offers greater flexibility, since practitioners can work from their home offices without long commutes to urban areas. Amwell ensures its providers feel that they are part of a medical group, not simply a member of a network. Providers receive clinical and technical support around the clock, as well as opportunities for continuing education.
"Working from home has its benefits, but we also are intentional about keeping people connected, functioning in teams and working collaboratively," Mr. Kramer said. "It's important for us to make Amwell a great place to work."
Clinicians also don't have to worry about the administrative aspects of running a practice. Amwell is a designated credentialer. As a result, individual providers no longer need to handle credentialing processes with various health plans and payers. Amwell also handles billing and claims submission.
"Many behavioral health professionals didn’t enter this field to run a business," Dr. Henderson said. "We allow practitioners to focus on what they are trained to do and what they are passionate about, which is delivering healthcare. This is a huge draw for a lot of people."
The future of behavioral health is virtual
Behavioral health is highly complex, affecting every aspect of a person’s life. Mental health conditions can erode an individual’s efficiency, relationships and success at work. Unfortunately, most communities have nothing resembling comprehensive mental healthcare services. Gaps in information and gaps between providers can have catastrophic consequences.
The good news is that teletherapy and telepsychiatry can close those gaps and create a more robust behavioral health ecosystem. The future of behavioral health is virtual. "Over the past few years, we've developed best practices and skill sets that support telehealth," Dr. Henderson said. "We feel lucky to be in a position where we can lead, educate and help people transition to this new world."
Mr. Kramer offered his thoughts about the future, noting, "Over the next 10 years, I'd like to see us deliver better access to behavioral health through better technology, better interoperability and better connectivity between the providers that serve on patient care teams. Keeping people as functional as possible is what we’re all about."