As the new coronavirus began spreading across the country, what was an infectious disease crisis also became a behavioral health emergency. Compared to a year ago, the rate of people reporting symptoms of anxiety and depression has tripled from April through June, according to the weekly Household Pulse Survey, a new product from the National Center for Health Statistics and the US Census Bureau.

The pandemic’s impact on the mental health of people of color is especially pronounced. Roughly 4 in 10 Black, Latino, or mixed-race people report symptoms of anxiety or depression at above-average rates. Deep societal injustices and related inequities in access to health care underlie the course of the pandemic and the resulting  behavioral health crises. We believe rates of anxiety, depression, substance use, and suicide may not have peaked yet.

CHCF remains dedicated to partnering with mental health and substance use disorder providers and leaders to advance behavioral health care in the face of this public health crisis.

That is why CHCF’s work to improve behavioral health care is so timely. We are focused on integrating and improving services that provide care for mental health, substance use, and physical health, especially for people insured through the state’s Medi-Cal program. Before the COVID-19 outbreak, we were concentrating our state policy efforts on reforms proposed in the state’s CalAIM initiative. Those changes have been delayed for at least a year by the pandemic and resulting recession, and we now see new opportunities set in motion by the crisis to advance better models for mental health and substance use disorder (SUD) services.

Telehealth’s Time Has Come

Because of COVID-19, telehealth is having a big moment. Early in the pandemic, the federal and California state governments temporarily relaxed rules for reimbursing health care providers for services delivered over the phone or by video. It also became easier for providers to care for telehealth patients across state lines. For now, physicians are permitted to prescribe medications to treat opioid use disorder following a telehealth appointment. CHCF is supporting research on these legal changes, assessing their short-term effects, and evaluating whether they should be made permanent.

Fortunately, behavioral health services are well suited to remote delivery. Many providers have pivoted rapidly and are working hard to ensure continuity of care for consumers. To help behavioral health providers develop practical skills in delivering care via telehealth, CHCF supported a 12-part webinar series created by the California Institute for Behavioral Health Solutions. The July 8 webinar focused on recognizing and countering implicit bias, and the July 15 webinar explored the experiences of providers offering telehealth in communities of color. All webinars are available to view. We invite you to check them out.

Telehealth isn’t a magic bullet. Remote visits can’t replace everything that providers did before the pandemic, and smaller providers may be challenged to survive. The outlook for county realignment funds — the source of most of the county dollars that sustain specialty behavioral health services in Medi-Cal — is murky. In this uncertain environment, payment and financing reform are more important than ever.

Building a Smarter, More Efficient, and More Person-Centered System

With behavioral health needs escalating and health care funding at risk,  CHCF is pursuing other ways to improve a system in which most people who need care fail to receive it.

• We are supporting research that looks at the health care experiences of people with co-occurring serious mental illness and substance use disorders. Researchers are interviewing dozens of people to better understand how they seek help and experience treatment, and what they want and need from mental health, SUD, and social services providers. We plan to publish this work this year.
• CHCF supports the UCSF, UC Davis, and UCLA schools of nursing in their development of California’s first remote-learning, post-master’s degree certificate for psychiatric mental health nurse practitioners. The volume of applications was overwhelming, and the first class of 45 students has been admitted, although the pandemic delayed the program until next year. In its first five years, the program will train 300 of these specialists, doubling the number who otherwise would have completed training. The new providers will expand care to an estimated 378,000 patients, many of whom live in underresourced communities.
• CHCF is working with California state officials and UCLA to develop a website for evidence-based, culturally competent resources. It will link to the state’s CalHOPE support line and other resources.

Our colleagues on the front lines of the pandemic have adapted to ensure that they continue providing essential care to Californians despite profoundly challenging conditions. CHCF remains dedicated to partnering with mental health and SUD providers and leaders to advance behavioral health care in the face of this public health crisis.

Catherine Teare

Catherine Teare is associate director of CHCF’s People-Centered Care team, which works to ensure that Californians — particularly those enrolled in Medi-Cal — receive responsive, comprehensive, and coordinated care that supports their health and well-being. She leads the foundation’s work on behavioral health care, including behavioral health integration in primary care and behavioral health interventions for high-cost populations. She also manages projects related to the county role in health care delivery and oral health care. Read More

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Katherine Haynes

Katherine Haynes is a senior program officer in CHCF’s People-Centered Care team, which works to ensure that Californians — particularly those enrolled in Medi-Cal — receive responsive, comprehensive, and coordinated care that supports their health and well-being. She uses research, strategy and organizational design, futurism, and design thinking to create scalable, sustainable programs. Read More

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