A crisis remains: Finding hope in a post-pandemic world.
While the debate rages as to whether COVID-19 still rates as a pandemic (nearly 2 million people in the United States are still getting infected daily), one thing is certain: the disease’s dubious legacy lives on among an entire generation of kids.
Isolating at home for as many as two and a half years, school-aged kids fell woefully behind in critical social, emotional, and academic development. When the national emergency finally ended and schools reopened, many kids abruptly found themselves not only behind the curve developmentally, but also burdened with heightened anxiety and struggling with distress tolerance, resilience, and persistence. Children of color, whose parents were more likely to be frontline healthcare workers, were disproportionately affected.
A problem compounded
While the demand for child and family mental health therapy spiked in the post-pandemic world, the supply of high-quality child and adolescent mental health providers dropped in dramatic fashion.
Even before the pandemic, healthcare professionals (mental healthcare providers included) were (and still are) feeling overworked and understaffed.
Underfunding of mental healthcare from the public and private sectors, lack of insurance coverage and low reimbursement rates, and, yes, the outbreak of COVID-19 (spawning an entirely new set of mental health and substance abuse challenges among kids and adults) worsened already dire conditions in the mental healthcare community.
More than a crisis, for providers it was a recipe for burnout.
More to the equation
To say the problems of mental healthcare today are two-fold (supply and demand), would be missing another important part of the equation. Unlike seeking care for a physical disorder (say, a broken arm), people pursuing mental healthcare must overcome an entirely unique set of additional challenges even when access to care is readily available. Stigma is as powerful a headwind as any other in mental healthcare, especially among children. Hopelessness often manifests a why-even-try attitude. And even with successful first contact, mental health patients often need prolonged and multifaceted treatment that could include establishing a medication regimen, as well as changes to diet and lifestyle.
Obstacles aside, and as mental health therapists know, we have the treatment and the administrative know-how for virtually every mental illness. With proper access to care, most patients can look forward to minimized symptoms and functional days at work, school, and at home. That understanding is equal parts encouraging and frustrating because, of course, the obstacles can’t be pushed aside.
Only about
20% of children
with mental, emotional, or behavioral disorders receive care from a specialized mental health care provider.[2]
Causes for hope
Two Acts, a Plan, and an Agenda have raised awareness, if not the level of conversation, in the halls of federal government about the mental health crisis in America.
Act 1
The 21st Century Cures Act, originated in 2016 and expanded in 2022, is a wide-ranging healthcare initiative that includes some of the most important mental healthcare reforms in 50 years. Provisions include:
- Safeguards that ensure that insurance companies cover mental healthcare on par with healthcare for physical disorders.
- Mental health programs put into service for children, early intervention, suicide prevention, and opioid treatment and prevention.
- Clarification of HIPAA rules that may stand as barriers to communication between caregivers and providers.
- Billions of dollars in funding to fight the opioid crises, homelessness reforms, and for brain research.
The expansion of the Cures Act in 2022 introduced new legislation that will foster stronger patient/provider relationships. For patients, free access to their own medical records and histories is now the law. With that, patients can collect, store, and share their own comprehensive medical records with providers (or whomever) in an instant for more informed decision making and without delaying care.
Act 2
The Bipartisan Safer Communities Act of 2022, easily the most significant gun violence legislation passed in 30 years, provides more than $2.35 billion for critical school mental health services and learning environments. The Act also includes initiatives that work to improve access to telehealth, support crisis intervention programs, and curb domestic violence.
The Plan
The American Rescue Plan (ARP) of 2021 was enacted in response to the economic and health crises caused by the COVID-19 pandemic. The Plan includes more than $3.5 billion in block grants to support community mental health services and substance abuse treatment, as well as funding for behavioral and mental health workforce education and training. The Restoring Hope for Mental Health and Well-Being Act of 2022 reauthorizes many of the programs established in the ARP through 2027.
The Agenda
And then there’s the Unity Agenda, a White House initiative. Released in May 2023, the Agenda serves up more than $200 million for scaling up suicide and crisis lifelines and new resources for school-based mental health services. It also includes a strategy for transforming the way mental health is understood, accessed, and treated.
It should also be noted that the federal government is supporting the expansion of Medicaid coverage for millions of Americans seeking mental healthcare.
The wheels are turning at the state level, too. Many states have enacted new laws that are designed to support school-based mental health services. Others are launching initiatives to fight stigma, simplify access to care, and establish greater mental health parity.
The uptick in federal and state recognition and support—much of which is unprecedented—is encouraging. What’s important going forward is sustaining (or better, improving on) that support.
Telehealth rising
If we can thank the pandemic for one thing, it might be rapid proliferation and acceptance of telehealth. Virtual visits with doctors shot up some 766%[3] in the first three months of the pandemic, which is not necessarily surprising. In the post-pandemic world though, virtual care is showing staying power and demonstrating increasing value as an important healthcare tool for patients and providers. For some patients, telehealth simplifies access to their providers and offers mobility and flexibility that makes more efficient use of their time. Simpler access and greater convenience increase the chance for successful engagement with providers.
Not every patient is comfortable with, or suitable for, telehealth. But when it comes to using technology to make healthcare more accessible to more people, telehealth is proving to be a powerful tool.
One more thing about technology: It would have been an easy thing to add the misuse of technology to the equation driving the woes of mental healthcare, and healthcare in general. Healthcare technology is decades behind the curve when it comes to providing the kind of support patients and practices need today.
There are encouraging developments on this front. We’ve seen how artificial intelligence can help speed up medical imaging reviews and clinical trials. How else can it support mental healthcare? We might know soon at the rate AI is proliferating.
More immediately, innovative practice management technology, such as that being developed at MediSprout, could well upend the habitual default to out-of-touch technology and provide the difference-making support for which today’s practices are desperate.
Practice-level innovation
In addition to practice management technology, much needed innovations are taking root in private practice models around the country as well, in part due to the increase in aforementioned governmental support for student outreach. But you can also attribute some of the progress to good old common-sense thinking and collaboration.
One of the many obstacles to effective care for school-aged patients has been the limited hours and opportunities for sessions. Typically, parents schedule therapy visits for their children during after-school hours. But the window of opportunity is tight and closes by dinner time. Further, there’s a lot of competition for those precious few hours in a kid’s day, which shuts many children out of care altogether.
At Kite Care, a startup mental healthcare practice supporting students and schools, we work directly with school counselors to open opportunities for parents to schedule visits for their kids at any time of day. Leveraging telehealth and a private and secure campus room during school hours, many student patients never have to leave the school property to engage with a qualified therapist. That’s huge. Access is everything when it comes to more effective care coordination and continuity, not to mention better care outcomes. Parents also feel a measure of relief knowing that access and care is there. School counselors can manage patient backlogs more effectively, if not eliminate them altogether.
People aged 0–25
Experience the greatest delay to initial treatment after onset of mental health symptoms.[5]
The Kite Care mission also addresses the healthcare worker shortage. To encourage more therapists into the field, Kite Care providers are encouraged to be creative and are afforded the freedom to explore a number of treatment approaches and create a robust, multifaceted toolbox that best meets children’s needs, without being stuck with one approach that can fall short of goals. Such latitude breeds higher job satisfaction and fosters a more sustainable career.
Taking on stigma
While the pandemic exacerbated the mental health crisis, it also served to push it higher into the national consciousness. Greater mental health awareness and open and frequent discussion about it might also prove to be what cracks the stigma code. More conversation about mental illness presents more opportunities to position it with parity to physical disorders; more opportunities to stifle words that serve to trivialize mental illness; more opportunities to make sure kids know that care—without shame—is possible.
Signs of progress
There’s still a mountain to move before the current mental health crisis can be called over, but in the examples cited here and others you may be witness to, it feels like, at long last, there’s a movement afoot and reason for hope.
Let’s keep that foot on the gas.
Guest author Emily Upshur, PhD, is a licensed clinical psychologist for Kite Care.
Footnotes and sources
1. The Behavioral Health care Workforce, June 8, 2023, National Institute for Healthcare Management Foundation (NIHCM)
https://nihcm.org/publications/the-behavioral-health-care-workforce-shortages-solutions
2. Improving Access to Children’s Mental Health Care, Center for Disease Control (CDC)
3. The State of Telehealth Before and After the COVID-19 Pandemic, NIH National Library of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035352/
4. Silver Linings Around the Increased Use of Telehealth After the Emergence of COVID-19, NIH National Library of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9130845/
5. Prevention and early intervention in youth mental health, NIH National Library of Medicine