Behavioral Health Insights
by Micah Hoffman, MD, DABPN, FAPA
AllMed Behavioral Health Medical Director
During the pandemic the demand for behavioral health services expanded exponentially, but the trend was underway long before the arrival of COVID-19. A 2020 PwC study noted that between 2014 and 2018, use of psychiatric services in the United States increased by 32 percent1 while the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that, by 2017, behavioral health disorders affected nearly one in five Americans.2 Those affected included populations with unique needs such as geriatric, veteran and LGBTQ+ groups as well as rural populations. Since then, the need for behavioral health services among these groups has continued to grow while, more recently, the effects of Covid-19 have created new demand.
All along, the supply of available resources has been shrinking steadily—a trend that is expected to continue. The Health Resources and Services Administration (HRSA) projects that by 2030 there will be a shortage of 12,530 adult psychiatrists to meet the growing demand of behavioral health disorders.3 In this challenging environment, health plans are under considerable pressure to ensure that they have the most appropriate expertise to review complex behavioral health cases promptly and cost-effectively to support optimal outcomes.
Social and Demographic Forces Converge
A number of societal factors have combined in recent years to propel the increase in demand:
Through the Affordable Care Act (ACA), enacted in 2010, about 20 million people gained insurance coverage, including mental health and substance use disorder coverage.4 People who had long needed, but been unable to afford, behavioral health services suddenly had access. Within the past two years, expanded coverage of telehealth, largely in response to COVID-19, has increased access still further.
In addition, employers increasingly have come to recognize the value of providing mental and behavioral health support to their employees. Investing in measures to help employees manage depression, stress and anxiety early on can boost job satisfaction, retention, and productivity and help prevent costly treatment for physical conditions such as hypertension and diabetes down the road.5
The aging of the baby boomers is having a dramatic impact on the need for behavioral health services as it is on society as a whole. An estimated 15 to 25-percent of older adults suffer from a behavioral health disorder.6 With the number of Americans age 65 and older expected to double in the next 40 years, the demand for geriatric care will continue to skyrocket.7
Veterans, too, many of whom were deployed during the country’s long engagements in Iraq and Afghanistan, are increasingly seeking services. Almost a third of all military servicepersons deployed in the Iraq and Afghanistan conflicts suffer from some clinically significant mental condition, primarily PTSD and added complications of suicide, addiction and domestic or other-directed violence.8 From 2006 to 2019, the number of veterans receiving mental health care from the Department of Veterans Affairs (VA) increased by 90 percent. Looking ahead, the VA projects a 32 percent increase in outpatient mental health services over the next 10 years.9
Across the U.S., the opioid epidemic has driven a significant rise in the need for substance use and mental health services. In 2018, the Substance Abuse and Mental Health Services Administration reported that an estimated 10.3 million Americans aged 12 or older had misused opioids in the past year.10 Since the start of the pandemic, the crisis has worsened. More than one in ten adults have reported that they started or increased the use of alcohol or drugs to cope with pandemic stresses, and drug overdose deaths have increased 30 percent from 2019 to 2020.11 Access to treatment support facilities, already scarce, has shrunk, partly in response to public health measures. While telemedicine has helped bridge the gap, it has not addressed the root problem: There aren’t enough mental health-care workers to treat everyone in need, and there is no substitute for trained professionals.12
Lastly, nearly 3 million children in the U.S. have been diagnosed with a serious emotional or behavioral health condition.13 From 2004 to 2019, the rates of adolescent depression nearly doubled. In the past two years, the forced office and school closures of the pandemic often cut children off from the trained teachers and therapists who supported them, sending many into crisis. Even for young people without pre-existing issues, isolation from peers and normal activities has impacted their mental health.
All of these factors predated the pandemic, but the isolation, economic instability and health uncertainty brought by COVID-19 have amplified many of them. In some ways, the pandemic has been a perfect storm, often placing new stressors on members while cutting them off from their traditional sources of support.
Expert Help When You Need It
For health plans, the surge in demand for behavioral health services has created a tsunami of specialty reviews that shows no signs of abating. To maintain their high-quality standards and control costs, many are turning to utilization management and independent review organizations such as AllMed for help.
With our expert network of board-certified psychiatrists and psychologists, we can provide the on-demand expertise you need as trends evolve. At AllMed, we serve as an extension of your team, drawing on the knowledge base of our reviewers to understand your members’ needs and deliver well-documented, evidence-based, compliance-driven determinations for optimal outcomes.