Becker's Hospital Review

16 Executive Briefing Sponsored by: I n 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 behavior- al 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 dis- cussed 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 offer no psychiatric care at all," Mr. Kramer said. "Statistics suggest that over half of American counties don't have zero psychiatrists, and over the last few years, we've lost and additional 10 percent of psychiatrists to retirement and aging 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. America's other epidemic: Why virtual care will continue to transform behavioral healthcare beyond COVID-19 "Our customers depend on us to make rapid decisions about psychiatric dispositions and get patients to places where they will receive help. When an ER patient needs behavioral health services, we are usually able to arrange a telehealth consult with a psychiatrist within a half hour." Miles Kramer, LCSW, CCHP, Vice President, Amwell Psychiatric Care

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