From the U.S. Government Accountability Office, www.gao.gov Transcript for: Demand for Behavioral Health Services Increases During the Pandemic Description: New stressors associated with the pandemic could increase the number of people seeking services for mental health and substance use issues. But this potential increase also highlights longstanding questions about the availability of behavioral health services and how they are covered by insurers. We talk to GAO's John Dicken to find out more. Related GAO Work: GAO-21-437R, Behavioral Health: Patient Access, Provider Claims Payment, and the Effect of the COVID-19 Pandemic Released: April 2021 [Intro Music] [John Dicken:] Unmet needs for behavioral health services persist and often were worsened by new challenges associated with the pandemic. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office--celebrating 100 years of fact-based, non-partisan oversight. I'm Holly Hobbs. Even before the pandemic, an estimated 52 million adults in the U.S. (about one-quarter of adults) were reported to have mental, behavioral or emotional health disorders. Another 20 million people (ages 12 and up) had substance use disorders. New stressors associated with the pandemic could increase these numbers. But this potential increase also highlights longstanding questions about the availability of behavioral health services and how they are covered by insurers. Today, we talk to John Dicken--a public health expert and a director in our Health Care Team--who has a new report out on behavioral health services. Thank you for joining us John! [John Dicken:] Thank you for discussing this. [Holly Hobbs:] So John, we're one year into the pandemic here in the U.S. What do we know about its effects on the number of people seeking or receiving behavioral health services? [John Dicken:] So, the pandemic has really increased the demand and challenges for many people that need behavioral health services. Certainly that's in part because of increased social isolation, many people facing job loss, and concerns about family or friends or their own health. We see a lot of indicators showing more people, up to 38 percent of people, according to a CDC survey, reporting anxiety or depression, which is much higher than pre-pandemic when about 11 percent of people reported that. We've also seen emergency department visits for overdoses or suicide attempts increase in 2020, up by 36 percent and 26 percent, respectively, from the year before. [Holly Hobbs:] How might an increase in demand affect people's access to care? [John Dicken:] They're challenges in terms of access to behavioral health services. Many mental health care providers have reported that they've laid off or furloughed staff. Some have even closed programs. And for even those programs that remain available, the need for social distancing has also made it harder for people who may need in-person treatment. One silver lining that we did hear, and it doesn't mitigate all of the issues, but for people who were able to make contact with mental health providers or substance use providers virtually, that's been a positive in that many people that we talked to said that there have been fewer missed appointments. But it's important to note that that tele-health services is not a substitute for the in-person services that may be needed or preferred for many people. [Holly Hobbs:] And I know we're talking about, you know, the impacts of COVID on mental health services. But, what was access like before the pandemic? [John Dicken:] Yeah, there have been long-standing challenges that certainly the pandemic has aggravated. For example, HHS has indicated that even before the pandemic, more than one-third of Americans live in areas that are designated as mental health provider shortage areas. We also heard as we talk to state officials and hospital associations that often there's a lack of community-based services and sometimes that can lead to longer hospital stays. [Holly Hobbs:] So, beyond access, what about paying for these services? How is behavioral health treated by insurers? [John Dicken:] Well historically, going back 10-20 years, insurers would often have limitations on mental health or substance use services. There have been a series of federal and state requirements that require parity so that mental health services, if they are offered, are no more restrictive than the services provided for other medical needs. We spoke to a number of health insurance regulators and hospital associations in four states and often heard anecdotal information from these groups about delays or denials of claims, most frequently with Medicaid, which is a large payer of behavioral health services. But when we asked to provide kind of data as to whether claims denials and delays have increased, very limited data to demonstrate whether that's been the case since the pandemic or how this would compare to other types of medical services. Some of the limited information that was provide either was inconclusive or did not support or was mixed in supporting the anecdotal evidence we heard. [Music] [Holly Hobbs:] So it sounds like, even before the pandemic, there were concerns about the availability of behavioral health services; and that COVID-19 could increase that demand. But that there are also concerns about whether or not behavioral health services are covered by insurers or health plans. John, what's the role of the federal government in addressing disconnect between demand and services, and also how claims for mental health coverage compare to that for other services? [John Dicken:] That's right. There are a number of federal efforts both to provide access to mental health services as well as to ensure that insurance has parity in mental health and substance use services. For example, GAO has reported on federal grant programs for increasing mental health and substance use programs for adolescents and young adults. We've also looked at compliance with federal requirements for mental health and noted that often regulators will rely on complaints or other targeted investigations of health plans and that given lack of awareness by consumers of parity requirements and even stigma for people that may have family members with mental health or substance use issues, the complaints are not necessarily a good indicator of compliance or non-compliance. And for this reason, we recommended that both HHS and the Department of Labor should assess whether there are other approaches beyond relying on complaints or targeted investigations that could better assure compliance with mental health and substance use parity. [Holly Hobbs:] And last question--what's the bottom line of this report? [John Dicken:] Yeah, there are kind of two key bottom lines. One is that longstanding, unmet needs for behavioral health services persist and often were worsened by new challenges associated with the pandemic. And also that as we talked to hospital associations and insurance regulators and other experts, we often heard concerns denials and delays in payments for behavioral health services, but unfortunately there's very limited data to assess the extent which that is occurring. [Holly Hobbs:] That was John Dicken talking about GAO's recent review of behavioral health services. Thank you for your time, John! [John Dicken:] Thanks so much! 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