1 00:00:04,360 --> 00:00:09,400 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day twenty nine 2 00:00:09,560 --> 00:00:13,960 Speaker 1: since coronavirus was declared a global pandemic. Our main story. 3 00:00:14,800 --> 00:00:18,040 Speaker 1: The effects of the outbreak are putting unprecedented stress on 4 00:00:18,200 --> 00:00:22,239 Speaker 1: thousands of people. But the difficulty of obtaining mental health 5 00:00:22,280 --> 00:00:25,840 Speaker 1: services while under lockdown and the spike in demand for 6 00:00:25,840 --> 00:00:29,360 Speaker 1: those services threatens to break a treatment network that was 7 00:00:29,400 --> 00:00:33,920 Speaker 1: already strained to the breaking point. But first, here's what 8 00:00:34,040 --> 00:00:46,960 Speaker 1: happened today. Anthony Fauci, the top infectious disease expert in 9 00:00:46,960 --> 00:00:50,160 Speaker 1: the US, says we might see a turn around after 10 00:00:50,320 --> 00:00:54,760 Speaker 1: this week in the fight against the coronavirus. Fauci says 11 00:00:54,800 --> 00:00:56,920 Speaker 1: that now is not the time to ease up on 12 00:00:56,960 --> 00:01:00,480 Speaker 1: social distancing to stop the spread of the virus. The 13 00:01:00,520 --> 00:01:04,240 Speaker 1: Trump administration is discussing how to reopen the economy, but 14 00:01:04,440 --> 00:01:09,160 Speaker 1: specifics haven't emerged. Global officials agree it's too soon to 15 00:01:09,240 --> 00:01:14,039 Speaker 1: lift widespread lockdowns. In a briefing today, Hans Kluge, the 16 00:01:14,080 --> 00:01:18,480 Speaker 1: World Health Organization's Regional director for Europe, said despite progress 17 00:01:18,520 --> 00:01:22,720 Speaker 1: in some places, spikes and cases in Sweden and Turkey 18 00:01:23,200 --> 00:01:29,319 Speaker 1: are concerning knowledge of COVID nineteen and some positive signs 19 00:01:29,360 --> 00:01:34,680 Speaker 1: from some countries do not yet represent victory. They offer 20 00:01:34,760 --> 00:01:37,880 Speaker 1: a rare chance for us to tighten old grip on 21 00:01:37,959 --> 00:01:43,680 Speaker 1: the virus. Now it's not the time to relax measures. 22 00:01:43,959 --> 00:01:48,600 Speaker 1: It is the time to once again double and triple 23 00:01:48,840 --> 00:01:52,760 Speaker 1: or collective efforts to drive towards suppression with the whole 24 00:01:52,800 --> 00:01:57,200 Speaker 1: support of the society. Much needed ventilators are still in 25 00:01:57,240 --> 00:02:00,560 Speaker 1: short supply in many US states, and the federal government 26 00:02:00,880 --> 00:02:05,840 Speaker 1: is unevenly supplying them with what they need. Louisiana, for example, 27 00:02:06,200 --> 00:02:09,680 Speaker 1: has received only five percent of the ventilators it requested 28 00:02:09,680 --> 00:02:14,239 Speaker 1: from the national stockpile. Other states also report that they're 29 00:02:14,240 --> 00:02:18,880 Speaker 1: getting far less than what they need. Even as President 30 00:02:19,000 --> 00:02:22,800 Speaker 1: Donald Trump boasted of great coordination between state and federal 31 00:02:22,840 --> 00:02:26,679 Speaker 1: governments during a Tuesday night news conference, governors say they're 32 00:02:26,720 --> 00:02:37,440 Speaker 1: still facing shortages and delays. Now for today's main story. 33 00:02:40,200 --> 00:02:42,640 Speaker 1: This pandemic has dealt a blow to more than just 34 00:02:42,720 --> 00:02:46,600 Speaker 1: our physical health. Job losses, The threat of sickness and 35 00:02:46,680 --> 00:02:50,000 Speaker 1: indefinite lockdowns have taken a toll on the public's mental 36 00:02:50,080 --> 00:02:54,040 Speaker 1: health as well. When people go through a major disruption 37 00:02:54,120 --> 00:02:59,440 Speaker 1: or loss, symptoms can emerge like anxiety, chess tightness, helplessness 38 00:02:59,480 --> 00:03:03,920 Speaker 1: and disord orientation. Mental health professionals have a term for this, 39 00:03:04,760 --> 00:03:09,839 Speaker 1: it's called adjustment disorder. But just as mental health care 40 00:03:09,840 --> 00:03:14,480 Speaker 1: becomes more necessary, physical distancing and business closures have made 41 00:03:14,480 --> 00:03:18,880 Speaker 1: it harder to obtain. Finding a therapist or checking into 42 00:03:18,880 --> 00:03:23,799 Speaker 1: rehab has become more challenging, And as more consumers look 43 00:03:23,840 --> 00:03:27,360 Speaker 1: for mental health services, companies trying to meet that demand 44 00:03:27,720 --> 00:03:33,040 Speaker 1: need to clear a host of regulatory hurdles. Cynthia Coons 45 00:03:33,200 --> 00:03:36,760 Speaker 1: is a senior reporter at Bloomberg. She recently wrote about 46 00:03:36,840 --> 00:03:39,600 Speaker 1: how a strained system was already failing to meet the 47 00:03:39,640 --> 00:03:42,040 Speaker 1: needs of a lot of people who need treatment for 48 00:03:42,120 --> 00:03:47,360 Speaker 1: mental health. This crisis could make that much worse, but 49 00:03:47,400 --> 00:03:50,640 Speaker 1: it could also open up new avenues to treatment that 50 00:03:50,680 --> 00:03:54,240 Speaker 1: could end up making the system better. I talked to 51 00:03:54,280 --> 00:04:03,520 Speaker 1: Cynthia recently. Before this pandemic even began, would you say 52 00:04:03,560 --> 00:04:07,240 Speaker 1: America was already in a mental health crisis. I spent 53 00:04:07,720 --> 00:04:09,720 Speaker 1: much of the last year writing about mental health in 54 00:04:09,760 --> 00:04:13,200 Speaker 1: America because of issues that had sort of come to 55 00:04:13,280 --> 00:04:16,760 Speaker 1: light about. We have rising suicide rates in the US, 56 00:04:16,920 --> 00:04:21,039 Speaker 1: we have increasing addiction problems, and so we spent a 57 00:04:21,040 --> 00:04:23,479 Speaker 1: lot of time looking into the reasons behind this, and 58 00:04:23,520 --> 00:04:27,360 Speaker 1: we looked into some of the failures of the pharmaceutical 59 00:04:27,400 --> 00:04:30,760 Speaker 1: industry to innovating new drugs, although that is starting to change. 60 00:04:31,360 --> 00:04:35,760 Speaker 1: Some issues around ensures not necessarily reimbursing or covering much 61 00:04:35,800 --> 00:04:38,480 Speaker 1: mental health care in network, and that's a chronic problem 62 00:04:38,520 --> 00:04:40,080 Speaker 1: that prevents a lot of people from being able to 63 00:04:40,120 --> 00:04:43,440 Speaker 1: afford care, and issues of literally not being a ton 64 00:04:43,480 --> 00:04:46,599 Speaker 1: of supply and the mental health sort of world at 65 00:04:46,680 --> 00:04:49,160 Speaker 1: large when you think about things like mental hospitals having 66 00:04:49,160 --> 00:04:51,440 Speaker 1: closed in recent years. So there are a lot of 67 00:04:51,480 --> 00:04:54,120 Speaker 1: reasons to believe that we're not in good shape from 68 00:04:54,120 --> 00:04:56,479 Speaker 1: a mental health perspective just to begin with. And that's 69 00:04:56,480 --> 00:05:00,000 Speaker 1: even before something like COVID comes along and gives us 70 00:05:00,000 --> 00:05:02,960 Speaker 1: all a new form of anxiety to deal with. So 71 00:05:03,040 --> 00:05:06,679 Speaker 1: many Americans right now are under stay at home orders, 72 00:05:06,760 --> 00:05:10,440 Speaker 1: and in particular, what challenges do they pose for someone 73 00:05:10,480 --> 00:05:13,640 Speaker 1: who needs access to mental health care. So there's a 74 00:05:13,640 --> 00:05:15,920 Speaker 1: couple of different layers of this. So there's the basic 75 00:05:16,080 --> 00:05:19,160 Speaker 1: person who might have therapy needs that they would normally 76 00:05:19,200 --> 00:05:21,800 Speaker 1: go visit their therapist in person, and a lot of 77 00:05:21,800 --> 00:05:24,520 Speaker 1: that is shifted to telehealth really quite quickly, and that's 78 00:05:24,520 --> 00:05:27,520 Speaker 1: been remarkable. So there's a company's like talk Space. They've 79 00:05:27,560 --> 00:05:32,599 Speaker 1: seen a six increase in demand since COVID quarantines took place. 80 00:05:32,960 --> 00:05:36,240 Speaker 1: The government said that they're relaxing the HIPPA rules, or 81 00:05:36,279 --> 00:05:39,480 Speaker 1: they're basically relaxing enforcement around HIPPA rules. So now people 82 00:05:39,520 --> 00:05:41,840 Speaker 1: can use FaceTime, which they might already have on their 83 00:05:41,839 --> 00:05:44,120 Speaker 1: phone or Skype, in order to see their therapists. That's 84 00:05:44,160 --> 00:05:47,080 Speaker 1: really a big change. And a lot of insurers have 85 00:05:47,200 --> 00:05:50,560 Speaker 1: moved to make telehealth available or add tell health services 86 00:05:50,680 --> 00:05:53,320 Speaker 1: or make them free. So those benefits have been great 87 00:05:53,360 --> 00:05:56,360 Speaker 1: for people who might need regular talk therapy kind of maintenance. 88 00:05:56,760 --> 00:05:59,000 Speaker 1: But there's another level of people who are really vulnerable 89 00:05:59,040 --> 00:06:02,719 Speaker 1: here getting into rehab, in patient rehab while they're open. 90 00:06:03,279 --> 00:06:05,679 Speaker 1: They're all it takes is one COVID case to change 91 00:06:05,720 --> 00:06:08,120 Speaker 1: the dynamics of whether a rehab is open or a 92 00:06:08,160 --> 00:06:12,039 Speaker 1: psych ward in a hospital. And what about services that 93 00:06:12,120 --> 00:06:15,320 Speaker 1: have to be in person that can't be done via 94 00:06:15,400 --> 00:06:19,400 Speaker 1: telehealth or done remotely. What happens if an issue requires 95 00:06:19,520 --> 00:06:24,400 Speaker 1: say hospitalization. Yeah, that's a big problem here because there 96 00:06:24,440 --> 00:06:27,440 Speaker 1: are rehabs open, there are mental health wards open, there 97 00:06:27,440 --> 00:06:30,280 Speaker 1: are mental hospitals open. But I've talked to a number 98 00:06:30,279 --> 00:06:33,120 Speaker 1: of providers in those settings who have said, were they 99 00:06:33,160 --> 00:06:35,520 Speaker 1: to have one case of COVID, they're probably going to 100 00:06:35,560 --> 00:06:38,200 Speaker 1: have to stop admitting new patients or they have to 101 00:06:38,279 --> 00:06:41,520 Speaker 1: isolate people. And then there's the sheer fact that people 102 00:06:41,560 --> 00:06:43,560 Speaker 1: in those settings can't do some of the group therapy, 103 00:06:43,560 --> 00:06:47,240 Speaker 1: which is quite effective for certain conditions. But hopefully as 104 00:06:47,279 --> 00:06:50,479 Speaker 1: the medical system sort of writes itself and the case 105 00:06:50,760 --> 00:06:53,400 Speaker 1: of COVID patients goes down, and mental health care can 106 00:06:53,520 --> 00:06:56,200 Speaker 1: resume as it had been previously. But it was already 107 00:06:56,200 --> 00:06:58,919 Speaker 1: a system that was slightly tenuously operating, and things like 108 00:06:59,000 --> 00:07:01,640 Speaker 1: detox some of these mental health conditions were handled by 109 00:07:01,640 --> 00:07:03,919 Speaker 1: the e R, and that's going to be a problem. 110 00:07:03,960 --> 00:07:07,080 Speaker 1: Are we looking at perhaps maybe what you might call 111 00:07:07,120 --> 00:07:09,640 Speaker 1: a resource crunch in terms of mental health? You know, 112 00:07:09,800 --> 00:07:13,920 Speaker 1: with even telehealth and these digital platforms, are there enough 113 00:07:14,120 --> 00:07:17,320 Speaker 1: therapists or or mental health providers to go around to 114 00:07:17,360 --> 00:07:21,200 Speaker 1: meet all these new demands for even digital therapies. Well, 115 00:07:21,240 --> 00:07:23,960 Speaker 1: if we left the state licensing system as it was, 116 00:07:24,120 --> 00:07:27,120 Speaker 1: probably the answer to your question would be we would 117 00:07:27,160 --> 00:07:30,840 Speaker 1: be in a very serious um supply shortage. But a 118 00:07:30,920 --> 00:07:33,400 Speaker 1: lot of states have moved to make it much quicker 119 00:07:33,440 --> 00:07:36,679 Speaker 1: and easier for people to use their license in another state. 120 00:07:36,920 --> 00:07:39,000 Speaker 1: So where it used to be, if you're a provider 121 00:07:39,000 --> 00:07:42,000 Speaker 1: in Nebraska, you could only see patients in Nebraska. That's 122 00:07:42,040 --> 00:07:46,720 Speaker 1: what you're licensing dictated. Now, other states that are have 123 00:07:46,840 --> 00:07:50,640 Speaker 1: high demand for therapy and for services are allowing therapists 124 00:07:50,640 --> 00:07:54,040 Speaker 1: and doctors and providers to get rapid access to get 125 00:07:54,080 --> 00:07:57,360 Speaker 1: their licensing approved in that state. So that's really meaningful. 126 00:07:57,720 --> 00:07:59,880 Speaker 1: It's great that the states are moving to rapidly imp 127 00:08:00,040 --> 00:08:02,720 Speaker 1: meant changes so providers can work in other states. But 128 00:08:03,080 --> 00:08:05,240 Speaker 1: it's still going to be a little bit of time 129 00:08:05,280 --> 00:08:07,520 Speaker 1: before we're really up and running. From a very meaningful 130 00:08:07,560 --> 00:08:09,480 Speaker 1: point of view, just because of the sheer nature of 131 00:08:09,520 --> 00:08:12,560 Speaker 1: the fact that it's really complex system, it sounds like 132 00:08:12,600 --> 00:08:16,040 Speaker 1: there is loosening, there's flexibility that we're seeing from the regulation, 133 00:08:16,120 --> 00:08:19,040 Speaker 1: the licensing side of things. I mean, are you also 134 00:08:19,080 --> 00:08:22,320 Speaker 1: seeing this from the, say, insurance side of things. Are 135 00:08:22,360 --> 00:08:26,520 Speaker 1: they taking specific actions to try and essentially just make 136 00:08:26,640 --> 00:08:30,320 Speaker 1: things easier, make life easier in this circumstance. Yeah, number 137 00:08:30,400 --> 00:08:33,040 Speaker 1: that was really encouraging. A number of insurers have said 138 00:08:33,080 --> 00:08:36,160 Speaker 1: that they would actually not even require co pais at 139 00:08:36,160 --> 00:08:39,440 Speaker 1: this time for behavioral health. Behavioral health is the umbrella 140 00:08:39,480 --> 00:08:43,000 Speaker 1: for mental health and um substance abuse and addiction treatment, 141 00:08:43,720 --> 00:08:48,520 Speaker 1: and things like eating disorders or autism spectrum therapy. So 142 00:08:48,679 --> 00:08:51,079 Speaker 1: a lot of insurers have actually said we're we're waving 143 00:08:51,120 --> 00:08:54,640 Speaker 1: copais right now, or they're adding telehealth mental health services 144 00:08:54,640 --> 00:08:56,840 Speaker 1: that they did not have before, and they're adding it 145 00:08:56,880 --> 00:09:00,160 Speaker 1: with either no co pay or regular copay so pople 146 00:09:00,200 --> 00:09:02,120 Speaker 1: can afford it. One of the biggest problems with mental 147 00:09:02,120 --> 00:09:04,800 Speaker 1: health in America getting treatment was finding in network care. 148 00:09:05,120 --> 00:09:08,959 Speaker 1: So the infrastructure under mental health has been pretty shaky, 149 00:09:09,040 --> 00:09:11,400 Speaker 1: and that's why so many people are seeking out of 150 00:09:11,400 --> 00:09:14,480 Speaker 1: network care on a normal day now. Because the insurers 151 00:09:14,520 --> 00:09:17,560 Speaker 1: recognized this surge in COVID, a lot of people are 152 00:09:17,600 --> 00:09:20,320 Speaker 1: seeking help now that might not be traditionally. They're really 153 00:09:20,440 --> 00:09:22,280 Speaker 1: rising to the occasion here and trying to make a 154 00:09:22,280 --> 00:09:26,839 Speaker 1: lot of care virtual care free and accessible. So the 155 00:09:26,920 --> 00:09:29,360 Speaker 1: question is really is this going to work? Are people? Really? 156 00:09:29,440 --> 00:09:31,800 Speaker 1: Is everyone who's seeking it or everyone who's seeking it 157 00:09:31,840 --> 00:09:33,680 Speaker 1: going to be able to get what they need. But 158 00:09:33,720 --> 00:09:36,319 Speaker 1: it's pretty remarkable step for an industry that has come 159 00:09:36,400 --> 00:09:39,560 Speaker 1: under fire for not necessarily adequately reimbursing for mental health 160 00:09:39,559 --> 00:09:43,040 Speaker 1: care for years now. It may be premature to try 161 00:09:43,040 --> 00:09:46,280 Speaker 1: and make these forecasts past the point that we're no 162 00:09:46,360 --> 00:09:48,880 Speaker 1: longer under stay at home orders or something like that. 163 00:09:48,920 --> 00:09:52,720 Speaker 1: But do you potentially think these changes were currently seeing 164 00:09:52,960 --> 00:09:57,200 Speaker 1: will have a more long term lasting effect on America's 165 00:09:57,240 --> 00:10:01,000 Speaker 1: mental health care system, say, after the endemic. That's a 166 00:10:01,040 --> 00:10:03,360 Speaker 1: million dollar question. I think that's what a lot of 167 00:10:03,400 --> 00:10:05,880 Speaker 1: advocates in the mental health community and world would love 168 00:10:05,920 --> 00:10:09,000 Speaker 1: to see. It's hard to say because so much is 169 00:10:09,040 --> 00:10:12,440 Speaker 1: going to change after this pandemic, but I think, you know, 170 00:10:12,679 --> 00:10:14,640 Speaker 1: one of the other benefits that I think we'll see 171 00:10:14,640 --> 00:10:17,440 Speaker 1: from this, our employers are also rolling out services for 172 00:10:17,480 --> 00:10:21,199 Speaker 1: employees and free services or services that are they may 173 00:10:21,240 --> 00:10:24,840 Speaker 1: not have had before, and so hopefully they don't roll 174 00:10:24,880 --> 00:10:28,240 Speaker 1: back those services as soon as the coronavirus fades. So 175 00:10:28,360 --> 00:10:31,040 Speaker 1: longer term, I don't I don't see a rollback to 176 00:10:31,080 --> 00:10:33,520 Speaker 1: the way things were necessarily, but I think we just 177 00:10:33,600 --> 00:10:35,400 Speaker 1: need to see how the health care system kind of 178 00:10:35,480 --> 00:10:38,200 Speaker 1: is reshaped by what's happened here in the last couple 179 00:10:38,280 --> 00:10:40,720 Speaker 1: of weeks and months and however long this goes on for. 180 00:10:41,600 --> 00:10:53,800 Speaker 1: And and that was Cynthia Coons whose article on the 181 00:10:53,880 --> 00:10:57,560 Speaker 1: deepening mental health crisis in America was published last week 182 00:10:57,760 --> 00:11:01,840 Speaker 1: on Bloomberg dot com. And that's it for the Prognosis 183 00:11:01,920 --> 00:11:05,160 Speaker 1: Daily Edition. For more on the pandemic from our bureaus 184 00:11:05,200 --> 00:11:10,400 Speaker 1: around the world, visit Bloomberg dot com slash coronavirus and 185 00:11:10,440 --> 00:11:12,800 Speaker 1: if you like the podcast, please take a moment to 186 00:11:12,920 --> 00:11:15,400 Speaker 1: rate us and leave us a review on Apple Podcasts 187 00:11:15,559 --> 00:11:19,240 Speaker 1: or Spotify. It helps more listeners find our global reporting. 188 00:11:20,480 --> 00:11:23,800 Speaker 1: The Prognosis Daily Edition is hosted by me Laura Carlson. 189 00:11:24,360 --> 00:11:27,920 Speaker 1: The show is produced by Me topher Foreheaz, Jordan Gospore, 190 00:11:28,400 --> 00:11:34,440 Speaker 1: and Magnus Hendrickson. Additional reporting by Cynthia Coons. Original music 191 00:11:34,600 --> 00:11:39,240 Speaker 1: by Leo Sitdrin. Our editors are Francesca Levi and Rick Shine. 192 00:11:40,200 --> 00:11:44,760 Speaker 1: Francesca Levi is Bloomberg's head of Podcasts. Thanks for listening.