Nearly overnight, the norm Massachusetts residents once knew for attending school, going to work, and meeting with friends and family, was flipped. The COVID-19 pandemic brought lockdowns, social distancing and mask mandates, and much of everyday life transitioned online.
These sudden changes brought about massive mental strains to teens and adults statewide. Increased rates of suicide and mental illness spikes both across the nation and the state — specifically for depression and anxiety-related cases — forced health experts and policymakers alike to take a hard look at the resources available for those suffering from the changes brought on by the pandemic.
But just as school, work and family interactions moved online, so did treatment. Telehealth services, virtually unused pre-pandemic, became the main mechanism of patient outreach.
“This is a serious problem. It’s really a crisis nationwide,” said Tony Piro, director of operations for behavioral health at Emerson Hospital in Concord. “Our state in particular is responding to it by devoting more money and effort toward building outpatient structures that really don’t exist so we can keep people out of the hospital.”
According to a trends report, Massachusetts saw a nearly 20% increase in outpatient mental health services during the pandemic months, while the number of substance abuse-related cases remained relatively stagnant.
“A lot of people have not been able to seek treatment because it is not available. And some of the numbers I believe are artificially depressed because of that,” Piro said. “In other words, it does not appear that people seeking help for substance abuse is higher, but that may not accurately entirely reflect the need for substance abuse treatment.”
A majority of recorded mental health cases were attributed to anxiety and depression brought on by a lack of social interaction and other pandemic-instigated factors.
According to Dr. Maurizio Fava, chief psychiatrist at the Department of Psychiatry at Massachusetts General Hospital, “It’s quite understandable the COVID-19 pandemic is likely to cause significant stress and psychological distress for a large proportion of the population.”
“We’ve seen a real increase in folks with more formal psychiatric illnesses — depression, bipolar disease, anxiety disorders, things like that,” Piro said.
Hospitals were forced to look to virtual care.
“There was an increase in people looking for treatment. And many of them have turned to — in the area that I really focused on — to telehealth as an alternative way of getting the treatment that they need,” said Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School.
But, like many other businesses across the state, hospitals were unprepared to make the unprecedented virtual shift.
“There are many, both medical and psychiatric practitioners, who have been using telehealth, but not a large number,” Piro said. “A lot of us weren’t prepared. And we had to sort of scramble to put together and bring ourselves into the telehealth age.”
Policymakers across the state helped cushion the blow from the sharp shift to virtual.
Lawmakers led by House Speaker Ronald Mariano, D-Quincy, and Senate Health Care Financing Committee Chair Cindy Friedman, D-Arlington, worked alongside the Baker administration to ensure insurance providers would cover all “medically necessary telehealth services” while also reimbursing providers at the same rates as in-person care.
“I have been a proponent of telehealth for a long time — it increases access to care and is an invaluable tool in the efficient delivery of health care,” Friedman said. “Fortunately, under the leadership of Senate President (Karen) Spilka and in collaboration with the House, we seized the opportunity last session to pass a bill to ensure that telehealth access remains a part of routine medical care in the commonwealth long after this pandemic is over.”
Friedman emphasized the bill’s aim to equalize health care in a time when socioeconomic factors could play a significant role in who had access to care. She highlighted the flexibility of the law that provides telemedicine services even to those without access to a computer or on-site care.
“Equalizing telehealth and in-person payment rates was critical to ensuring greater access to telehealth services, offering safe care options for patients during the pandemic, and providing a financial lifeline for hospitals, doctors and community health centers as they grappled with a dramatic decrease of in-person patient visits,” Friedman said.
Despite the fact that hospitals are now bringing patients back into their waiting rooms, many Massachusetts residents prefer virtual doctor visits from the comfort of their homes. According to Piro, telemedicine now serves as a complement to traditional methods, with doctors now having another means to see patients.
Dr. Dean Singer, owner and sole practitioner of Greenfield Primary Care, said previously that while it once seemed like an impossibility, telehealth has entered the mainstream.
“That’s going to be such a good thing for patients and for primary care in general,” Singer said. “I think sometimes we forget how quickly it gets rural — even just to get to Greenfield from the hilltowns can be difficult.”
Mehrotra believes telehealth will not only continue to play a large role in patient services, but will grow as a leading health care medium.
“I think telehealth will play a really substantial role in the treatment of mental illness moving forward,” Mehrotra said. “And it could be even the dominant form of treatment.”
Haley Chi-Sing writes for the Daily Hampshire Gazette from the Boston University Statehouse Program.