We interviewed Matthew Ruble, M.D., Director of Behavioral Health at Humana and a member of the Families for Depression Awareness Clinical Advisory Board, about how the health insurance industry has addressed mental health care access during the Covid-19 pandemic.
Families for Depression Awareness: What have been the biggest challenges for health insurers in making mental health services available during the pandemic? How has access to mental health care changed??
Matthew Ruble, M.D.: One of the greatest challenges – but also one of the greatest advances – has been the increased utilization of tele-psychiatry and tele-therapy services, in addition to digital therapy services. One indicator of higher utilization is that increases in tele-behavioral health services outpaced primary care services in the healthcare industry. With tele-behavioral health, a greater number of people have access to mental health care services. However, this shift has also highlighted technology deserts and the inequities of access to Internet services, making it that some people must continue to attend in-person appointments or simply not access mental health care.
Select insurers lowered barriers to behavioral health services by rapidly expanding tele-psychiatry services; some also waived outpatient co-pays through 2020. These two actions dramatically increased access and decreased financial barriers. In February 2021, JAMA Psychiatry published a powerful review of increased utilization of emergency departments due to drug overdoses and suicide attempts. Despite efforts to reduce barriers, it’s apparent that there need to be different approaches to get people into care before these crises occur.
FFDA: Have more people been using mental health services than previously (e.g., as compared to a couple of years ago)?
Dr. Ruble: I believe there are mixed results here. I look at the Centers for Disease Control and Prevention (CDC) Household Pulse Survey and the World Health Organization (WHO) Pulse Survey, which show the percentage of adults who report symptoms related to mental health disorders. These have revealed increased rates of symptoms of anxiety and depression and reported substance use issues, so we know there is a greater need. However, at the beginning of the pandemic, when health care providers and facilities restricted on-site service delivery and hospital emergency rooms were overrun with Covid-19 patients, there was a decline in mental health care utilization. Despite tele-mental health ramping up quickly, I believe that overall utilization is below pre-pandemic levels and not everyone needing care is accessing it.
FFDA: As a psychiatrist, which changes in the delivery of mental health services do you expect to see kept in place after the pandemic? What other approaches to expanding access do you support?
Dr. Ruble: I believe tele-behavioral health services are here to stay. Also, a recent review of patient-centered medical homes, an effort to integrate primary care and behavioral health services, highlighted the fact that the use of technology for communication with members with serious mental illness (SMI) significantly improved access to care and quality of care and decreased the costs. I would like to see this effort increase.
FFDA: On a related subject, it seems to me that there is a bit of formulary-tightening going on, meaning insurers may be restricting the medications that they cover. Is that your perception as well?
Dr. Ruble: The Trump administration was set to change how the six protected classes of medications (such as anti-depressants, anticonvulsants, and oncology agents that were required to be kept on the formulary) were handled by insurers. However, on March 16, 2021, the Biden administration announced it was tabling those changes. I am not aware of other formulary changes, but clinicians would have first-hand experience with any changes in or difficulties with their patients accessing medications.
FFDA: How can caregivers support their loved ones in getting the mental health care they need in this time when there is so much competition for the available providers?
Dr. Ruble: Reach out to your insurer’s customer service or behavioral health line and explore the possibility of telepsychiatry, teletherapy, and digital therapy. If your loved one doesn’t already have a provider, narrow down the options and get on waiting lists. In addition, caregivers can support themselves by accessing similar services or virtual support groups.
- Understand the Role of a Family Caregiver
- Get Started with Finding Care
- Watch our Caregiver Conversations: Tele-Mental Health with Dr. Nicole Christian-Brathwaite
- Take Advantage of Using Health Insurance for Mental Health Care