Questions about mental and behavioral health have been at the forefront of many minds, especially as the COVID-19 pandemic continues. Of course, the problem did not start with COVID-19.
“Before the devastating COVID pandemic, we were experiencing an ongoing opioid crisis,” says Sheilah McGlone, RN, CCM, care management consultant, expert trainer, and active member of the Case Management Society of America. “The shocking COVID pandemic justifiably captures headlines, but the devastation of opioid overdose deaths during the pandemic are no longer hidden. New data are now being made public revealing an astounding increase in fatal overdose deaths, topping 100,000 for the first time from April 2019 to April 2020.”1
McGlone notes lockdowns, lack of socialization, financial collapses, and a pause in social services have created the perfect storm, resulting in a serious decline in mental health and a surge in overdose deaths.
“People diagnosed with serious mental illness have been unable to attend special programs or visit their providers, causing deep emotional stress and deterioration of social skills and mental stability,” she explains. “Disruption and isolation create a ‘storm of the worst possible things,’ driving an ever-growing number of vulnerable people to seek comfort in drugs.”
Amid staffing shortages throughout the healthcare system, it is increasingly difficult to provide treatment for the surge in patients. The problems are compounded, between a “lack of needed hospital beds due to patient distancing, and staffing struggles, including the ability to retain staff,” McGlone says. In homes, she adds, “family life has been disrupted due to the need for family members to monitor and oversee virtual classes for their children.”
As the bereavement community also has grown due to the loss of life related to the pandemic, additional behavioral health issues are created.
“Life as we knew it has drastically changed due to these new, unforeseen triggers resulting in mental health instability,” McGlone laments.
COVID-19 lockdowns have negatively affected the mental health of both patients and providers. The problem, too, is circular. With the overwhelming number of patients seeking treatment for anxiety, depression, bereavement, and drug use, providers are challenged to risk their own mental health to care for so many people.
“Providers are often exhausted meeting the professional COVID struggles, and often require respite and counseling for themselves,” McGlone says. “Patients feel alone and isolated, and often are unable to receive the professional help that they need.”
Other groups also suffer the consequences. “Special education students and patients previously diagnosed with a mental illness are especially impacted, often losing the progress they have made through their special education and social service programs that have been temporarily stopped,” McGlone explains.
In all categories, people who have suffered the effects of the COVID-19 lockdowns and isolations are expected to be managing these issues for the long haul.
“Patients suffering from extreme loneliness are known to have lasting effects of depression and anxiety,” McGlone says. “Those previously diagnosed with mental illness have had major setbacks due to pauses in social service programs. People who have lost family members and friends due to COVID will need time to endure the bereavement process due to the lack of in-person support groups and social contacts with friends and family.”
As the pandemic winds down, mental health provider networks should be re-established as telehealth options expand. “Hopefully, as treatment options open up, patients can progress to a healthier mental health state,” McGlone says.
Case managers and other healthcare providers should not underestimate their role in helping those struggling with behavioral health issues. They should work to expand their network to help affect positive change. Thankfully, telehealth options have helped providers offer treatment in ways that were previously more limited.
“The expansion of telehealth has assisted providers with outreach and treatment for the large influx of new patients and the maintenance of existing patients,” McGlone notes. “The ability to prescribe medication without seeing a patient ‘in person’ has had a positive impact on patient outcomes. Although not always ideal for underserved populations due to the lack of technology, it has been a tremendous help in keeping patients connected while maintaining the safety of both the patient and provider.”
As case managers determine how to best coordinate care for people who are struggling with mental and behavioral health issues, they should consider seeking special training to increase their expertise and confidence. McGlone recommends this training to especially help case managers work with complex patients with multiple mental health issues and addiction disorders.
“Respect is key [as well as] the understanding that relapse is not failure,” she explains. “An integrated case management model is more effective when one case manager establishes trust and engages with a patient across all domains of health: physical health, behavioral health, social health, and navigating the system. Barriers to improved outcomes can then be easily identified, prioritized, and immediately addressed during these challenging times.”
McGlone also suggests motivational interviewing techniques, as they have “been determined to be more successful than routine assessments when working with a patient with a substance use disorder.”
Creating a “collaborative, non-judgmental conversation will help the patient move toward their own motivation to change,” she adds. At the same time, the case manager should plan to work closely to assist mental health providers to whom patients might be referred.
According to McGlone, case managers have a great opportunity to continue assisting providers and families using “open engagement strategies” for patients with mental health issues and substance use disorders. “Don’t give up,” she encourages.
For case managers, it is always the right time to protect their own mental and behavioral health, too. “Case managers should be mindful of their own mental [and] behavioral health status,” shared McGlone. “Keeping an open conversation with peers and reaching out to services provided by local hospitals and hotlines [is key]. New York State has a Project Hope hotline with well-trained staff ready to help reduce anxiety, fear, and depression.”
McGlone, herself a mother who has lost a son, notes several options for case managers who are interested in the campaign to end the stigma surrounding mental illness and substance use disorder. She recommends case managers consider local grassroots projects in their area that provide community education on these issues, including:
- The Black Poster Project, created by a mother who lost her son to an overdose;
- Hope Not Handcuffs, founded by Families Against Narcotics.
“The pandemic, although catastrophic, has raised awareness of mental health issues and substance disorders,” McGlone says. “It is no longer a secret.”
REFERENCE
- Centers for Disease Control and Prevention. Drug overdose deaths in the U.S. top 100,000 annually. Nov. 17, 2021.
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