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Behavioral Health in a Time of Social Isolation

Dr. Julianne Holt-Lunstad

Health Care Council Hosts Second Virtual Panel

In late April, the Nashville Health Care Council hosted its second panel discussion via Zoom. "Virtual Models of Care: Behavioral Health in a Time of Social Isolation" addressed long-term effects of social isolation and loneliness, the potential fallout from the COVID-19 crisis, and innovations helping providers adapt to the 'new normal' and reach those in need through telehealth.

The event was moderated by Susan Dentzer, senior policy fellow for the Duke-Margolis Center for Health Policy. She was joined by panelists Julianne Holt-Lunstad, PhD, professor of Psychology and Neurosciences at Brigham Young University; Patrick J. Kennedy, former congressman (D-RI) and co-founder of OneMind and Nashville-based Psych Hub (see Sharing Best Practices in Behavioral Health); and Rob Rebak, CEO of ForeFront Telecare and a graduate of the Nashville Health Care Council Fellows Program.

Holt-Lunstad, who has spent her entire career researching how social relationships can influence physical health, noted, "In light of the current pandemic, it is critical that we have evidence-based information and actionable steps to help protect the public."

She pointed to a National Academies of Science report released in February, prior to the pandemic, that underscored loneliness and social isolation as major public health concerns. "When it comes to long-term health effects, we have very robust evidence that social isolation and loneliness are independent risk factors for premature mortality and that social connection is a significant protective factor," she said.

Referencing a metanalysis of 3.4 million participants that Holt-Lunstad and colleagues at BYU conducted, they found loneliness is associated with a 26 percent increased risk for earlier death, social isolation a 29 percent increased risk, and living alone a 32 percent increased risk for death from all causes. Conversely, a metanalysis of 148 studies found being socially connected increases the odds of survival by 50 percent. She noted the studies followed participants for an average of more than seven years with the outcomes being long-term effects. Holt-Lunstad stressed the risks outlined should not be seen as evidence to disregard COVID-19 social distancing recommendations.

Nonetheless, she continued, many people are feeling significant distress and concerns due to the quarantine recommendations.

"To a certain extent, these feelings of distress are normal. This is our body signaling a need to reconnect, just like hunger signals us to eat and thirst signals us to drink water," explained Holt-Lunstad. "Loneliness is thought to be a biological drive that motivates us to reconnect. When we lack proximity to trusted others, our brain and body respond with a state of heightened alertness that can increase blood pressure, stress hormones and inflammatory processes which, if experienced on a chronic basis, can put us at increased risk for a variety of chronic illnesses. So, we need to be vigilant to mitigating these effects."

She added the healthcare system plays an important part. The National Academies report, she said, outlined five key goals for enhancing the role of the healthcare system in addressing the impacts of social isolation and loneliness:

  • Develop more robust evidence-based strategies for effective assessment, prevention and intervention,
  • Translate current research into healthcare practices,
  • Improve awareness of health and medical impacts of loneliness and social isolation across both the healthcare workforce and the public,
  • Educate and train the healthcare workforce on best practices, and
  • Strengthen ties between the healthcare system and community-based networks.

Patrick J. Kennedy

Turning to Kennedy, he said as someone living in long-term recovery, "I have spent my life focusing on mental health and addiction treatment." While he has worked for decades advocating for mental health parity, he said it has largely been hard to gain a lot of traction. He noted the current crisis, while a tragedy, might help open some minds to the fact that all of us are affected to some degree by mental health symptoms and issues.

He described the current public health crisis as pouring gas on "the fire of disconnectedness." Kennedy added, "I love that we can share remotely through new forms of technology, but I know firsthand there is no substitute for the personal connection of a 12-step meeting and being part of a recovery community in person."

In preparation for what comes next, Kennedy said, "We've been very active in trying to get mental health provisions in all of these stimulus bills so that we're ready to deal with the tsunami of mental health crises that we're expecting in the wake of COVID-19."

He added, "I'm convinced we're going to lose more people to suicide and addiction than the coronavirus. We need to help both, but the double standard for lives lost to mental health is staggering, and this crisis highlights the disparity." Kennedy said we should be pushing out certified community behavioral health providers, Medicaid funding and block grants to facilitate infrastructure of treatment. "We need to prepare now for the other half of COVID-19: The mental health crisis," Kennedy stated.

Rob Rebak

Rebak, whose company connects behavioral health providers to rural facilities, said he has been focused on safety, understanding changes and helping others during the pandemic. Trying to stay on top of the massive regulatory, reimbursement, technical and funding changes has been all-consuming for behavioral health organizations.

However, Rebak added he was encouraged and heartened by the number of people who were making it a priority to step up to help others during a difficult time. As phase three of his company's "Rural Health Strong" program, ForeFront offered their network of behavioral health professionals to volunteer using the company's platform for free to serve those on the frontlines.

As a telehealth company, he said social distancing rules have put virtual care platforms front and center during the coronavirus outbreak. Rebak noted telehealth is part of the solution to Americans' mental health needs and that a tremendous amount of progress has been made in the last two months. "The pandemic has been an accelerant to increase access, decrease cost and increase quality of care," he said. "The numbers are staggering: Telehealth visits per year that are normally in the 2 percent to 3 percent range will triple or quadruple in a matter of months in response to the pandemic."

While the decreased restrictions around telehealth have been beneficial for behavioral healthcare during the pandemic, Rebak admitted they would need thorough review to ensure HIPAA compliance going forward. However, he said those issues could be addressed. He called what's happened over the last few months "a dramatic accelerator" for utilizing telehealth and noted mental health services, which typically don't require invasive procedures like drawing blood, are a natural fit for the medium.

"I'm really happy to finally see more parity for mental health, finally see more parity for telehealth. It's about time, so keep going," said Rebak.

Rebak said the crisis has somewhat forced the tech-enabling of providers. However, Kennedy said much more work remains to be done on the technology infrastructure side and pay parity pieces of the puzzle to truly "do this right" and have a robust lasting impact.


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Behavioral Health, Julianne Holt-Lunstad, Mental Health Parity, Nashville Health Care Council, Patrick Kennedy, Rob Rebak, Susan Dentzer, Telehealth
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