WEBVTT - A Mental Health Crisis Worsens 0:00:04.360 --> 0:00:09.400 Welcome to Prognosis. I'm Laura Carlson. It's day twenty nine 0:00:09.560 --> 0:00:13.960 since coronavirus was declared a global pandemic. Our main story. 0:00:14.800 --> 0:00:18.040 The effects of the outbreak are putting unprecedented stress on 0:00:18.200 --> 0:00:22.239 thousands of people. But the difficulty of obtaining mental health 0:00:22.280 --> 0:00:25.840 services while under lockdown and the spike in demand for 0:00:25.840 --> 0:00:29.360 those services threatens to break a treatment network that was 0:00:29.400 --> 0:00:33.920 already strained to the breaking point. But first, here's what 0:00:34.040 --> 0:00:46.960 happened today. Anthony Fauci, the top infectious disease expert in 0:00:46.960 --> 0:00:50.160 the US, says we might see a turn around after 0:00:50.320 --> 0:00:54.760 this week in the fight against the coronavirus. Fauci says 0:00:54.800 --> 0:00:56.920 that now is not the time to ease up on 0:00:56.960 --> 0:01:00.480 social distancing to stop the spread of the virus. The 0:01:00.520 --> 0:01:04.240 Trump administration is discussing how to reopen the economy, but 0:01:04.440 --> 0:01:09.160 specifics haven't emerged. Global officials agree it's too soon to 0:01:09.240 --> 0:01:14.039 lift widespread lockdowns. In a briefing today, Hans Kluge, the 0:01:14.080 --> 0:01:18.480 World Health Organization's Regional director for Europe, said despite progress 0:01:18.520 --> 0:01:22.720 in some places, spikes and cases in Sweden and Turkey 0:01:23.200 --> 0:01:29.319 are concerning knowledge of COVID nineteen and some positive signs 0:01:29.360 --> 0:01:34.680 from some countries do not yet represent victory. They offer 0:01:34.760 --> 0:01:37.880 a rare chance for us to tighten old grip on 0:01:37.959 --> 0:01:43.680 the virus. Now it's not the time to relax measures. 0:01:43.959 --> 0:01:48.600 It is the time to once again double and triple 0:01:48.840 --> 0:01:52.760 or collective efforts to drive towards suppression with the whole 0:01:52.800 --> 0:01:57.200 support of the society. Much needed ventilators are still in 0:01:57.240 --> 0:02:00.560 short supply in many US states, and the federal government 0:02:00.880 --> 0:02:05.840 is unevenly supplying them with what they need. Louisiana, for example, 0:02:06.200 --> 0:02:09.680 has received only five percent of the ventilators it requested 0:02:09.680 --> 0:02:14.239 from the national stockpile. Other states also report that they're 0:02:14.240 --> 0:02:18.880 getting far less than what they need. Even as President 0:02:19.000 --> 0:02:22.800 Donald Trump boasted of great coordination between state and federal 0:02:22.840 --> 0:02:26.679 governments during a Tuesday night news conference, governors say they're 0:02:26.720 --> 0:02:37.440 still facing shortages and delays. Now for today's main story. 0:02:40.200 --> 0:02:42.640 This pandemic has dealt a blow to more than just 0:02:42.720 --> 0:02:46.600 our physical health. Job losses, The threat of sickness and 0:02:46.680 --> 0:02:50.000 indefinite lockdowns have taken a toll on the public's mental 0:02:50.080 --> 0:02:54.040 health as well. When people go through a major disruption 0:02:54.120 --> 0:02:59.440 or loss, symptoms can emerge like anxiety, chess tightness, helplessness 0:02:59.480 --> 0:03:03.920 and disord orientation. Mental health professionals have a term for this, 0:03:04.760 --> 0:03:09.839 it's called adjustment disorder. But just as mental health care 0:03:09.840 --> 0:03:14.480 becomes more necessary, physical distancing and business closures have made 0:03:14.480 --> 0:03:18.880 it harder to obtain. Finding a therapist or checking into 0:03:18.880 --> 0:03:23.799 rehab has become more challenging, And as more consumers look 0:03:23.840 --> 0:03:27.360 for mental health services, companies trying to meet that demand 0:03:27.720 --> 0:03:33.040 need to clear a host of regulatory hurdles. Cynthia Coons 0:03:33.200 --> 0:03:36.760 is a senior reporter at Bloomberg. She recently wrote about 0:03:36.840 --> 0:03:39.600 how a strained system was already failing to meet the 0:03:39.640 --> 0:03:42.040 needs of a lot of people who need treatment for 0:03:42.120 --> 0:03:47.360 mental health. This crisis could make that much worse, but 0:03:47.400 --> 0:03:50.640 it could also open up new avenues to treatment that 0:03:50.680 --> 0:03:54.240 could end up making the system better. I talked to 0:03:54.280 --> 0:04:03.520 Cynthia recently. Before this pandemic even began, would you say 0:04:03.560 --> 0:04:07.240 America was already in a mental health crisis. I spent 0:04:07.720 --> 0:04:09.720 much of the last year writing about mental health in 0:04:09.760 --> 0:04:13.200 America because of issues that had sort of come to 0:04:13.280 --> 0:04:16.760 light about. We have rising suicide rates in the US, 0:04:16.920 --> 0:04:21.039 we have increasing addiction problems, and so we spent a 0:04:21.040 --> 0:04:23.479 lot of time looking into the reasons behind this, and 0:04:23.520 --> 0:04:27.360 we looked into some of the failures of the pharmaceutical 0:04:27.400 --> 0:04:30.760 industry to innovating new drugs, although that is starting to change. 0:04:31.360 --> 0:04:35.760 Some issues around ensures not necessarily reimbursing or covering much 0:04:35.800 --> 0:04:38.480 mental health care in network, and that's a chronic problem 0:04:38.520 --> 0:04:40.080 that prevents a lot of people from being able to 0:04:40.120 --> 0:04:43.440 afford care, and issues of literally not being a ton 0:04:43.480 --> 0:04:46.599 of supply and the mental health sort of world at 0:04:46.680 --> 0:04:49.160 large when you think about things like mental hospitals having 0:04:49.160 --> 0:04:51.440 closed in recent years. So there are a lot of 0:04:51.480 --> 0:04:54.120 reasons to believe that we're not in good shape from 0:04:54.120 --> 0:04:56.479 a mental health perspective just to begin with. And that's 0:04:56.480 --> 0:05:00.000 even before something like COVID comes along and gives us 0:05:00.000 --> 0:05:02.960 all a new form of anxiety to deal with. So 0:05:03.040 --> 0:05:06.679 many Americans right now are under stay at home orders, 0:05:06.760 --> 0:05:10.440 and in particular, what challenges do they pose for someone 0:05:10.480 --> 0:05:13.640 who needs access to mental health care. So there's a 0:05:13.640 --> 0:05:15.920 couple of different layers of this. So there's the basic 0:05:16.080 --> 0:05:19.160 person who might have therapy needs that they would normally 0:05:19.200 --> 0:05:21.800 go visit their therapist in person, and a lot of 0:05:21.800 --> 0:05:24.520 that is shifted to telehealth really quite quickly, and that's 0:05:24.520 --> 0:05:27.520 been remarkable. So there's a company's like talk Space. They've 0:05:27.560 --> 0:05:32.599 seen a six increase in demand since COVID quarantines took place. 0:05:32.960 --> 0:05:36.240 The government said that they're relaxing the HIPPA rules, or 0:05:36.279 --> 0:05:39.480 they're basically relaxing enforcement around HIPPA rules. So now people 0:05:39.520 --> 0:05:41.840 can use FaceTime, which they might already have on their 0:05:41.839 --> 0:05:44.120 phone or Skype, in order to see their therapists. That's 0:05:44.160 --> 0:05:47.080 really a big change. And a lot of insurers have 0:05:47.200 --> 0:05:50.560 moved to make telehealth available or add tell health services 0:05:50.680 --> 0:05:53.320 or make them free. So those benefits have been great 0:05:53.360 --> 0:05:56.360 for people who might need regular talk therapy kind of maintenance. 0:05:56.760 --> 0:05:59.000 But there's another level of people who are really vulnerable 0:05:59.040 --> 0:06:02.719 here getting into rehab, in patient rehab while they're open. 0:06:03.279 --> 0:06:05.679 They're all it takes is one COVID case to change 0:06:05.720 --> 0:06:08.120 the dynamics of whether a rehab is open or a 0:06:08.160 --> 0:06:12.039 psych ward in a hospital. And what about services that 0:06:12.120 --> 0:06:15.320 have to be in person that can't be done via 0:06:15.400 --> 0:06:19.400 telehealth or done remotely. What happens if an issue requires 0:06:19.520 --> 0:06:24.400 say hospitalization. Yeah, that's a big problem here because there 0:06:24.440 --> 0:06:27.440 are rehabs open, there are mental health wards open, there 0:06:27.440 --> 0:06:30.280 are mental hospitals open. But I've talked to a number 0:06:30.279 --> 0:06:33.120 of providers in those settings who have said, were they 0:06:33.160 --> 0:06:35.520 to have one case of COVID, they're probably going to 0:06:35.560 --> 0:06:38.200 have to stop admitting new patients or they have to 0:06:38.279 --> 0:06:41.520 isolate people. And then there's the sheer fact that people 0:06:41.560 --> 0:06:43.560 in those settings can't do some of the group therapy, 0:06:43.560 --> 0:06:47.240 which is quite effective for certain conditions. But hopefully as 0:06:47.279 --> 0:06:50.479 the medical system sort of writes itself and the case 0:06:50.760 --> 0:06:53.400 of COVID patients goes down, and mental health care can 0:06:53.520 --> 0:06:56.200 resume as it had been previously. But it was already 0:06:56.200 --> 0:06:58.919 a system that was slightly tenuously operating, and things like 0:06:59.000 --> 0:07:01.640 detox some of these mental health conditions were handled by 0:07:01.640 --> 0:07:03.919 the e R, and that's going to be a problem. 0:07:03.960 --> 0:07:07.080 Are we looking at perhaps maybe what you might call 0:07:07.120 --> 0:07:09.640 a resource crunch in terms of mental health? You know, 0:07:09.800 --> 0:07:13.920 with even telehealth and these digital platforms, are there enough 0:07:14.120 --> 0:07:17.320 therapists or or mental health providers to go around to 0:07:17.360 --> 0:07:21.200 meet all these new demands for even digital therapies. Well, 0:07:21.240 --> 0:07:23.960 if we left the state licensing system as it was, 0:07:24.120 --> 0:07:27.120 probably the answer to your question would be we would 0:07:27.160 --> 0:07:30.840 be in a very serious um supply shortage. But a 0:07:30.920 --> 0:07:33.400 lot of states have moved to make it much quicker 0:07:33.440 --> 0:07:36.679 and easier for people to use their license in another state. 0:07:36.920 --> 0:07:39.000 So where it used to be, if you're a provider 0:07:39.000 --> 0:07:42.000 in Nebraska, you could only see patients in Nebraska. That's 0:07:42.040 --> 0:07:46.720 what you're licensing dictated. Now, other states that are have 0:07:46.840 --> 0:07:50.640 high demand for therapy and for services are allowing therapists 0:07:50.640 --> 0:07:54.040 and doctors and providers to get rapid access to get 0:07:54.080 --> 0:07:57.360 their licensing approved in that state. So that's really meaningful. 0:07:57.720 --> 0:07:59.880 It's great that the states are moving to rapidly imp 0:08:00.040 --> 0:08:02.720 meant changes so providers can work in other states. But 0:08:03.080 --> 0:08:05.240 it's still going to be a little bit of time 0:08:05.280 --> 0:08:07.520 before we're really up and running. From a very meaningful 0:08:07.560 --> 0:08:09.480 point of view, just because of the sheer nature of 0:08:09.520 --> 0:08:12.560 the fact that it's really complex system, it sounds like 0:08:12.600 --> 0:08:16.040 there is loosening, there's flexibility that we're seeing from the regulation, 0:08:16.120 --> 0:08:19.040 the licensing side of things. I mean, are you also 0:08:19.080 --> 0:08:22.320 seeing this from the, say, insurance side of things. Are 0:08:22.360 --> 0:08:26.520 they taking specific actions to try and essentially just make 0:08:26.640 --> 0:08:30.320 things easier, make life easier in this circumstance. Yeah, number 0:08:30.400 --> 0:08:33.040 that was really encouraging. A number of insurers have said 0:08:33.080 --> 0:08:36.160 that they would actually not even require co pais at 0:08:36.160 --> 0:08:39.440 this time for behavioral health. Behavioral health is the umbrella 0:08:39.480 --> 0:08:43.000 for mental health and um substance abuse and addiction treatment, 0:08:43.720 --> 0:08:48.520 and things like eating disorders or autism spectrum therapy. So 0:08:48.679 --> 0:08:51.079 a lot of insurers have actually said we're we're waving 0:08:51.120 --> 0:08:54.640 copais right now, or they're adding telehealth mental health services 0:08:54.640 --> 0:08:56.840 that they did not have before, and they're adding it 0:08:56.880 --> 0:09:00.160 with either no co pay or regular copay so pople 0:09:00.200 --> 0:09:02.120 can afford it. One of the biggest problems with mental 0:09:02.120 --> 0:09:04.800 health in America getting treatment was finding in network care. 0:09:05.120 --> 0:09:08.959 So the infrastructure under mental health has been pretty shaky, 0:09:09.040 --> 0:09:11.400 and that's why so many people are seeking out of 0:09:11.400 --> 0:09:14.480 network care on a normal day now. Because the insurers 0:09:14.520 --> 0:09:17.560 recognized this surge in COVID, a lot of people are 0:09:17.600 --> 0:09:20.320 seeking help now that might not be traditionally. They're really 0:09:20.440 --> 0:09:22.280 rising to the occasion here and trying to make a 0:09:22.280 --> 0:09:26.839 lot of care virtual care free and accessible. So the 0:09:26.920 --> 0:09:29.360 question is really is this going to work? Are people? Really? 0:09:29.440 --> 0:09:31.800 Is everyone who's seeking it or everyone who's seeking it 0:09:31.840 --> 0:09:33.680 going to be able to get what they need. But 0:09:33.720 --> 0:09:36.319 it's pretty remarkable step for an industry that has come 0:09:36.400 --> 0:09:39.560 under fire for not necessarily adequately reimbursing for mental health 0:09:39.559 --> 0:09:43.040 care for years now. It may be premature to try 0:09:43.040 --> 0:09:46.280 and make these forecasts past the point that we're no 0:09:46.360 --> 0:09:48.880 longer under stay at home orders or something like that. 0:09:48.920 --> 0:09:52.720 But do you potentially think these changes were currently seeing 0:09:52.960 --> 0:09:57.200 will have a more long term lasting effect on America's 0:09:57.240 --> 0:10:01.000 mental health care system, say, after the endemic. That's a 0:10:01.040 --> 0:10:03.360 million dollar question. I think that's what a lot of 0:10:03.400 --> 0:10:05.880 advocates in the mental health community and world would love 0:10:05.920 --> 0:10:09.000 to see. It's hard to say because so much is 0:10:09.040 --> 0:10:12.440 going to change after this pandemic, but I think, you know, 0:10:12.679 --> 0:10:14.640 one of the other benefits that I think we'll see 0:10:14.640 --> 0:10:17.440 from this, our employers are also rolling out services for 0:10:17.480 --> 0:10:21.199 employees and free services or services that are they may 0:10:21.240 --> 0:10:24.840 not have had before, and so hopefully they don't roll 0:10:24.880 --> 0:10:28.240 back those services as soon as the coronavirus fades. So 0:10:28.360 --> 0:10:31.040 longer term, I don't I don't see a rollback to 0:10:31.080 --> 0:10:33.520 the way things were necessarily, but I think we just 0:10:33.600 --> 0:10:35.400 need to see how the health care system kind of 0:10:35.480 --> 0:10:38.200 is reshaped by what's happened here in the last couple 0:10:38.280 --> 0:10:40.720 of weeks and months and however long this goes on for. 0:10:41.600 --> 0:10:53.800 And and that was Cynthia Coons whose article on the 0:10:53.880 --> 0:10:57.560 deepening mental health crisis in America was published last week 0:10:57.760 --> 0:11:01.840 on Bloomberg dot com. And that's it for the Prognosis 0:11:01.920 --> 0:11:05.160 Daily Edition. For more on the pandemic from our bureaus 0:11:05.200 --> 0:11:10.400 around the world, visit Bloomberg dot com slash coronavirus and 0:11:10.440 --> 0:11:12.800 if you like the podcast, please take a moment to 0:11:12.920 --> 0:11:15.400 rate us and leave us a review on Apple Podcasts 0:11:15.559 --> 0:11:19.240 or Spotify. It helps more listeners find our global reporting. 0:11:20.480 --> 0:11:23.800 The Prognosis Daily Edition is hosted by me Laura Carlson. 0:11:24.360 --> 0:11:27.920 The show is produced by Me topher Foreheaz, Jordan Gospore, 0:11:28.400 --> 0:11:34.440 and Magnus Hendrickson. Additional reporting by Cynthia Coons. Original music 0:11:34.600 --> 0:11:39.240 by Leo Sitdrin. Our editors are Francesca Levi and Rick Shine. 0:11:40.200 --> 0:11:44.760 Francesca Levi is Bloomberg's head of Podcasts. Thanks for listening.