'You can see people under pressure' — pandemic exacerbates behavioral health problems

Addiction is a “disease of isolation,” and the COVID-19 pandemic has certainly contributed to the isolation of people in need – posing new challenges for care providers and exacerbating mental health problems across the population.

“At a time when we’re seeing use and addiction amplified, we’re seeing a decrease in capacity … for the system to serve those in need,” Amy Dellwo, public policy director for NUWAY, told the House Behavioral Health Policy Division Wednesday.

“You can see people under pressure,” said Paul Fleissner, director of behavioral health for the Department of Human Services.

However, some adjustments intended to help patients get the care they need have proven to be “game changers at the local level,” giving the state a chance to consider new strategies to improve access, he said.

The changes include:

• allowing a broader use of telemedicine services, including in Targeted Case Management, psychiatric care provider services, and School-Linked Mental Health programs;
• initiatives to improve access to Medical Assistance and MinnesotaCare coverage;
• extending recertification timelines for mental health programs and waiving licensing requirements for providers, which alleviated administrative burdens and allowed providers to focus on treatment and patient care; and
• grant management flexibilities.

Telehealth – which saw a particularly sharp spike in use from February to April that decreased as more providers were able to open their offices for in-person services – has proven particularly promising in many ways, testifiers said.

Preliminary findings from a study being conducted by NUWAY and the University of Minnesota suggest that people who receive both in-person and telemedicine services have better outcomes than both people who receive only in-person or only video services, Dellwo said.

Having that option helps people sustain treatment when they might otherwise stop and allows them to work around limitations connected to the demands of everyday life, like transportation and child care, said Kirsten Anderson, executive director of AspireMN.

“It allows that flexibility for … clients to manage those other parts of their life,” Dellwo said.

Unfortunately, the technology has limitations and doesn’t work for all clients, said Neerja Singh, behavioral health clinical director at the Department of Human Services.

Young children don’t engage in treatment the same way they would when face-to-face with care providers, and people with inconsistent internet access, inadequate technology, or cramped living conditions still struggle to access treatment, testifiers said.

BIPOC communities are also not using telemedicine services as extensively as others, and lack support in accessing services, Singh said.

Racial disparities are one of several long-standing problems that have persisted or been exacerbated by the pandemic, including workforce shortages in both mental health and substance abuse treatment fields, and difficulties connecting clients with culturally responsive providers, testifiers said.