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April 30, 2020

Virtual Models of Care: Behavioral Health in a Time of Social Isolation

Virtual Models of Care:  Behavioral Health in a Time of Social Isolation
On April 22, the Nashville Health Care Council hosted its second virtual panel discussion, “Virtual Models of Care: Behavioral Health in a Time of Social Isolation,” for more than 120 Council members who tuned in via Zoom videoconferencing. The panel addressed the serious long-term health effects of social isolation and loneliness, the urgent need to address mental health during the COVID-19 crisis and beyond, and telehealth innovations helping frontline health care providers adapt to the “new normal.
The conversation was moderated by Susan Dentzer, senior policy fellow, Duke-Margolis Center for Health Policy. Panelists included Patrick J. Kennedy, former congressman (D-RI), co-founder of OneMind, and founder of The Kennedy Forum; Rob Rebak, CEO of ForeFront Telecare, and fellow, Nashville Health Care Council; and Julianne Holt-Lunstad, Ph.D., professor of psychology and neuroscience, Brigham Young University.
According to a National Academies of Science report released in February, social isolation and loneliness are major public health concerns. Holt-Lunstad shared statistics from a Brigham Young University metanalysis of 3.4 million participants that found loneliness is associated with a 26% increased risk for earlier death, social isolation a 29% increased risk, and living alone a 32% increased risk. Conversely, a metanalysis of 148 studies found being socially connected increases the odds of survival by 50%. She noted the studies followed participants for an average of more than seven years, and that these risks should not be seen as evidence to disregard COVID-19 social distancing recommendations.
“When it comes to long-term health effects, we have very robust evidence that social isolation and loneliness are independent risk factors for premature mortality and social connection is a significant protective factor,” said Holt-Lunstad. “Many people are feeling significant distress and to a certain extent, these feelings are normal. This is our body signaling a need to reconnect, just like hunger and thirst signal us to eat and drink. Loneliness is a biological drive to reconnect. When we lack proximity to trusted others, our brain and body respond with a state of heightened alertness that can increase blood pressure, stress hormones and inflammatory processes which, if experienced on a lingering basis, put us at risk for chronic illness.”
Kennedy reaffirmed Holt-Lunstad’s statement, describing the current public health crisis as pouring gas on “the fire of disconnectedness.”
“I love that we can share remotely through new forms of technology, but I know firsthand there is no substitute for the personal connection of a 12-step meeting and being part of a recovery community in person,” Kennedy said. “The coronavirus crisis is a terrible tragedy, but it will open minds to the fact that all of us are impacted in some degree by symptoms of mental health.”
Kennedy also acknowledged the disparity between mental and physical health care and warned that our health care system must act now to prevent a bigger crisis following the coronavirus. “I’m convinced we’re going to lose more people to suicide and addiction than the coronavirus. We need to help both, but the double standard for lives lost to mental health is staggering and this crisis highlights the disparity. We need to push out certified community behavioral health providers, Medicaid funding and block grants that facilitate infrastructure of treatment. Right behind COVID-19 will come a demand for [behavioral health] services unlike anything we’ve seen in our history. We need to prepare now for the other half of COVID-19: The mental health crisis,” said Kennedy.
Dentzer asked Rebak to explain what ForeFront Telecare has witnessed during the coronavirus pandemic and whether telehealth is a successful intervention for support during this time. Rebak said telehealth is part of the solution to Americans’ mental health needs and that a tremendous amount of progress has been made in the last two months.
“The pandemic has been an accelerant to increase access, decrease cost and increase quality of care,” he said. “The numbers are staggering: Telehealth visits per year that are normally in the 2% to 3% range will triple or quadruple in a matter of months in response to the pandemic.”
While telehealth appointments have increased, hospital volumes for non-COVID-19 conditions have decreased, the speakers noted. Individuals experiencing strokes, heart attacks and chronic conditions like diabetes are receiving less care, which could lead to increased mortality. According to the Wall Street Journal, Spain and Italy have reported mortality rates unrelated to COVID-19 doubling in the last month.
Dentzer concluded the discussion by asking the panelists to provide one strategy they would implement now to prepare for the post-COVID-19 future. Kennedy emphasized the significance of organizations like Psych Hub, which he co-founded with colleague Marjorie Morrison, and which provides a comprehensive online learning platform for mental health, substance use and suicide prevention topics. Holt-Lunstad highlighted the need for a national resource center for training, best practices and centralized systems. Rebak acknowledged the decreased restrictions around telehealth have been beneficial for behavioral health care during the pandemic, but they will need thorough review to ensure HIPAA compliance.
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