Coronavirus: Mental Health Treatment

Mental health treatment during the coronavirus pandemic is extremely important to ensure continuity of care for those already receiving treatment and people who become newly symptomatic.

During this crisis, some people may experience added stress, anxiety and depression. In some cases, these symptoms can be addressed through coping strategies. However, if your symptoms are affecting your ability to function, you may want to consider seeking professional help.

It might also be helpful to take a screening. The 7-item Generalized Anxiety Disorder Scale is a brief screening tool widely used by health care providers. The PHQ-9 is a screening tool for depression.They may help you determine if you need medical treatment.

Social distancing during the coronavirus has led many patients and providers to quickly consider and adopt alternatives to in-person consultations, including telepsychiatry, telepsychology and mental health apps. Government and private insurance companies are also making it easier to access these alternatives given the challenges and additional needs posed by the pandemic.

If you do need to continue or start treatment during this time, here are some mental health treatment options to consider as well as information about changes to health insurance plans.

Telepsychiatry

The popularity of telepsychiatry sessions using videoconferencing is growing and has many possible advantages when compared to in-person visits. Many psychiatrists are adopting telepsychiatry, if they had not already, to serve their patients during the current restrictive period.

Evidence has shown that telepsychiatry and face-to-face treatment have comparable outcomes. The key benefit currently is to be able to see a health care provider while under social distancing and quarantine guidelines. This is especially important for the those who are at high risk for coronavirus.

Telepsychiatry can significantly enhance access to care by offering the following benefits:

• Facilitated access for those with mobility restrictions
• Reduced childcare costs due to no travel requirements
• Increased availability in underserved and rural areas
• Reduced scheduling delays due to greater appointment availability and flexibility
• Improved continuity of care, including appointment compliance

For many of these reasons, I have been happily using telepsychiatry for four years. Given my particular circumstances, I actually prefer telepsychiatry to in-person visits. However, some patients may have concerns such as establishing rapport with their provider, privacy, safety and technology limitations. It is important for telepsychiatry sessions to be conducted in a safe and private area. Extra safety precautions should be taken.

Medication

Ensuring no interruption to medication regimens is very important, particularly given potential disruptions in the global pharmaceuticals supply chain as a result of the coronavirus outbreak. Some psychiatrists are advising patients to have a 90-day supply of medication to manage this risk. But medication rules and coverage may vary with each insurance provider.

Providers and patients should make inquiries directly with their insurance company. My insurance provider only allowed me to fill a 30-day prescription through my pharmacy, but did allow me to fill a 90-day prescription directly through their home delivery mail order program.

It is also possible to pay for medications out-of-pocket to extend the supply, though the cost may be prohibitive. Medications may be brand name or generic, which are less expensive. NAMI’s Covid-19 Resource and Information Guide offers helpful information on prescription medications, including several payment assistance programs that provide discounts for medication.

Telepsychology

The use of telepsychology and teletherapy is also growing during the coronavirus pandemic. Finding and selecting the right therapist can be challenging as there are many to choose from. The most comprehensive psychologist directory is Psychology Today. You can search for an online therapist the same way you would search for an in-person provider.

The American Psychological Association has also encouraged psychologists to explore telepsychology options during the pandemic. For reference, it has identified key research findings that may be helpful in considering the mental health impact of coronavirus. As with telepsychiatry, research shows that telepsychology is as effective as traditional in-person treatment. Many of the same benefits for telepsychiatry also apply to telepsychology.

People currently seeing a psychiatrist or therapist should talk to their provider about telepsychiatry and telepsychology options.

Health Insurance Considerations

It is important to carefully review insurance coverage for telepsychiatry and telepsychology. The following are important changes to insurance rules governing access to telepsychiatry and telepsychology. They generally help people access mental health treatment during the pandemic.

Medicare

Forthe duration of the COVID-19 Public Health Emergency,under the CMS 1135 Waiver, Medicare patients may be seen by video at home by a provider in any state. There will be no penalties for noncompliance with HIPAA rules. As such, HIPAA non-compliant video platforms such as Skype and FaceTime may be used. This may significantly reduce the cost and time required to implement telepsychiatry and telepsychology. Importantly for providers, virtual visits will be considered the same as in-person visits and paid at the same rate as in-person visits.

Medicaid

Most state programs reimburse for some telepsychiatry. Coverage of psychological services in Medicaid programs vary widely by state. Psychiatrists and psychologists must be licensed in the state in which the patient resides. There will be no penalties for noncompliance with HIPAA rules.

Private Insurance 

Psychiatrists and psychologists must be licensed in the state in which the patient resides. There will be no penalties for noncompliance with HIPAA rules. It is important to check a commercial insurance providers’ rules and regulations, including specific policies in advance. Many private insurance companies will cover telepsychiatry and telepsychology appointments, but it will depend on the person’s specific insurance plan.You may appeal your insurance company’s denial to cover remote sessions.

The American Telemedicine Association and Federation of State Medical Boards both have information on state policy and laws to address coronavirus. Many health systems are also waiving patient copays for virtual treatment.

In response to coronavirus, large employers are also encouraging employees to use Employee Assistance Programs for remote based mental health services and resources.

Mental Health Apps

There are thousands of mental health apps available, and the Coronavirus has led to a spike in usage. The American Psychiatric Association (APA) cautions about the limited evidentiary support for these apps and suggests them as a complement, not a replacement, for treatment.

There are two mental health app directories users can consult to find a mental health app, namely the NHS Apps Library and PsyberGuide in partnership with Anxiety and Depression Association of America.  The NHS Apps Library lists apps that have been “approved” following assessment using a number of criteria including effectiveness, security and technical stability. PsyberGuide includes ratings based on “credibility, user experience and expert review,” and a credibility score that “represents the strength of the scientific research support for the app itself, and the therapeutic interventions the app provides.”

A few anxiety and stress apps with a credibility score of four out of five or higher include This Way Up, Brain HQ, Headspace, Woebot, Good Days Ahead, CogniFit, Calm, Mood Mission and Sanvello. PTSD Coach from the U.S. Department of Veterans Affairs also has good quality evidence to support its effectiveness.

According to Dr. John Torous, who leads  the APA’s workgroup on the evaluation of smartphone apps, the top evidence-based mental health apps are: IntelliCare, Breathe2Relax, CBT-i Coach, Stop, Breathe & Think, DBSA Wellness Tracker, Virtual Hope Box, and Medisafe. Five well known teletherapy apps that offer connections to a licensed therapist are AbleTo, Betterhelp, Online-Therapy, Talkspace and 7-Cups.

It is always important to seek and receive mental health treatment when needed, particularly during a stressful situation like the coronavirus outbreak. We cannot wait until this pandemic is over to get the mental health care we need. The best possible care is what can help us get through this crisis safely.

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This blog post is for informational purposes only. Independent inquiries should be made with health care providers, insurance providers and mental health apps directly. The mention of mental health apps in this blog post does not constitute or imply their endorsement or recommendation by the author or NAMI.

Reliable Resources: NAMI COVID-19 (Coronavirus) Resource and Information Guide, Find Your Local NAMI, American Psychiatric Association, American Psychological Association: Pandemics, Anxiety and Depression Association of America (ADAA), Psychology Today Therapist Directory, Centers for Disease Control (CDC), World Health Organization (WHO), SAMHSA Disaster Distress Helpline: 800-985-5990, NAMI HelpLine: 800-950-6264, Crisis Text Line: Text HOME to 741741 and National Suicide Prevention Lifeline: 800-273-8255.

Author’s note: A survey of people with mental illness by ForLikeMinds analyzed by Yale University.  Program for Recovery and Community Health found that 39% and 38% of respondents, respectively, fear not being able to receive mental health treatment and running out of medication during the pandemic, which may contribute to the fact that 64% of people surveyed were concerned that their condition would worsen. The ForLikeMinds Coronavirus Mental Health Concerns Survey is ongoing. We encourage you to take our survey. Results are publicly available on the ForLikeMinds website.

Katherine Ponte is a mental health advocate, writer and entrepreneur. She is the founder of ForLikeMinds, the first online peer-based support community dedicated to people living with or supporting someone with mental illness, and Bipolar Thriving, a recovery coaching service for caregivers and their loved ones affected by bipolar disorder. She is also the creator of the Psych Ward Greeting Cards program in which she personally shares her recovery experiences and distributes donated greeting cards to patients in psychiatric units. She is in recovery from severe bipolar I disorder with psychosis. She is also on the board of NAMI New York City.