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In 2019, it was estimated that 1 in 5 people in the US, or more than 51 million people, experienced some form of mental health challenge. And yet, of the more than 20% of Americans with mental illness, less than half received treatment for their condition.
In the wake of the COVID-19, pandemic, though, incidences of mental illness have skyrocketed, and that trend is only expected to amplify as the pandemic itself recedes and survivors endeavor to return to “normal” life. In the face of a long-standing and worsening physician shortage, however, the US healthcare system seems little prepared to adequately address the anticipated mental health crisis to come. Nevertheless, there is hope in alternative forms of mental health care, from the use of telehealth services to the increasing role of the nurse practitioner (NP).
As stark as the 2019 statistics on mental health may be, they are likely to pale in comparison to the mental health crisis that the US healthcare system is to face in the wake of the COVID-19 pandemic. Indeed, ample evidence of the deleterious effects of the pandemic on Americans’ mental health already exists. Studies show surging rates of depression, anxiety, and substance use disorders (SUD), even among persons with no history of mental illness.
But the mental health effects of the pandemic are not expected to end with the pandemic itself. Rather, experts anticipate a significant increase in rates of mental illness as Americans move from the coping and survival stage of the crisis to the processing phase. Indeed, research into the long-term mental health effects of disaster shows that, for many survivors, the psychological impacts of the trauma are not felt while in the throes of the crisis but after, when all those feelings of pain, fear, grief, and loss can no longer be avoided in the struggle just to get by and get through.
As people attempt to resume the ordinary rhythms of life as they knew it before the pandemic, they will inevitably be faced with the realization, and the forced recognition, that not only has the world changed but so have they. And that is when the processing begins and the inevitable psychological challenges emerge. However, unlike other disasters of the modern era, which were typically localized to discrete geographic regions, states, or towns, the pandemic was both a national crisis and a global one. This means that the American health system must serve the mental health needs, not of dozens, hundreds, or thousands of disaster survivors, but of tens and even hundreds of millions in the US alone.
Even before the coronavirus outbreak, the US healthcare system was faced with a severe and worsening physician shortage. The loss of licensed and practicing medical doctors hasn’t just proven detrimental to general healthcare, but to the field of psychiatry itself. In a system in which persons with mental illness rarely receive adequate mental health care, the physician shortage will only exacerbate the insufficiency of psychiatric care in the US.
Indeed, a 2018 study found that psychiatry is one of the areas of medical specialization most severely impacted by the physician shortage. The study also predicted that, by 2025, demand for psychiatric services may exceed the number of practicing psychiatrists by 15,000 or more. How much more severe that shortfall may be in the aftermath of the pandemic, however, remains to be seen.
As the US health system braces for a mental health crisis borne of the pandemic, there is hope in the possibility of alternative care. For example, highly-trained nurse practitioners, particularly those serving as family nurse practitioners (FNP), are helping to mitigate the detrimental impacts of the physician shortage. In many states, FNPs are authorized to provide comprehensive care, from ordering tests to prescribing medications, without the sign-off of a physician.
FNPs, indeed, are playing a particularly important role in the most vulnerable and underserved communities, where the physician shortage tends to be greatest. Rural areas are a particular area of concentration for FNPs, which has important implications for psychiatric care, as the lack of access to mental healthcare also tends to be especially acute in these areas.
While FNPs often fulfill roles most similar to that of a family physician or general practitioner, their capacity to independently prescribe medication in most states enables them to offer pharmaceutical treatment to patients in need of psychotropic medications, such as antidepressants or antianxiety drugs. FNPs can also typically refer patients to specialists, circumventing the need for patients to wait weeks or even months for a consultation with a primary care physician who can make the referral.
The COVID-19 pandemic has changed healthcare in dramatic ways, but perhaps the most significant of these changes is in the ascendancy of telehealth. While telehealth is certainly nothing new, its role was significantly expanded during the peak of the pandemic as a powerful tool for providing consistent, comprehensive, and high-quality care without further burdening the traditional system.
Patients could consult with their care providers for both acute and chronic conditions, and healthcare providers could provide medications, order tests, and even prescribe remote health monitoring devices when appropriate. And this could all be done from the comfort and security of the patient’s home, without the risk of patients exposing themselves to or potentially spreading the virus in a physical clinic or hospital.
For those experiencing mental illness, the benefits of telehealth are particularly significant. With the touch of a button, patients can connect with licensed psychiatrists and trained mental health counselors at any time and from anywhere. This means no more waiting for an appointment. This means no more hustling to find transportation to the doctor’s office or worrying about the threat of the virus once there.
Indeed, the expansion of telehealth is increasing acceptance, access, and service quality and variety for practically anyone who needs care. And that may well mean that those facing mental health challenges are even more likely to receive care than before the pandemic and the surge in telehealth.
In the wake of the COVID-19 pandemic, the US health system faces a potential mental health crisis. However, in the face of a long-standing physician shortage and a notorious history of inadequate care for those suffering from mental illness, the system seems ill-prepared to address the onslaught of demand. There is hope, though, for mitigating the crisis through alternative care solutions, including the use of telehealth services and the deployment of high-trained nurse practitioners.
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