Behavioral Health

Keeping Pace with Escalating Demand for Behavioral Health Services

Behavioral Health Insights

by Micah Hoffman, MD, DABPN, FAPA

AllMed Behavioral Health Medical Director

In the United States, the need for behavioral health services has long outstripped the available resources. Even before the pandemic, an estimated 52 million U.S. adults (about one-quarter of adults) were reported to have mental, behavioral, or emotional health disorders, and another 20 million (ages 12 and up) had substance use disorders.1 Meanwhile, 55 percent of counties in the continental U.S. had no psychiatrists at all.2

Since the pandemic began, new stressors have increased the number of people seeking services for mental health and substance use issues. According to an October 2021 American Psychological Association practitioner survey, more than 8 in 10 (84%) psychologists said that they have seen an increase in demand for anxiety treatment since the start of the pandemic, while 7 in 10 report that their waitlists have grown longer.3

Compounding the problem, Covid-19 has forced many behavioral health service providers to reduce staff sizes and hours. In a February 2021 survey conducted by the National Council for Behavioral Health (NCBH), 27 percent of member organizations reported laying off employees. Another 45 percent reported closing some programs, and 35 percent decreased staff hours.4

Expanded access to and coverage of telehealth services are helping to narrow the gap in terms of care delivery. Still, payers face significant challenges as they work to support their members with timely, optimal behavioral health care. Trying to manage the growing demand with limited resources can lead to physician burnout, inappropriate care and overutilization. To prevent such outcomes, payers are evaluating and trying a variety of approaches.

How We Got Here

Before we look more closely at where we are today, it’s worth taking a step back to review how we got here. The current supply-demand imbalance has deep roots. In the years leading up to the pandemic, a number of trends converged to create a growing need for behavioral health care just as the supply of behavioral health professionals was declining. The aging of the baby boomer generation pushed the demand for geriatric care to new highs. At the same time, the demand for child and adolescent and addiction medicine services surged. Members increasingly began seeking gender-affirming care and help with managing refractory mood disorders, including unipolar depression and bipolar disorder. Providing optimal care to members with these needs requires specialized expertise and familiarity with the latest clinical evidence, yet the acute shortage of mental health providers forecast by the Association of American Medical Colleges in 2016 was accelerating.5

Then came the pandemic. Members whose conditions previously had been managed in traditional outpatient settings suddenly lost access to those preventative care resources. As a result, they began to decompensate significantly and to seek care at a more emergent level—in psychiatric urgent care centers, access centers, and emergency rooms. Receiving higher levels of care, even inpatient care, at much higher rates than they had prior to the pandemic, these members strained—and continue to strain—the system further.

In many healthcare systems currently, the immediate treatment, because these members are so decompensated when they arrive, is a very costly and time-intensive inpatient admission. With resources so scarce, even once the members stabilize, inpatient care teams struggle to put together care plans that allow them to step down to appropriate lower levels of care, leading to extended inpatient stays.

Building an Effective Strategy

Like their colleagues in emergency and internal medicine, mental and behavioral health specialists, whether they be psychologists, psychiatrists, licensed clinical social workers, or LMFTs (licensed marriage and family therapists), and health plans have felt the pressure of the tsunami of health care needs that has hit since the pandemic started. They are coping in a variety of ways and getting creative about how to deliver care to the large numbers of people who so desperately need it.

In quite a few cases, providers have split their practices, doing some in-person appointments and some via telehealth. The expansion of telehealth has made behavioral health care available to many people who lacked access before. However, it is not necessarily the best way to manage all members, and particularly not the chronically mentally ill.

Some health plans have increased the number of physician extenders and primary care physicians they use to review more complex cases, both in outpatient and inpatient settings. There are significant short-term benefits to this approach, in terms of being able to evaluate more members cases faster, but it brings challenges, too. Because physician extenders don’t have the clinical experience that a subspecialized psychiatrist would have, longer-term care plans and outcomes may not be optimal for the member, nor as cost-effective as they could be.

This is where AllMed can help. Our on-demand services are designed to support optimal member outcomes and control costs, while minimizing the use of physician extenders. Our panel of board-certified psychiatrists and psychologists acts as an extension of your team, delivering well-documented, compliance-driven, evidence-based determinations when you need them, with a focus on appropriate medications and care settings.

In the coming weeks, we’ll explore in more detail the specific factors creating greater demand for behavioral health services along with the benefits, challenges, and financial impact of working with physician extenders. Please check back in this space.