COVID-19 Impacts Treatment Access for Many with Serious Mental Illness — The Mental Health Ecosystem has Responded

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COVID-19 presented new challenges that have taken a toll on our nation’s collective mental health. In fact, nearly half of U.S. adults report that their mental health has been negatively impacted during the pandemic. As the pandemic wears on, the mental health burden will likely increase as measures to slow the spread of the virus—such as social distancing and ongoing closures—can lead to greater isolation and distress.¹

As the COVID-19 crisis continues, we can expect the impact on those living with a serious mental illness (SMI), such as schizophrenia, to be amplified.² During this public health emergency, when access to care and in-person visits have been disrupted, those with SMI are navigating many new obstacles.³

In response to these challenges, the mental health ecosystem has been forced to respond rapidly in innovative and necessary ways in order to help ensure that people living with SMIs continue to get the services, support and care they need. Examples include:

• Increased adoption of telepsychiatry platforms: Telepsych applies telemedicine to psychiatry⁴ and allows people to still see their psychiatrist or psychologist, engage in therapy/counseling and maintain their treatment regimen while complying with social distancing guidelines and reducing risk of in-person exposure.^3,5 For those without access to video software, audio-only contact is also available and the Centers for Medicare and Medicaid Services (CMS) will now reimburse for some phone-only sessions.³ After many years of slow growth, adoption of telemedicine has grown rapidly across the country in a few short weeks. If the practice of telemedicine extends after the COVID-19 pandemic subsides, it has the potential to continue to help patients, including those in rural communities.^5,6

• Adjustments to treatment options: In light of the pandemic, new restrictions have made it challenging for people to see their healthcare providers in person as often as they may have in the past, so people may want to consider talking to their doctor about their current treatment regimen and whether other treatment options may be appropriate during this time.³ Different treatment options, such as long-acting injectables (LAIs), were recently recommended in guidance from the American Psychiatric Association (APA) and Substance Abuse and Mental Health Services administration (SAMHSA) for their potential role in supporting continuity of care.⁷ At a time when in-person visits are limited, LAIs may be an option.⁸

• Expanded patient access and support services: Recognizing the importance of helping patients stay engaged in treatment during the COVID-19 pandemic, the healthcare industry was asked to explore measures that may help ensure patients continue to have access to medications.⁹ Patients who use LAIs, for example, may now be able to get their injections at pharmacies⁸ or clinics in their community. The expansion of these types of services could help ensure that treatment continues to be accessible during this crisis.⁸ In addition, federal guidelines have eased some requirements on in-person visits for medication prescribing¹⁰ and some insurers may waive required timeframe between medication refills.⁹ Please make sure to consult with your healthcare provider and your individual insurer for information about refill frequency. Those who may be struggling to pay for their medications as a result of COVID-19 and its economic impacts may have access to support services to help with the cost of prescriptions.¹¹

The mental health care ecosystem must continue to provide support and strive to find innovative ways to ensure safe delivery of services to those with chronic conditions, including SMIs.¹² If you or a loved one suffers from SMI, consider consulting a healthcare provider to determine if these new services and treatment options may meet your needs during this time of social distancing. For additional peer support, groups like the National Alliance of Mental Illness (NAMI) and Mental Health America (MHA) host online discussion groups which are open to individuals with SMI and their loved ones.

This is intended as informational only and not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical and/or mental health condition.

References:

¹ Kirzinger, A., Hamel, L., Muñana, C., Kearney, A., & Brodie, M. (2020, April 24). KFF Health Tracking Poll – Late April 2020: Coronavirus, Social Distancing, and Contact Tracing. Retrieved from https://www.kff.org/coronavirus-covid-19/issue-brief/kff-health-tracking-poll-late-april-2020/

² Kozloff, N., Mulsant, B. H., Stergiopoulos, V., & Voineskos, A. N. (2020, April 28). The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders. Schizophrenia bulletin, sbaa051. doi:10.1093/schbul/sbaa051

³ American Psychological Association (2020, May 1). Serious mental illness and COVID-19: How to help your patients right now.Retrieved from https://www.apaservices.org/practice/legal/technology/serious-mental-illness-covid-19

⁴ American Psychiatric Association (2017, January). What is Telepsychiatry? Retrieved from https://www.psychiatry.org/patients-families/what-is-telepsychiatry

⁵ Weigel G., Ramaswamy A., Sobel L., Salganicoff A., Cubanski J., & Freed M. (2020, May 11). Opportunities and Barriers for Telemedicine in the U.S. During the COVID-19 Emergency and Beyond. Retrieved from https://www.kff.org/womens-health-policy/issue-brief/opportunities-and-barriers-for-telemedicine-in-the-u-s-during-the-covid-19-emergency-and-beyond/

⁶ Kelly A Hirko, PhD, Jean M Kerver, PhD, Sabrina Ford, PhD, Chelsea Szafranski, MHA, John Beckett, MD, Chris Kitchen, RRT, Andrea L Wendling, MD (2020, June 26). Telehealth in Response to the Covid-19 Pandemic: Implications for Rural Health Disparities, Journal of the American Medical Informatics Association, , ocaa156, https://doi.org/10.1093/jamia/ocaa156

⁷ Anzia D., Fochtmann L., Keepers G., et al.(2019, Dec). The American Psychiatric Association Practice Guideline for The Treatment Of Patients With Schizophrenia. American Psychiatry Association. Retrieved from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline-Dec2019.pdf

⁸ SMI Advisor. What are clinical considerations for giving LAIs during the COVID-19 public health emergency? (2020, March 25). Retrieved from https://smiadviser.org/knowledge_post/what-are-clinical-considerations-for-giving-lais-during-the-covid-19-public-health-emergency

⁹ Alexander GC, Qato DM. Ensuring Access to Medications in the US During the COVID-19 Pandemic. JAMA. 2020;324(1):31–32. doi:10.1001/jama.2020.6016

¹⁰ SMI Advisor. How has the U.S. public sector behavioral health system been changing in response to the COVID-19 pandemic? What will the "new normal" look like for the treatment of SMI? (2020, May 29). Retrieved from https://smiadviser.org/knowledge_post/how-has-the-u-s-public-sector-behavioral-health-system-been-changing-in-response-to-the-covid-19-pandemic-what-will-the-new-normal-look-like-for-the-treatment-of-smi

¹¹ Mental Health America. Medication Access During COVID-19 (2020). Retrieved from https://mhanational.org/medication-access-during-covid-19

¹² Druss BG. (2020, April 3). Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness. JAMA Psychiatry. Retrieved from: doi:10.1001/jamapsychiatry.2020.0894

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