By Haley Chi-Sing
Boston University Statehouse Program
BOSTON – Nearly overnight, the norm Massachusetts residents once knew for attending school, going to work, meeting with friends and family, was flipped. The pandemic brought statewide lockdowns, social distancing and mask mandates and everyday life – including school and extracurricular activities – to a standstill. Reality was now solely an online phenomenon.
These sudden changes, although implemented cautiously at the start, brought about massive mental strains to teens and adults statewide. Increased rates of suicide and mental illness spikes both across the nation and the state – specifically for depression and anxiety-related cases – forced experts and policymakers alike to take a hard look at the resources available for those suffering from the changes brought on by the coronavirus pandemic.
But just as school, work and family interactions moved online, so did treatment. Telehealth services, virtually unused pre-pandemic, became the main mechanism of patient outreach.
“This is a serious problem. It’s really a crisis nationwide,” said Tony Piro, director of operations for behavioral health at Emerson Hospital in Concord. “And a lot of states, our state in particular, is responding to it by devoting more money and effort toward building outpatient structures that really don’t exist so we can keep people out of the hospital.”
According to a trends report released, the commonwealth saw a nearly 20% increase in outpatient mental health services during the pandemic months while the number of substance abuse-related cases remained relatively stagnant.
“A lot of people have not been able to seek treatment because it is not available. And some of the numbers I believe are artificially depressed because of that,” said Piro. “In other words, it does not appear that people seeking help for substance abuse is higher, but that may not accurately entirely reflect the need for substance abuse treatment.”
A majority of recorded mental health-related cases were attributed to anxiety and depression brought on by a lack of social interaction and other pandemic-instigated factors.
According to Dr. Maurizio Fava, the psychiatrist-in-chief at the Department of Psychiatry at Massachusetts General Hospital, “It’s quite understandable the COVID-19 pandemic is likely to cause significant stress and psychological distress for a large proportion of the population.”
“We’ve seen a real increase in folks with more formal psychiatric illnesses – depression, bipolar disease, anxiety disorders, things like that. A lot of ASD kids, it’s with autism spectrum disorders, whose services have been limited during the pandemic,” added Emerson’s Piro.
Hospitals were forced to look to virtual care.
“There was an increase in people looking for treatment. And many of them have turned to – in the area that I really focused on – to telehealth as an alternative way of getting the treatment that they need,” said Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School.
But, like many other businesses across the state, hospitals were unprepared to make the unprecedented virtual shift.
“There are many, both medical and psychiatric practitioners, who have been using telehealth, but not a large number,” Piro said. “So a lot of us weren’t prepared. And we had to sort of scramble to put together and bring ourselves into the telehealth age.”
Policymakers across the state helped cushion the blow from the sharp shift to virtual.
Lawmakers led by House Speaker Ronald Mariano, D-Quincy, and Senate Health Care Financing Committee chair Cindy Friedman, D-Arlington, worked alongside the Baker administration stating that insurance providers would cover all “medically-necessary telehealth services” while also reimbursing providers with the same rate as in-person care.
“As Majority Leader, Speaker Mariano was involved in a years-long effort in the Legislature to provide coverage for telehealth services. During that time, in-person treatment remained the overwhelmingly preferred and more popular method of accessing health care services,” said a spokesperson. “The pandemic, and the public health restrictions put in place in response, changed that dynamic and provided the necessary push to settle the long-standing issues that had previously prevented consensus.”
Friedman echoed the need to expand telehealth to make health care more accessible to the most vulnerable in the community.
“I have been a proponent of telehealth for a long time – it increases access to care and is an invaluable tool in the efficient delivery of health care,” said Friedman. “Fortunately, under the leadership of Senate President Spilka and in collaboration with the House, we seized the opportunity last session to pass a bill to ensure that telehealth access remains a part of routine medical care in the commonwealth long after this pandemic is over.”
Friedman emphasized the bill’s aim to equalize health care in a time when socioeconomic factors could play a significant role in who had access to care. She highlighted the flexibility of the law that provides telemedicine services even to those without access to a computer or on-site care.
“Equalizing telehealth and in-person payment rates was critical to ensuring greater access to telehealth services, offering safe care options for patients during the pandemic, and providing a financial lifeline for hospitals, doctors, and community health centers as they grappled with a dramatic decrease of in-person patient visits,” said Friedman.
In an article, Dr. Lee H. Schwamm, director of the center for telehealth at Massachusetts General Hospital, stressed the importance of telehealth services during the pandemic and post-pandemic.
“It will be important for health systems to reap the benefits of this digital innovation to redesign inpatient and ambulatory care delivery now and in the future, as we transition from clinical surge to a recovery phase.”
As the state works to resume normalcy post-pandemic, the integration of telehealth services continues to be a priority for hospitals and health care providers.
Despite the fact that hospitals are now bringing patients back into their waiting rooms, many Massachusetts residents prefer virtual doctor visits from the comfort of their homes. According to Piro, telemedicine now serves as a complement to traditional methods, with doctors now having another means to see patients.
Mehrotra said telehealth will not only continue to play a large role in patient services but even grow as a leading healthcare medium.
“I think telehealth will play a really substantial role in the treatment of mental illness moving forward. And it could be even the dominant form of treatment.”
This article was part of a package created by the Boston University Statehouse Program about the effects of the COVID-19 pandemic in Massachusetts.