Kacie Kelly is the deputy director of the military service initiative at the George W. Bush Institute in Dallas, Texas.
The United States has been facing a shortage in mental health providers for a number of years. With the added strain of COVID-19 to the health system, that shortage will be felt even more as many of the nation's best treatment programs are closing their doors to reduce patient exposure and to create capacity for coronavirus health care needs.
Roughly three out four Americans are living under strict social distancing restrictions, and 3.3 million Americans filed for unemployment last week. Many more are dealing with the added stress of financial uncertainty. The shortages in the mental health workforce are of particular concern, especially with veterans suffering from post-traumatic stress or traumatic brain injury. Feelings of uncertainty, anxiety and depression can be heightened at a time of crisis. For those with a history of traumatic experience, these emotions can be detrimental. For some, it can lead to long-term mental health challenges, perhaps even suicide.
Telemental health, if optimized, is a solution in providing care to those who need it most. Unfortunately, existing licensure and regulatory limitations restrict many providers and health care organizations from fully utilizing telehealth tools and resources. Some state governors are beginning to loosen these regulatory constraints, but more can be done.
Most mental health clinicians who are available to provide care are able to do so only within their home state where they are licensed. One exception to this licensure barrier is within the Department of Veterans Affairs (VA). As a federal agency, clinicians are credentialed to deliver care across the country. On the other hand, private-sector providers face unwieldy barriers to providing care for patients in other states. Additionally, we know that the majority of veterans do not receive care from the VA.
In order to limit a second looming crisis in this country, the Centers for Medicare & Medicaid Services (CMS), along with state governors across America, should consider increasing the workforce power that is available to support the mental health demand across the United States for not only veterans but all Americans.
We applaud CMS and several governors for taking a number of actions recently to address some of the country's health care needs. For example, psychiatrists, who hold M.D. licenses, are allowed to see patients via videoconferencing in their homes, regardless of geography. CMS has also waived privacy policies and is allowing individuals to use more popular video-conferencing platforms such as Skype and FaceTime.
Furthermore, until recently, insurance companies would pay providers less money if they delivered care through telehealth, thus discouraging such practices. Now, they are paying them equal amounts to in-person visits.
It was heartening to see CMS expand telehealth coverage across the professions for all Medicare beneficiaries, inclusive of doctors, nurse practitioners, clinical psychologists, licensed clinical social workers and other providers. The coverage expansion should include all Americans, not only Medicare beneficiaries. This will help mitigate the risk of a mental health crisis in the future.
However, the overwhelming majority of talk therapy that is delivered in this country is by professions such as psychologists, social workers and licensed practicing counselors, who are not able to provide telehealth services across state lines.
The George W. Bush Center's Warrior Wellness Alliance was established to connect more veterans to effective care for mental health and brain health challenges by linking veteran peer networks and high-quality programs. The Alliance would like to see CMS and state governors take actions to reduce state-based licensure barriers across all mental health professions, so more veteran families can access these resources.
Many of our clinical partners offer telemental health as part of their programming, but all Americans, including veterans, could receive care if actions were taken to remove state-based telehealth restrictions across the country.
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