Since the onset of the COVID-19 pandemic, behavioral healthcare providers have had to provide the best care to their most vulnerable populations while also adapting to the impacts the virus has had on facility design. To better understand the long-term effects of COVID-19 and develop solutions for our healthcare system clients, Design Leader Emily Williams and Principal Steve Wilson have researched how healthcare providers are adapting to the current pandemic and what it could mean for the future of behavioral healthcare.
1) What impact has COVID-19 had on patient mental health?
Since the pandemic, behavioral health clients are seeing higher rates of patients with mental health concerns from stress contributed to the loss of jobs, anxiety about the pandemic, isolation, and loss of loved ones, among other issues. For those with substance abuse issues, providers see increased rates of relapse due to lack of support and lack of daily structure. While patients are experiencing more mental health issues during this crisis, concerns about social distancing and fear of contracting COVID-19 have prevented some patients from accessing routine care.
2) What did telehealth look like for these patients before COVID-19, and what does it look like now?
Before the pandemic, many medical facilities could use telehealth but were rarely using it for behavioral health purposes. When used for mental health, it was most often used to reach a rural population. Several barriers impeded telehealth’s full adoption for behavioral health services, including insurance reimbursement issues, Health Insurance Portability and Accountability Act (HIPAA) regulations, and licensing.
Medicare has typically limited its reimbursement for telehealth to rural areas, and Medicaid programs often have regulations that limit the type of facility that may be a reimbursable originating site, excluding a patient’s home. For a provider to receive reimbursements, the Centers for Medicare & Medicaid Services (CMS) requires both an audio and video communication connection, making it difficult for patients without access to computers or smartphones to receive telehealth care. While HIPAA compliant telecommunications platforms do exist, they were not used regularly. Finally, state licensing requirements mandate that a provider must be licensed in every state that they accept telehealth patients, limiting a patient’s options for care.
Now, telehealth is being used regularly for behavioral health cases, and many of the barriers are now removed. The Substance Abuse and Mental Health Services Administration (SAMHSA) has recommended that the use of telehealth or telephonic services be used to provide evaluation and treatment of patients with mental or substance abuse disorders during the pandemic. Penalties will not be imposed during the pandemic against covered healthcare providers for violations of HIPAA in connection with the good-faith provision of telehealth. CMS has temporarily waived the requirement for out-of-state practitioners to carry a license from the state where they are providing services, giving patients more options, and allowing providers to care for a larger pool of patients.
Telehealth is a vital resource for many behavioral health and therapy programs. One treatment program focusing on the opioid crisis uses videoconferencing for counseling and treating patients and allows patients to connect with their peers through group therapy. Family and community support are often a vital part of a patient’s recovery. Another treatment program has prohibited visits with friends and family and have incorporated virtual communications platforms to help patients in inpatient facilities communicate with their friends and family.
3) How are behavioral health facilities adapting to the current pandemic?
Some inpatient units were already being designed with more flexibility in mind, including the ability to section off into smaller units. Some facilities are offering a mix of double- and single-patient rooms in each unit or all single beds to be able to quarantine specific patients if needed. West Springs Hospital, for example, can separate out a three or four-bed sub-unit flex area in each unit; this allows for the treatment of more acute patients. This plan is currently in use to serve patients with COVID-like symptoms. Clients should consider dedicated air systems for better infection control if these types of units are adapted. Dedicated exhaust systems for specific patient rooms or units will ensure that, in the event of infection, other units and patients throughout the facility will not be contaminated.
Clients are also realizing the need for greater access to handwashing for patients and staff, especially in common areas like group rooms and at the entrance to the dining room. For some facilities, the only place for patients to wash hands is often the bathroom in their rooms or in group spaces. Facilities are also implementing social distancing measures such as reducing the number of patients in a group therapy session either by scheduling more sessions or holding sessions in larger spaces.
4) What are some of the regulatory and budgetary impacts the current pandemic is having on behavioral health facilities?
The current pandemic may have a permanent effect on regulations, which could allow for behavioral healthcare providers to treat those in other states without a separate license through telehealth. CMS and private insurance companies may also keep policies in place to allow hospitals to bill for telehealth visits.
CMS has expanded its reimbursement policy to allow hospitals to bill for telehealth visits to patient homes, and they can also bill for audio-only psychiatric appointments when previously providers were required to use video communication to receive reimbursements. Insurance companies are waiving copays for mental health telemedicine.
5) What kinds of space needs do you predict COVID-19 will have on behavioral health facilities?
Facilities are planning for more space between people everywhere within the facility, including administration areas, dining areas, and larger entry areas for fever screenings. Facilities may also need larger spaces to conduct socially distanced group classes.
Many patients experiencing behavioral health issues sometimes seek treatment at their local emergency department (ED), and the current pandemic could lead hospitals to create crisis and stabilization units to clear behavioral health patients from the ED, protect them from contamination, and provide more specialized care for behavioral health.
With the adoption of more telehealth services, the future of behavioral health facilities could potentially include less space for private offices in outpatient facilities. Longer-term solutions might include a hybrid model of traditional care combined with new digital interventions for outpatient care. There are benefits to telehealth for behavioral healthcare; it helps avoid the stigma if patients can get help from the privacy of their homes, and more people may seek treatment. And, as care is more accessible, providers are noticing fewer “no-show” appointments. Providers may see an increase in more HIPAA compliant telehealth software, touchless technologies within the facilities such as elevators, check-in kiosks, doors, or automated disinfecting robotics to use in high-impact group or sensory rooms. Access to mental health facilities will still be a challenge for many, but increased connectivity to providers should create an avenue to improved wellness.