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Mental health and substance abuse providers relying on telehealth during COVID-19

Behavioral health providers will be playing a crucial role as the COVID-19 pandemic continues to disrupt daily life. Some have already found that the isolation stemming from social distancing guidelines is causing an increase in depression and anxiety symptoms, and folks who already had mental health or substance abuse issues before the pandemic are facing more difficulty than ever before.

As their workload suddenly increased, these providers are looking to connect with clients remotely in order to protect public health. Most have phased out their in-person therapy sessions and have moved to online meetings.

The Warm Line, a confidential, non-emergency phone service operated by HOPE Incorporated, has seen an 80 percent increase in calls over the last month and a half. HOPE Incorporated provides peer-driven behavioral health services, and the Warm Line was set up to give general support and reliable resources to those dealing with mental health and substance abuse challenges. Before COVID-19, they received more than 2,500 calls each month.

The phone operators have fielded many calls relating to symptoms of anxiety, depression, and just pure fear of what is happening globally right now.

"It's definitely increased the need for services," said Michael Van Story, manager of the Warm Line. "We work with people who have depression and anxiety every day of their lives in a clinical manner. And when you cut them off from their support system or parts of their support system and further isolate them, which is the exact wrong thing to do with depression and anxiety, it only increases that fourfold."

He said the Warm Line provides an "actively listening ear" that will hear their callers' issues and concerns without judgment, and will try to relate to them and let them know how they've worked through similar situations themselves. Everyone who works at HOPE Incorporated has experienced mental health and/or substance abuse issues firsthand. They can also help with "psycho-social" issues such as being out of work, not being able to buy food or pay rent.

While the Warm Line has regular callers who use their services for ongoing challenges, they're also starting to hear from new callers who have never experienced these symptoms before.

Van Story added nine additional staff members for the increased demand, and even with three or four people working each shift they're still fighting to keep up with the calls.

"But that's OK, that's what we're here for and that's what they need," he said.

The Warm Line (520) 770-9909 is funded through a grant from Arizona Complete Health and is available for free to residents of Pima, Pinal, Cochise, Graham, Greenlee, La Paz, Santa Cruz and Yuma counties from 8 am to 10 pm daily. Callers can remain anonymous if they choose.

telehealth coverage

when governor doug ducey signed his "Expansion of Telemedicine" executive order on March 25, it required all health insurance providers regulated by the Arizona Department of Insurance to provide coverage for telemedicine services. Insurers are required to reimburse healthcare providers at the same level of payment for a telemedicine visit as they would for a regular in-person visit.

As recently as this week, some federal insurance providers refused to cover telehealth services and could do so since they were outside of the state's jurisdiction.

Richard Poppy, the owner and executive director of Desert Star Addiction Recovery Center located in northwest Tucson, said they are in-network providers with all major insurance companies including TRICARE, which is managed by the federal government and covers active and retired military members.

TRICARE had refused to reimburse Desert Star for the telehealth services it provided to its policyholders. The center specializes in Intensive Out-Patient and Partial Hospitalization programs for people with mental health and substance abuse disorders.

Poppy said TRICARE's refusal to cover their clients' costs was contradictory to the governor's goal to expand telehealth. Desert Star switched to telehealth six weeks ago in preparation for the COVID-19 pandemic to reach Southern Arizona. They are utilizing online therapy sessions and online support groups to keep their clients connected and engaged in recovery programs during this difficult time. After contacting U.S. Rep. Ann Kirkpatrick's office as well as Senators Kyrsten Sinema and Martha McSally for assistance with this issue, Poppy found vindication in a letter from the Defense Health Agency addressed to Health Net, which administers TRICARE insurance, stating that IOPs and other behavioral health programs will now be covered.

"The COVID-19 pandemic has created seismic shifts in the availability of all medical services, including behavioral health care services," said DHA Contracting Officer Frederick M. Kmiecik in the letter. "Many of these programs have either suspended operations or transitioned to online-only services to support State and Regional directives for social distancing. ... This is especially important for those patients requiring intensive behavioral health care intervention who may also have comorbid risk factors, readiness needs, or family members who may be at high risk from COVID-19, where the dangers to health or readiness must be balanced with the need for behavioral health care services."

Before this change in policy, Poppy provided services to six of his clients pro bono. He said now is a crucial time for those with substance abuse issues to be receiving care, and he couldn't deny people services just because their insurance wouldn't cover it.

"You've probably seen in the paper alcohol sales are going through the roof," Poppy said. "Someone that might have a problem, that's probably going to get exasperated, and we're starting to hear that from loved ones. On the mental health side, it's kind of the same thing. People don't have as much to do and they're just kind of with themselves and their thoughts. We're hearing about more depression and anxiety and you know, people have had some trauma in their life that's starting to pop up, those memories and those feelings, thoughts."

He expects telehealth to be a regular part of the field going forward, and hopes insurance companies and state and federal governments will understand the need for such capabilities on a regular basis, even after the COVID-19 pandemic is over.

More by Kathleen B. Kunz

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