Uncertainty and isolation trigger a spike in mental health treatments

Will a new normal develop for mental health care insurance coverage as a result of Covid-19?

Better insurance coverage for phone, text and video or telehealth appointments by those seeing mental health care could be driving a spike of calls to clinicians since the coronavirus pandemic. 

“In my opinion there is at least a 20 percent increase, compared to the same period last year, in both our mental health and wellness services,” said Eduardo Espiridion, chairman of the Department of Psychiatry at Reading Hospital Tower Health. Espiridion attributes the spike to fear of coronavirus, joblessness and isolation resulting from stay at home orders.

Health care professionals are connecting an increase in patients to the pandemic which has created a shift aided by health care insurance for services that were not previously covered. The shift has expanded care to more people with the hope at least some of the benefits will become permanent. 

Area clinicians are seeing increased medical insurance reimbursements for telehealth services, too, as well as payment breaks to patients including waived co-pays, co-insurance and deductible fees. 

Televideo and telephone visits, along with virtual appointments have caused an increase in patients attending scheduled visits, said Laura Campbell, interim clinical director of the outpatient behavioral health clinic at Geisinger Medical Center in Danville.

“Patients who might have been no-shows or cancelled their appointments pre-COVID are now able to engage with us and receive the services they need,” she said.

Virtual visits by phone or video link have removed barriers for many patients – from transportation to making childcare arrangements or coordinating work appointment times, she noted. 

According to a recent report by The Washington Post about 50 percent of Americans reported the crisis is impacting their mental health, and a federal emergency hotline handing emotional distress calls reported a 1,000 percent surge in contacts in April.

“I think people are anticipating a spike and the concern is being able to handle it,” said Stacy D. Martin, a licensed psychologist in Hellertown.

Prior to Covid-19, Martin was offering telehealth visits to patients. She said the transition was easy once the crisis began. Since the pandemic and shutdown order by Pennsylvania Gov. Tom Wolf, Martin has retained the majority of her clients and added new ones. 

Because many insurance carriers are waiving co-pays and co-insurance and deductible costs, financial stresses associated with seeking treatment in light of job uncertainty now – and in the future – are lessened, she said.

“Insurance is now all covering phone calls, which they never did before,” Martin said.

From losing family members or friends to the virus, being away from schools and routine and the inability to celebrate milestone occasions like weddings, graduations or significant birthdays, the pandemic was taking a significant toll. 

“It’s a really big loss,” she said.

While some insurance companies were already reimbursing telehealth visits for mental health appointments, the reimbursement amount was at a lower rate than face-to-face reimbursement to practitioners. 

“Now they are reimbursing at the same rate, and the other agencies that didn’t cover it pre-pandemic, there is a huge hope this will continue,” Martin said.

Beyond convenience and flexibility, some patients respond better to telehealth services than in-office visits. “I really think it’s a great model for providing mental health treatment,” she said.

Tripp Carey’s practice was already full and he was not taking new clients prior to the coronavirus outbreak. The licensed psychologist and operator of White Oak Counseling Center in Upper Saucon Township, said some of his colleagues’ practice loads were also full. But oncecoronavirus restrictions were put in place some treatment times opened up.

“Some patients dropped care or did not feel comfortable working electronically,” Carey said.

Some new patients were motivated by the extra stress caused by the pandemic to seek help, and nearly everyone is being treated online despite the state listing mental health care an essential sector for in-person treatment.

“A lot of therapists had never done this – it was a massive shift. Lots of people were learning how to set it up and get it going,” Carey said.

But virtual therapy isn’t a magic solution for everyone. Carey said there are non-verbal cues that are lost online, and some patients don’t have the space in their homes for private appointments right now, with children home from school.

Carey suggested a hybrid model for treatment could emerge after coronavirus, especially if insurance companies continue to pay the same reimbursement fees for telehealth as they do in office visits.

Espiridion said virtual visits at Reading have increased access to mental health services. “It will complement well with the face-to-face visits to increase patient and clinician options. In the era of a pandemic, it is also a very safe way of delivering healthcare services,” he said.

Tower Health started virtual care in ambulatory locations, and all outpatient providers are were furnishing mental health care to new and established patients. 

Telemedicine consultation services to reduce staff exposure to Covid-19 were a way to meet the needs of patients while keeping everyone safer, he said. 

Outreach as a result of virtual communication could also expand services in the region moving forward. 

“This is an additional way to provide mental health services at facilities that don’t have mental health providers on their staff,” Espiridion said.