Behavioral Health Post-Pandemic: Self-Care is not Selfish

Amy Harrington, MD Christopher Catalfamo, Psy.D.

As a behavioral health provider, I recall a situation where one of my patients was reporting gastrointestinal symptoms to me in our appointment, but he could not get in to see a specialist for further work-up. The patient was on a waitlist that was months long, but each time I met with him his symptoms and his anxiety about them dominated our conversation. I can only imagine the frustration that providers in other specialties must feel about the growing lack of access to mental health services, despite an increased number of patients, particularly young people, seeking treatment for mental health related issues.

Our region, like other parts of the country, has seen an increase in need for mental health services since the onset of the COVID-19 pandemic, with 3 in 10 residents of Massachusetts reporting symptoms of depression or anxiety in February of 2023. Unfortunately, only about 1 out of every 3 residents who need mental health services are able to access treatment [1].

One of the contributors to the worsening access to mental health care is the shortage of providers, and this is exacerbated by burnout within the mental health care provider community. In a survey of behavioral health providers published in April of 2023 by the National Council for Mental Wellbeing, 70% reported an increase in client severity since the COVID-19 pandemic, and 90% reported concern about the lack of access for new patients. An overwhelming 93% of behavioral health providers surveyed endorsed symptoms of burn-out [2].

Burnout is a problem facing medical providers across the entire spectrum of healthcare. Having rapid access to therapy or other behavioral healthcare services could help prevent medical providers from leaving clinical care, yet we struggle to meet the needs of our own colleagues. It creates an unfortunate feedback loop where lack of access exacerbates burnout which exacerbates lack of access.

Fortunately, there appears to be some hope for the future. Medicine has always promoted stoicism, but since the pandemic there has been a greater recognition of the emotional impact that our profession experiences. An underutilized resource is an available Employee Assistance Program or EAP. This type of program used to be perceived as a place where a physician or other provider would go if he or she was impaired in some way. Now EAPs are robust programs, offering services from short-term counseling to help with financial planning, access to legal services or help finding child or elder care. Whenever I encounter a professional who is trying to access counseling, I encourage them to call their EAP as a first step.

I am encouraged to see a greater emphasis being placed on mental health care services for our patients. MassHealth recently implemented a new, transformational system for addressing behavioral health needs in the ambulatory setting. The agency identified Community Based Health Centers (CBHC) throughout the state, and offered enhanced financial reimbursement in exchange for rapid access to services. Each geographic catchment area has a CBHC, so if a patient knows their zip code, they know where they can go to connect for behavioral health treatment.

What gives me the greatest hope is the fact that there is a greater acceptance, both within medicine and in the general population, that mental health care is important. The stigma associated with seeking treatment for depression, anxiety or substance use, though still present, is improving [3].

One of the main reasons for this is that we all experienced the trauma of Covid and its consequences together. This was true, especially in the field of healthcare, although we may have experienced it in different ways. As a profession, we have an opportunity to lean more on our colleagues because we have all been through this common experience as a community.

The explosion of telemedicine has created new opportunities and greater flexibility for providing mental health treatment. Although the pandemic created a secondary mental health pandemic in its wake, it also showed us innovative ways to provide services while reducing the stigma associated with seeking treatment for depression or anxiety.

Amy Harrington, MD is the Assistant Professor of Psychiatry, Program Director of the Addiction Psychiatry Fellowship, and Medical Director of Out-Patient Psychiatry at University of Massachusetts Chan Medical School

Christopher Catalfamo, Psy.D. is a Clinical Psychologist at UMass Memorial Medical Group

References:

1. https://www.kff.org/statedata/mental-health-and-substance-use-state-factsheets/massachusetts/, accessed July 5, 2023

2.https://www.beckersbehavioralhealth.com/behavioral-health-news/thebehavioral-health-workforce-in-10-numbers.html, access June 27, 2023

3. https://www.optum.com/health-articles/article/healthy-mind/how-covid19-changed-conversation-mental-health/, accessed June 30, 2023