Hope for the Future: Seeking Solid Ground in Behavioral Health in 2021

At the beginning of 2020, we never could have imagined that the development of a vaccine for a virus would be the highlight of our year. It gives us all hope for a better future. Some of the other hardships we have endured this year also bring hope for positive changes in the behavioral health landscape.

Through all the extraordinary challenges of 2020, we have learned much that can serve us in 2021 and beyond. This year’s watershed moments have taught us that the pressure for immediate solutions in a crisis can sometimes produce lasting changes for the better.

Dramatic Changes in Daily Interactions

At the risk of stating the obvious, let’s review some of the seismic shifts that occurred this year:

• The coronavirus pandemic flipped our normal way of life on its head.
• Infection control and prevention became a public priority.
• Immediate families were thrown together 24/7, juggling childcare, work, and school in the home.
• Extended families were separated and discouraged from gathering for fear of endangering one another.
• Issues of racial equity and violence against Black people boiled over and became more prominent.
• Businesses closed or cut back, and many people lost their jobs, their income, and their health insurance.
• Political dissension worsened, and differences among family members and friends became magnified.

Adapting Behavioral Health Amid Crises

While Americans dealt with the effects of these dramatic developments, 40% of adults reported struggling with mental health or substance use in late June, as reported by the Centers for Disease Control and Prevention.

As changes in public and private expectations occurred in response to these upheavals, many people had to carry on without their familiar support networks. Amid these ups and downs, the behavioral health landscape shifted:

• Fear of the unknown, increases in anxiety and depression, and the desire for help coping with loss increased the demand for mental health services.
• Provision of services shifted to virtual more than in-person visits.
• Congress temporarily allowed reimbursement for telehealth under federal programs in many care settings.
• Racial trauma became more widely recognized and discussed.
• People with substance use disorder were forced to find virtual support systems to prevent relapse.
• Trauma of all kinds percolated as the effects of the COVID-19 pandemic spread.
• Organizations struggled to acquire the personal protective equipment necessary to keep their teams and clients safe for in-person treatment.

To respond to all these pressures, organizations worked to find different ways of reaching clients. As a behavioral health service provider, you may have recognized that more flexible approaches were desirable. Even when the potential benefits were evident, policies and procedures did not support quick implementation of innovations.

When COVID-19 entered the picture, “this really very quickly and profoundly altered the way that behavioral health care services are provided,” Frankie Berger, Director of State Policy and Advocacy for the National Council for Behavioral Health, said. In a recent webinar, Relias: Regulatory, Financial, and Workforce Impact of COVID-19 for Behavioral Health, Berger noted, “One of the biggest changes with lasting impact is this shift that we’re seeing to widespread telehealth services.”

Existing Technology Supports Telehealth

Before the pandemic, telehealth was an option, but not as widely available. Although many clients desired the option of virtual visits, questions circulated about how reimbursements would work, how technology could be used, and how privacy could be preserved.

The baby steps that telehealth took before the pandemic turned into giant leaps in 2020. Policy makers’ and organizational leaders’ reservations faded amid the public health crisis. Forced to find temporary solutions, they allowed widespread use of telehealth.

With pervasive use of telehealth, barriers to mental health and substance use services have dwindled for many people. Those who are benefiting include people in rural areas far from behavioral health offices. People with mobility limitations, work schedule restrictions, caregiver challenges, and many other challenges now have more convenient options.

In addition, some people previously may have been reluctant to seek assistance for fear of having their presence at a behavioral health site noticed by community members. Telehealth supports their privacy concerns as well.

Even support groups recognized that virtual meetings provided good options for many people dealing with substance use disorders. Isolation can make substance use issues even more difficult. Online meetings have served as a lifeline for people who rely on peer support.

If government leaders and legislators can get the funding and reimbursement issues nailed down for permanent use, telehealth can be a strong option in the future for many behavioral health clients.

As Berger noted, many states are working to ensure that telehealth flexibility remains in place after the public health emergency ends.

Increasing Awareness of Racial Inequities

At the same time that Americans were adjusting to the difficulties imposed by the COVID-19 public health crisis, longstanding inequities came to the fore when instances of violence against Black people gained widespread public attention. Racial issues became more visible in the news and the subject of fresh conversations at work and home.

Across the country, people began voicing their concerns by protesting and demanding change. Then, disturbing clashes among protesters, police, and opposing groups shook the foundations even further.

Media coverage was both beneficial and detrimental, as Jamila Holcomb, Ph.D., LMFT, noted in a Relias webinar on racial issues. The news highlighted the systemic trauma experienced by many Black people and exacerbated it. Unfortunately, the increased coverage negatively affected individuals’ mental health and their feelings about being able to enact change, she said.

Amid this discord, many people learned the term “racial trauma.” As Holcomb explained in the webinar, the term refers to the physical, emotional, and psychological pain associated with experiencing or witnessing racism or discrimination.

As public awareness of racial inequities increased, individuals who had experienced this type of trauma had an opportunity to share their experiences and find support. Issues related to lack of accessible behavioral health services gained the spotlight as well.

In response, many clinicians looked inward to explore their own explicit biases. With sometimes new awareness, clinicians committed to ensuring safe and healing environments for all people.

Preparing for Future Shifts

Although it would be nice to believe that stability will magically return on January 1, that is not reality. Looking forward, the aftershocks of 2020 will continue to favor systems that allow flexibility and adaptation.

Amid all these life altering changes encountered this year, education played a role in navigating these difficulties.

Behavioral health organizations will naturally continue to seek solid ground in the future. While doing so, we can acknowledge that online communication saved the day, every day, amid the pandemic.

Training was another valuable tool this year. In a recent survey, Relias found that 80% of health and human services agencies noted moderate or major changes in the use of online learning this year. Some of the topics prioritized amid the COVID-19 crisis were employee wellness and self-care, pandemic planning and response, infection control, and telehealth.

Then issues related to racial equity gained public attention, and leaders expressed the desire for more exploration and understanding. At that point, training on diversity, equity, and inclusion became a stronger need.

Relying on Education To Aid Preparation

As we all strive to move beyond the unexpected twists and turns of 2020, behavioral health organizations can support continued learning and enhanced staff competency. A knowledgeable staff is naturally in a better position to adapt and build up new support systems when any type of dramatic shift occurs.

Opportunities for education and growth that will be top of mind in the coming months and years include:

• Promoting resilience among staff and clients.
• Providing trauma-informed supervision and care.
• Supporting alternative ways of seeking mental health and substance use services.
• Increasing sensitivity to racial trauma.
• Preparing to adapt to changes in the healthcare market.
• Implementing systems that allow more tailoring of services to individual needs.

Behavioral health providers will always work to support their clients’ health and wellness. Focusing on their own health and wellness is just as important, especially as they emerge from this difficult year. With 2020 in the rear view, “resilience” is the word for 2021.