A behavioral health crisis should lead to regulatory changes

Co-authored by Soteri Polydorou, Medical Director of Addiction Services at Northwell Health.

We see all the headlines: suicide rates are rising, overdoses are rising, and cases of depression and anxiety are rising.

It will be difficult to change the direction of these trends unless the treatment becomes as freely available as the substances on our streets.

We learned lessons during the height of the COVID-19 pandemic. For example, when the government relaxed some well-meaning regulations, it freed up the healthcare industry to provide care more broadly. This included the ability to increase services remotely, resulting in a surge in telehealth visits.

Data from the Department of Health and Human Services showed Medicare visits rose to 52.7 million in 2020 from less than 1 million before the pandemic. These visits were particularly helpful for behavioral health. HHS reported that remote visits accounted for about one-third of behavioral health visits, compared to 8% of visits to primary care providers.

We also know that remote care has helped. There were concerns that the lack of in-person contact from providers offering care for substance use disorders could lead to an increase in overdoses among people in treatment. This did not happen in part because behavioral health professionals were remotely prescribing needed medications to patients and providing telehealth services.

But we need to do more, because too many people don’t have access to the care and treatment they need. The encouraging news is that we can enlist the support of our broader healthcare system to help you. Given that, like the COVID-19 pandemic, the issue of access to mental health is a crisis, we must be allowed to be more flexible in how we deliver care.

A good example: for the better part of 20 years, physicians in offices were allowed to prescribe or dispense buprenorphine, a drug effective in the treatment of opioid use disorder, as part of a broader treatment plan.

This helped patients access treatment without waiting for — or paying out of pocket — for behavioral health appointments. Since COVID-19, it is also allowed to be prescribed via telehealth, which allows greater flexibility to initiate the new treatments. However, that could change if the relaxed but still temporary regulations are not extended permanently.

In addition, it would help if access to methadone were carefully relaxed. Methadone treatment, for example, can only be provided in certain licensed drug rehabilitation and outpatient settings. Access is limited due to these restrictions, which create barriers. Methadone is a very effective treatment for opioid use disorder, but requires regular clinical monitoring and evaluations. Allowing more knowledgeable providers to prescribe methadone in medical settings will further de-stigmatize addictions and improve access to treatment.

The regulatory aspects of mental health care are only part of facilitating access for all. It is, however, a problem that we can solve quite easily if everyone pulls in the same direction. For the sake of everyone struggling with mental health issues, let’s make this happen.

If you or someone you love is considering suicide, seek help immediately. For 24/7 help, contact the National Suicide Prevention Lifeline, 1-800-273-TALK, or contact the Crisis Text Line by texting TALK to 741741. To find a therapist near you you, visit the Psychology Today Therapy Directory.

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