Addressing the COVID-19 behavioral health crisis, and building for a more resilient future

Vic Siclovan, Director, and Hanna Helms, Manager, Medicaid Challenges, AVIA

Read on to learn how health systems can expand access to behavioral health services during the initial surge, rolling recovery, and new normal.

Last week, we discussed how the COVID-19 pandemic is exacerbating America’s behavioral health crisis. This crisis is felt most acutely by the same health delivery systems that must deal with COVID-19 itself. Hospitals, health systems, and clinical practices – together with other first responders – are the front line. They bear the burden of their own stress, and must also cope with the many patients who present with a range of mental illnesses and substance use disorders.

In early 2019, more than two-thirds of AVIA’s Member health systems joined the Medicaid Transformation Project (MTP) initiatives in Behavioral Health and Substance Use Disorder (SUD). That work identified the highest priority challenges faced by these health systems, and investigated the most promising solutions. As a result, AVIA has a ready body of vetted solutions that can improve patient care and the financial integrity of care models to drive system performance for behavioral health and SUD, which have been thoroughly studied and tested for Member interest.

Even more importantly, these solutions enable health systems and health plans to meet their most urgent needs in the era of COVID-19 more rapidly and with fewer resources than would be needed for traditional care models. Some solutions also help systems take advantage of favorable, albeit time-sensitive, conditions (e.g., loosened telehealth regulations), enabling them to lay the foundation for broader behavioral health initiatives in the “rolling recovery” and “new normal” phases.


Feelings of social isolation, loneliness, and anxiety brought about by the pandemic are widespread. Health system employees, many of whom are on the frontlines of the pandemic response, are intensely affected, as are those individuals with acute behavioral health conditions. Even with numerous competing priorities, it’s critical that health systems provide behavioral health services to protect frontline staff and prevent exacerbations of behavioral health conditions that can spike ED visits and admissions in a time when preserving hospital capacity is of critical importance. We offer a few considerations below.

Focus Area 1: Health System Employees 

The most pressing need for health system leaders is keeping their workforce healthy, focused, and productive during this unprecedented time.

Healthcare workers and their families are experiencing extreme levels of stress, anxiety, and trauma. Many have also been self-isolating to prevent potential transmission and, consequently, have been cut off from their families and communities. Through the current period and likely successive waves of the virus’ diffusion, the need for ongoing, easily accessible behavioral health resources for the healthcare workforce will only grow.

Solutions: Consider beginning with the commitment to provide immediate, free access to behavioral health services to employees and their families. You may also consider extending access to solutions to first responders, other healthcare workers, and other essential services workers in the community.

Example solutions include teletherapy, online cognitive behavioral therapy (CBT), online peer support groups, and social networks that help reduce feelings of loneliness and isolation. Many digital solutions are granting temporary access to these services and are expanding their offerings to include new, COVID-19-specific modules, resources, and/or guidance at no cost. The following are several solution types to consider for this population:

  • Recovery management tools for individuals with SUD. WEconnect Health and DynamiCare Health are both offering free daily online recovery support groups.
  • Text-based peer support groups. Organizations are using Marigold Health to address loneliness and social isolation in group-based chat settings, one-on-one interactions between individuals and peer staff, and broader community applications.
  • Online CBT solutions. These tools are being used to expand access to lower-acuity behavioral health services, targeting both frontline workers and the general population. In particular, MyStrength and SilverCloud have deployed COVID-19-specific programming, featuring content focused on isolation and self-care, among others.

Focus Area 2: Individuals with Acute Behavioral Health Conditions 

During the initial surge the overwhelming focus is on containing and treating COVID-19; this disrupts services that are essential for individuals with severe mental illness (SMI) and SUD. Preventing exacerbations and maintaining as much continuity of care as possible will be critical to preventing decompensation of these patients, which could drive increased rates of ED visits and admissions.

  • Individuals who have relied on in-person community-based services, like certified community behavioral health clinics and mutual aid groups, are often experiencing service disruptions due to shelter-in-place orders.
  • Feelings of isolation and loneliness are known to increase substance misuse; in the height of the pandemic, individuals with SUD are at greater risk of recovery disruption.

Solutions: Many digital companies are hosting virtual recovery meetings and providing access to virtual peer support groups. Additionally, shifts in federal and state policies are easing restrictions around critical services, including medication-assisted treatment (e.g., buprenorphine can now be prescribed via telephone), that can mitigate risky behavior and ensure ongoing access to treatment. The following are several solution types to consider for this population:

  • Medication-assisted therapy (MAT) via telemedicine. These solutions provide access to professionals who can prescribe and administer MAT medications, provide addiction counseling, and conduct behavioral therapy (e.g., CBT, motivational interviewing) digitally. Solution companies providing these critical services include Eleanor Health, PursueCare, and Workit Health.
  • Behavioral health integration. Providing screening, therapy, and psychiatric consultations across settings of care — especially primary care — will help with the increased demand. Solutions like Valera Health and Concert Health allow organizations to scale collaborative care programs.


Following the initial surge and the heavy focus on availability of testing, PPE, and other critical functions of the emergency response, we anticipate that behavioral health will be a major area of focus. Many people have — and will continue to — experience trauma as a result of COVID-19, having lost loved-ones, jobs, and/or the ability to care for themselves and their families.

Focus area: Connecting these vulnerable individuals to the appropriate resources and services (e.g., employment assistance, financial assistance) will offset some of the behavioral health impacts of COVID-19.

Solutions: Healthcare organizations should look to new funding opportunities to develop digital infrastructure that expand access to critical services. Specifically, as part of the CARES Act, the FCC launched the COVID-19 Telehealth Program and the Connected Care Pilot Program to provide avenues for immediate funding for the build-out of much-needed digital health capabilities.

  • The COVID-19 Telehealth Program allocates $1M per successful applicant to fund telecommunications, information services, and connected monitoring devices, with a focus on healthcare providers serving high-need and low-income populations.
  • The Connected Care Pilot Program allocates a total of $100M over three years with the goals of improving health outcomes, reducing health care costs, and supporting initiatives furthering connected care. The FCC specifically cites opioid dependency and mental health conditions as areas to which they will give preference.

Finally, new telehealth flexibilities, including reimbursement for audio-only services, temporarily eased provider licensure requirements. The overall increase in use of telemedicine creates opportunities to expand access to behavioral health services in geographies previously difficult to reach.


It is difficult to say exactly what the “new normal” will look like and when it will arrive for each community, given the highly variable nature of the pandemic’s spread. But certain outcomes, highlighted below, are beginning to feel inevitable.

Focus Area 1: Increasing adoption of telehealth and remote monitoring capabilities.

Solution: Leverage initial investments made in telehealth in the surge and rolling recovery phases to develop robust tele-behavioral health capabilities that can be integrated into a larger virtual health platform.

Focus Area 2: Managing increased strain on the safety net and social services as a result of rising unemployment.

Solution: Find ways to connect newly un- or under-employed individuals to necessary services, both online and in the community, until they can secure more stable employment opportunities. Financial assistance programs, especially those that can help individuals navigate unemployment benefits and enroll in Medicaid, will be of critical importance.

Focus Area 3: Exacerbated behavioral health needs for vulnerable populations, especially those requiring high-touch in-home care.

Solution: Expand telehealth-enabled home care capabilities. Here, as elsewhere, early investments in telehealth infrastructure will allow organizations to more easily implement robust telehealth-enabled home care solutions and augment them with virtual behavioral health services.

In short, we believe that the organizations that will emerge best positioned in a post-COVID-19 world are those that recognize that investments made in behavioral health capabilities today, though initially small, will be of great benefit to their communities in the “new normal” of America’s ongoing behavioral health crisis.

Renew your commitment to behavioral health and understand where your health system stands today. Take our COVID-19 Digital Response and Readiness Pulse to see how you rank in COVID-19 capabilities for clinical care, operations, and coordination. Sign up here.

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