Opinion

Mental Health and Addiction Crises Will Worsen During Pandemic Without Better Policy

By Patrick J. Kennedy & Shawn Coughlin
April 20, 2020 at 5:00 am ET

In January, the Centers for Disease Control and Prevention announced some hopeful news when it reported a slight uptick in U.S. life expectancy following years of decline largely due to historic rates of overdoses and suicides. 

Sadly, COVID-19 has the potential to reverse serious progress made in addressing our nation’s mental health and addiction crises — particularly around overdose rates — unless policymakers mitigate the pandemic’s serious effects on behavioral health in the next stimulus package. 

Lawmakers must understand mental health care for what it is: an integral part of overall health care. Science shows that mental health affects physical health, and we know whole-person care is critical to longevity. Treating the body and mind separately has cost too many lives already. Unfortunately, our policymakers have followed this old pattern in the recent emergency COVID-19 bills. 

For example, Congress has failed to acknowledge that people struggling with mental health and substance use disorders are highly vulnerable to contracting COVID-19, especially because many of them have other co-existing physical health conditions and higher rates of homelessness. 

Congress has also failed to consider how social isolation, unemployment, skyrocketing anxiety and extreme disruptions to mental health and addiction treatment and support systems will cause enormous harm to millions of Americans now and in the future. 

Meanwhile, calls to suicide prevention hotlines have spiked during the pandemic. What will happen if our unemployment rate hits 32 percent (more than triple the rate of the Great Depression), as Federal Reserve economists have predicted? 

Despite these indicators and predictions, only 0.02 percent of the latest stimulus package is allotted to address mental health and addiction. We offer practical steps to ensure this latest round of COVID-19 legislation doesn’t repeat that mistake. 

First, Congress must designate mental health and addiction treatment providers as essential providers so they have access to personal protection equipment. Behavioral health care providers often don’t have access to PPE because they frequently don’t need this equipment. They also need access to emergency funding to cover huge COVID-related costs, including PPE, temporary shelters for testing at facility entry points and additional telehealth services. 

Next, Congress must expand access to telehealth services so patients can receive treatment through their phones and computers, allowing for both audio and video services, given that not all patients have video capabilities. While many governors and state insurance commissioners have mandated that health plans cover telehealth services, their actions don’t apply to self-funded employer-based plans that are not subject to state regulation. More than half of Americans who receive health insurance through their private employer — tens of millions of people — have such plans. 

Third, Congress should enhance access to all medications to treat opioid use disorder. For example, Congress must remove restrictions on buprenorphine prescribing. Before the COVID-19 pandemic, only one-third of patients who could benefit from medication-assisted treatment to treat opioid use disorder received such medication. A key barrier has been physicians’ inability to prescribe buprenorphine without obtaining a separate waiver. In the CARES Act, Congress made progress by removing data-sharing barriers for addiction treatment. Now lawmakers must remove the separate waiver and related patient cap, which limit access to MAT. 

Additionally, Congress should ensure that Opioid Treatment Program physicians can perform telemedicine evaluations and order methadone, which like buprenorphine treats opioid use disorder, for new patients who are with onsite nurses. A significant number of OTP physicians are over age 60 — the vulnerable age group for COVID-19 — and many are unable to prescribe in person. 

Fourth, Congress must eliminate Medicaid’s Institutions for Mental Diseases exclusion and Medicare’s 190-day lifetime limit on inpatient psychiatric treatment. The outdated IMD exclusion prevents adult Medicaid beneficiaries from accessing short-term, acute mental health care in psychiatric hospitals and other residential treatment facilities with more than 16 beds, while the 190-day lifetime limit places an unrealistic and inhumane cap on lifesaving care. No other Medicare specialty inpatient hospital service has this type of arbitrary cap on benefits. 

General acute-care hospitals need to ensure their beds are available for potential COVID-19 patients, so the Centers for Medicare & Medicaid Services has allowed these facilities to use psychiatric unit beds for this purpose. So then where will individuals with serious psychiatric conditions receive needed inpatient care? 

We know Congress can include these measures in the next stimulus package to ensure COVID-19 does not exacerbate America’s mental health and addiction crises. To do this effectively, policymakers must work to flatten the curve of overdoses and suicides with the same urgency, dedication and funding they have applied to COVID-19 testing and treatment. 

Lives depend on it. 

Former Rep. Patrick J. Kennedy (D-R.I.) is the founder of The Kennedy Forum and DontDenyMe.org, chair of Mental Health for US, a former member of the President‘s Commission on Combating Drug Addiction and the Opioid Crisis, and author of “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.” Shawn Coughlin is president and CEO of the National Association for Behavioral Healthcare. 

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