Patient-Centered Mental Health Response for the COVID-19 Pandemic

The COVID–19 pandemic is a global public health emergency of unprecedented scope. As mental healthcare workers, NUHW members see the toll this pandemic is taking on the wellbeing of our patients, and we recognize that each day this pandemic wears on, a growing number of new patients will need our care.

We have crafted six recommendations for addressing the underlying issues that keep people from getting the mental health care they need now and that will only get worse as the pandemic grinds on.

COVID-19’s Impact on Mental Health

Research indicates that epidemics produce widespread stress and cause emotional, behavioral, and cognitive disturbances, including post-traumatic stress disorders in parents and children. Economic recessions also have a tremendous psychological impact. A study of the 2007-2009 Great Recession showed that “a one-percentage point increase in unemployment is associated with an increase of 1.6% in suicide rates.” In May, the official national unemployment rate (which is widely accepted to be an underestimate) hit 13.3% and unemployment in California was estimated to be over 20%. These figures surpass the 10% peak rate during the Great Recession.

There is already substantial data pointing to a surge in mental health needs resulting from COVID-19, including a Washington Post report that a U.S. government distress hotline recorded a 1,000 percent increase in April, compared to the previous April. A Kaiser Family Foundation poll found that nearly half (45%) of adults “reported that their mental health has been negatively impacted due to worry and stress over the virus.” And, according to a Gallup online survey, “Americans say their mental health is suffering more than their physical or financial health due to COVID-19.” The mental health consequences of COVID-19 are likely to be even more profound in communities of color, which are experiencing higher rates of COVID-19 infections and deaths. The pandemic also will require expanded services for substance use disorders as researchers have found that “deaths of despair” from alcohol or drug misuse and suicide could increase by 75,000 as a result of COVID-19.

Despite federal and state laws mandating parity for mental health care, millions of people in California and across the country were already unable to access or afford timely, clinically appropriate mental health care prior to the outbreak of COVID-19. According to a February 2020 survey by the California Health Care Foundation, access to mental health care was the top health-related concern among Californians. According to the survey, 48% of Californians with health insurance found it “very difficult” or “somewhat difficult” to find a provider who took their insurance. Of those who tried to make an appointment, 52% said they waited longer than was reasonable to get one.

A Call to Action

The increased demand for mental health services driven by COVID-19 threatens to overwhelm a mental health care system that is already stretched too thin. The hospital and insurance industries, as well as elected leaders, must act immediately to expand insurance coverage, lower prohibitive out-of-pocket costs, and expand inadequate provider networks. As the United Nations has declared, ”good mental health is critical to the functioning of society at the best of times. It must be front and centre of every country’s response to and recovery from the COVID-19 pandemic.”

Mental health clinicians are committed to meeting the growing need to provide patients with timely, clinically appropriate care. We call on the healthcare industry and elected officials to join us in this effort and adopt the following policies to prioritize patient care now—during this critical moment of need—and into the future:

1. Expand and Enforce Mental Health Parity Laws: The healthcare industry must remove all barriers to timely access to high-quality mental health care services, elected officials must strengthen and expand legislation to protect mental health patients, and regulatory agencies must enforce parity laws and punish violators.
2. Reverse Generations of Structural Racism: Mental health resources must be directed to the communities most in need including communities of color, which are disproportionately impacted by the pandemic and historically have had less access to mental health care.
3. Mental Health Workforce Development: Given the existing shortage of mental health clinicians, particularly in low-income and rural communities, the healthcare industry and the public sector must invest in education and training programs so that everybody has access to timely, clinically appropriate mental health care, including crisis intervention services and substance use disorder treatment. Training to provide culturally and linguistically competent care and increasing the number of clinicians who reflect the patient population must also be prioritized.
4. Clinician Input: Corporations and organizations that provide mental health care must involve clinicians in developing the models of care and best practices for addressing the mental health needs of patients.
5. Support for Essential Workers: Tailored services must be provided to essential workers experiencing mental health issues as a result of their work during the pandemic and other public health emergencies.
6. Patient-centered Telehealth: Clinicians must be empowered to partner with their patients to determine the most effective treatment modality, which may include telehealth. Clinicians should also be given the telehealth-specific training, equipment, and technical infrastructure needed to support their work.