Mental healthcare driving forces for change

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Some evidence of COVIDrelated mental health issues has been published appendix pp 1—6 , but it is preliminary and needs to be supported by well designed longitudinal studies. The results of these surveys are heterogeneous, probably because of differences in methods used, study locations, and the timing of the studies in terms of the course of the pandemic. Quarantine can also contribute to stress, anger, 8 , 11 , 13 and an increase in risky behaviours such as online gambling. In previous pandemics, quarantined children were more likely to develop acute stress disorder, adjustment disorders, and grief than were those who had not been quarantined.

The pandemic could also exacerbate mental health conditions—and further limit scarce access to mental health services—in people living in humanitarian and conflict settings. For people with COVID, lack of contact with their families or loved ones during quarantine and hospital stays can produce psychological instability.

High rates of post-traumatic symptoms have been reported in clinically stable people discharged from hospital after recovering from COVID People who have had COVID can experience post-intensive-care syndrome, which comprises cognitive, psychological, and neurological symptoms. Emerging reports 38 , 39 suggest the possibility of a post-viral syndrome that resembles depression.

The possibility that SARS-CoV-2 is neurotropic emphasises the need for evaluation of potential short-term and long-term effects on the nervous system.

Because of their life circumstances, people with pre-existing mental health disorders might have a higher risk of SARS-CoV-2 infection than those without mental health disorders. Physical distancing can be challenging in these contexts, either because the nature of patients' conditions makes it difficult to manage eg, people with learning disabilities or because of overcrowding eg, prisons.

Increased death rates in assisted living facilities have been reported worldwide, 51 especially among older people and people with learning disabilities. People with pre-existing mental health disorders have reported increased symptoms and poorer access to services and supports since the onset of the COVID pandemic. People with serious mental illness and associated socioeconomic disadvantages are particularly at risk of both the direct and indirect effects of the pandemic.

Health-care workers, 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 especially those working on the frontline, have reported negative consequences as a result of stress exposure and fear of infecting themselves or their loved ones. These symptoms were more common in women than in men, in nurses than in physicians, in respondents from Wuhan than in those from other cities, and in frontline workers directly engaged in diagnosis and treatment of COVID or providing nursing care for affected patients than in those fulfilling other health-care roles.

These challenges, usually observed in military contexts, have been faced by health-care staff during the COVID pandemic, which has necessitated very difficult decisions about how to prioritise scant or inadequate resources, potentially resulting in deaths that might not have occurred under normal circumstances.

The COVID pandemic could provide an opportunity to improve the scale and cost-effectiveness of different mental health interventions. After the severe acute respiratory syndrome outbreak in Canada and Hong Kong in —04, most adverse psychological consequences of physical distancing and quarantine resolved without the need for specialised mental health care.

These people will need professional psychological support and are likely to be affected by public messaging emphasising the usefulness of voluntary quarantine and the altruism of self-isolating.

Education, self-care, and family support should form part of mental health prevention strategies, which should involve multiagency collaboration among housing, education, and employment services, with support from the voluntary and mental health sectors.

These agencies should mobilise social support networks and work with local communities to help address identified stressors and encourage those in need to seek help from mental health services. Different strategies for community outreach have been used. In the USA, for example, mental health providers and programmes have organised food delivery for vulnerable community members and worked with community leaders to ensure the inclusion of mental as well as physical health concerns in programmes.

Almost all mental health services have implemented infection-control measures. Pre-admission quarantine periods have been effective in some countries, 53 , 88 but implementation might be problematic in low-income countries, many of which had insufficient bed numbers before the pandemic. Physical-distancing requirements might further decrease their limited capacity.

Mental health-care adaptations for infection-control reasons could have been detrimental to people whose treatment has been reduced or who have been confined alone in hospitals with greatly reduced therapeutic programmes. Services have promoted changes to facilitate access, including widespread use of telehealth and virtual meetings for medication management, nursing, case management, vocational interventions, and peer support.

Home-based treatment is an essential part of COVID mental health services and will be key to future service configurations to prevent the spread of infection and perhaps also as a more acceptable alternative to inpatient treatment for some service users and their families.

Efforts need to be made to maintain community support for people with severe mental illness. The threshold for hospital admission for mental illness varies among individuals and depends on the risk of hospital-acquired infection, which will change over time. Admission decisions are therefore complex, require continuous adaptation, and should be informed by the availability of community support.

Access to appropriate psychiatric voluntary or involuntary and medical treatment including ICU treatment needs to be guaranteed for SARS-CoVpositive patients with mental disorders. Most countries have strengthened public health protocols, including guidance on how to access mental health support. Many countries have dedicated teams comprising managers and volunteers to provide mental health support for health-care workers 6 , 73 , and psychiatric liaison services.

Initially, in China, teams set up psychological treatment services for health-care workers, but few people used them. In the UK, these measures proved very popular, with one acute-care hospital noting a footfall of staff through the room on its third day Cross S, King's College Hospital, personal communication. Teams of health-care workers should be encouraged to support and monitor each other, and team leaders should be trained to identify serious issues.

For the family members and loved ones of people with COVID, coping with the people they care about having to deal with illness alone and possibly dying in isolation is potentially traumagenic.

Increases in complicated grief are likely to occur due to the circumstances of death during the pandemic. COVID raises numerous ethical questions and dilemmas, including potential discrimination related to both SARS-CoV-2 status and mental ill health in adjudicating access to insufficiently available health interventions and applying and weighing the added risk of SARS-CoV-2 exposure in decisions about involuntary institutionalisation.

Ethnic and racial disparities in access to mental health care raise numerous social justice concerns about the distribution of resources and underlying social drivers of inequality.

The emergence of the second wave of the Black Lives Matter movement has drawn attention to how systemic racism and discrimination affect health outcomes and other domains central to recovery from the COVID pandemic eg, employment, education, housing.

For the best outcomes, the users of mental health services and their families need to feel empowered to take ownership of their healing journey.

The relative risks and benefits of treatment changes to limit potential exposure to SARS-CoV-2 eg, for users receiving clozapine, injectable medications, or electroconvulsive therapy should be considered. Treatment plans might need to be rapidly renegotiated, and should be based on best practices.

There is thus a need to enhance and create robust resources to support shared decision making. Service users should be centrally involved in the development of mental health-care services and systems.

The role of service users in guiding person-centred approaches in mental health services is well established if not consistently implemented in Australia, Canada, New Zealand, the UK, and the USA, is rapidly becoming more common in Switzerland, and is developing slowly in some Asian and Latin American countries.

Clinical service design and delivery can also be strengthened by increased peer worker involvement in the co-design of adapted services and by increasing the number of peer workers involved in service delivery, particularly in countries with limited resources for mental health. Most importantly, decision makers must commit to maintaining adequate mental health service provision for current and future needs. Community monitoring and mental health screening could be implemented in selected groups, or digital health and digital phenotyping could be used to switch from individual-based approaches to population-wide screening.

Mental health professionals with experience in social sciences and community-based services should also advise regulators to develop, implement, and assess strategies for dealing with the pandemic and its aftermath. For people experiencing acute distress who are at risk of developing long-term conditions and those who do not trust or engage with mainstream mental health services, the facilitation of diverse and flexible access to mental health care is particularly important.

Local community-led, user-led, and family-led organisations and small independent peer-support initiatives have quickly mobilised to provide immediate help and guidance during the pandemic. Vulnerable populations, including patients with mental health issues, have been disproportionately affected by changes to public transportation systems, housing and emergency shelter infrastructure, and unemployment, as well as by social isolation and loneliness.

Remote community treatment and support has long been suggested, but has not previously been implemented widely because of barriers and challenges from both health-care staff and service users.

There is already some evidence of short-term success, , and remote service delivery could also have longer-term advantages, especially in countries with low investment in mental health services and low capacity. However, there are also challenges and drawbacks associated with the use of remote therapies, especially in people who might be in most need. Potential issues include access to the requisite technology and the knowledge to use this technology , internet access, data allowance costs, and privacy and data security.

Digital therapies thus might not be appropriate for older people, people with reading difficulties, poor people, or people who are not technologically adept. Knowledge from countries with a history of deploying digital services for widely dispersed populations eg, Australia, Canada should be harnessed.

Australian research suggests that information technology staff should be available to offer technical support during the early stages of switching to video-conferencing to deliver treatment, particularly for older people or people with low technological literacy. Free internet is sometimes available in public places, but gatherings of people at these sites to access this service could complicate physical distancing. Homeless people and asylum seekers generally do not have internet access, and when they do, it tends not to be private.

A systematic approach to internet and device access is suggested for vulnerable populations, and needs to be a key funding consideration. In addition to technological proficiency, therapists and others offering support need to develop a so-called webside manner to support and maintain the important therapeutic alliance that mediates recovery.

The rules governing remote therapy in countries including the USA have been relaxed, so that some medications can be prescribed remotely without the need for routine face-to-face contact. If telehealth care is to be continued, the minimum acceptable levels of privacy and security need to be clearly defined, as do the processes by which this flexible form of care can be securely organised and reimbursed. In addition to telehealth, there are opportunities for digital services to track health via passive and active monitoring.

The need to be flexible has required rapidly and constantly adapting teamworking and problem solving in response to changing needs. Teams have had to develop efficient, multipronged communication strategies, which are especially valuable in times of confusion.

Experience from previous pandemics and global research have provided mental health teams with the information needed to adapt services. Strategies that mental health service users have successfully used to adapt to coping during the pandemic, at least during the acute phase, should be researched and leveraged. Technological solutions to support collaboration between general practice and community and inpatient teams have advanced, and facilitate moves between different services.

Similarly, liaison psychiatry has increased collaboration with other medical specialties and helps to organise the services required to support mental health teams, patients, and their families. Adaptations have been implemented in response to the COVID crisis table , and it is essential to systematically assess their effects on defined indicators and outcomes before new long-term mental health practices are planned and developed.

Comparison of data for the transmission of SARS-CoV-2 and COVID morbidity and mortality in people with mental health disorders with the corresponding data in the general population by country and region should help to elucidate which procedures effectively control disease spread in mental health settings, which approaches have the greatest positive effect on COVIDassociated morbidity and mortality panel , and which strategies should be prioritised should a similar situation occur in the future.

Similarly to Holmes and colleagues, 7 we consider prevalence assessments of mental health oucomes and comorbidities in different populations to be essential in the post-COVID era. These data will aid the design and development of appropriate mental health treatments and help to identify patients with a continued need for care. Potential effects of health service changes on access to, and quality and outcomes of, mental health care during and after the COVID pandemic.

COVID monitoring and use of mental health services in individuals with pre-existing mental disorders. The availability and uptake of COVID related health information; the prevalence of severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 diagnostic tests, antibody tests, and vaccination if and when available ; and, among people who test positive for SARS-CoV-2, the prevalence of outpatient, inpatient, intensive-care, and ventilator treatment for COVID, and COVID mortality, should be assessed on an ongoing basis in clearly defined cohorts of persons with pre-existing mental disorders and cognitive or intellectual disabilities including psychiatric inpatients and outpatients and people with mental or cognitive disorders in residential settings, prisons, etc.

These data should be compared with the corresponding data in the general population. The frequency of face-to-face, video, and telephone contact with different types of mental health providers; rates of prescription and use of psychiatric medication; rates of emergency mental health treatment and psychiatric hospitalisation; and the proportion of patients with severe mental disorders lost to follow-up should be compared with the corresponding data from before the pandemic.

In people with pre-existing mental or cognitive disorders, the incidence and prevalence of changes in the severity of the underlying disorder, medication or treatment adherence, social or occupational dysfunction, and suicidal behaviour, and the potential emergence of comorbid substance use problems should be compared with the incidence and prevalence of these outcomes before the emergence of COVID objective and subjective measures should be used.

In people with no pre-existing mental or cognitive disorders and people with previously resolved mental disorders —both the general population and specifically people at high risk of psychological problems eg, frontline health-care workers, isolated elderly people, relatives of people who died from COVID —the incidence, severity, and duration of all types of mental disorders, including common mental disorders primarily anxiety and depression , post-traumatic stress disorder, substance use disorders, behavioural disorders, in children and adolescents , and suicidal behaviour should be compared to the incidence, severity, and duration of these outcomes before the emergence of COVID The following indicators should be continuously assessed during and after the pandemic and compared with corresponding indicators before the COVID pandemic to establish COVIDrelated changes in local and national delivery systems for mental health:.

In this new climate, the use and effectiveness of mental health services—including those already available and new or adapted services—should be regularly monitored.

This monitoring should focus on accessibility especially for elusive populations, such as frontline workers, people with severe mental disorders, and racial minorities and clinical outcomes associated with different mental health services before, during, and after the pandemic. Routine monitoring of health-care disparities that links socioeconomic, race, and ethnicity data with measures of quality measures is also crucial panel. There is an opportunity to replace the old way of managing the gap between the supply of and demand for mental health care ie, rationing with a system that prioritises high-quality and equitable care rather than focusing only on how much work is done.

Subjective experience and acceptability of new approaches should guide changes and inform the need to adapt to changing mental health needs. Service users and carers have identified clinical outcome measures that adequately capture their experiences. This approach requires a reorientation towards user-defined outcomes, including the family view, and mechanisms to collect service users' views on evolving expected outcomes. The outcomes of regular monitoring should be reported, along with outcomes of the other measures proposed.

The psychological toll of the disease is already apparent both in the general population and specifically in people with mental disorders particularly those with severe mental illness and cognitive impairment and frontline workers. Mental health systems have rapidly changed during the pandemic and a sustained response to the challenges posed by COVID needs to be coordinated.

Despite heterogeneity in political, social, and health systems, mental health services worldwide have implemented acute responses that focus on infection control, continuity of care for mental health service users, and facilitating access to mental health assessment and care for patients with new-onset issues and high-risk patients. Some new approaches that have been developed seem efficacious, but they might still be associated with risks. Implementation of a COVIDrelated physical and mental health monitoring system that includes outcomes related to mental health service use would inform practice, and could help to shape optimal mental health care for the times to come.

Retaining existing services and promoting new practices that expand access and provide cost-effective delivery of effective mental health services to individuals who already have mental disorders or who have developed them during the pandemic should be a priority. Service provision needs to be individualised: effective practices already in place should be refined and scaled up, and both the usefulness and limitations of peer support and remote health delivery should be recognised.

A focus on accountability based on routine measurement of meaningful and valued outcomes, co-production of service design and evaluation with expansion of health insurance coverage of mental health, and promotion of primary care support and its greater integration with secondary care could further help to sustain mental health care in the aftermath of the pandemic.

It is important to be cognisant of the risks of promoting cheap solutions to broadening access to mental health care. Low-quality mental health care based on affordability without assessment of quality or monitoring of needs and efficiency will only contribute to increasing inequalities and worsening mental health globally. Now more than ever, we need to put in place service provision that targets health needs and reduces disparities, both globally and within individual countries.

Despite substantial cross-national differences in social and mental health systems, we believe that such an approach is feasible with some location-specific adaptations. It could even turn the COVID pandemic into an opportunity to improve mental health care for everyone. In April and May, , an international panel of mental health experts, service users, and family carers from 14 countries, acting in a personal capacity and as representatives of two international patient organizations Global Alliance of Mental Illness Advocacy Networks-Europe and EUFAMI , assembled to assess the potential effects of the COVID pandemic on community mental health and changes to mental health services.

This online publication has been corrected. The corrected version first appeared at thelancet. All authors attended two online meetings to establish the structure and scope of the Position Paper. Thereafter, participants joined one of six writing groups to produce the first draft. CM and CA participated in all meetings to ensure coherence and continuity, and drafted the final manuscript.

CM coordinated the writing and editing of the Position Paper, which was reviewed, revised, and approved by all authors. All other authors declare no competing interests.

Lancet Psychiatry. Published online Jul Author information Copyright and License information Disclaimer. All rights reserved. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source.

See editorial " Mental health matters " in Lancet Glob Health , volume 8 on page e This article has been corrected. See Lancet Psychiatry. Associated Data Supplementary Materials Supplementary appendix. Abstract The unpredictability and uncertainty of the COVID pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities.

Potential consequences of COVID for mental health General public Some evidence of COVIDrelated mental health issues has been published appendix pp 1—6 , but it is preliminary and needs to be supported by well designed longitudinal studies.

People with pre-existing mental health disorders Because of their life circumstances, people with pre-existing mental health disorders might have a higher risk of SARS-CoV-2 infection than those without mental health disorders. Health-care workers Health-care workers, 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 especially those working on the frontline, have reported negative consequences as a result of stress exposure and fear of infecting themselves or their loved ones.

Public mental health responses and community outreach After the severe acute respiratory syndrome outbreak in Canada and Hong Kong in —04, most adverse psychological consequences of physical distancing and quarantine resolved without the need for specialised mental health care.

Mental health-care settings Almost all mental health services have implemented infection-control measures. Mental health needs of special populations Many countries have dedicated teams comprising managers and volunteers to provide mental health support for health-care workers 6 , 73 , and psychiatric liaison services. Sustainable adaptations of mental health delivery Ethics-driven and rights-driven considerations COVID raises numerous ethical questions and dilemmas, including potential discrimination related to both SARS-CoV-2 status and mental ill health in adjudicating access to insufficiently available health interventions and applying and weighing the added risk of SARS-CoV-2 exposure in decisions about involuntary institutionalisation.

Service user knowledge and involvement For the best outcomes, the users of mental health services and their families need to feel empowered to take ownership of their healing journey. Longer-term mental health needs Many questions remain about how to mitigate the mental health effects of the COVID pandemic. Remote therapy Remote community treatment and support has long been suggested, but has not previously been implemented widely because of barriers and challenges from both health-care staff and service users.

Assessment of mental health outcomes in clinical practice Adaptations have been implemented in response to the COVID crisis table , and it is essential to systematically assess their effects on defined indicators and outcomes before new long-term mental health practices are planned and developed. Table Potential effects of health service changes on access to, and quality and outcomes of, mental health care during and after the COVID pandemic.

Open in a separate window. The proportion of all mental health services provided in inpatient, emergency, institutional eg, prisons , outpatient, community, and home-based settings. Rates of face-to-face, video, and telephone contact with different types of mental health providers. Access to, and use of, different mental health services both by people with pre-existing mental health disorders and those with new incident cases of mental illness, and the sociodemographic characteristics of these users.

Quality of care of different mental health services including acceptability and satisfaction with health-care providers , with a focus on user expectations and satisfaction and on functional, vocational, and clinical outcomes including families' or carers' views.

Disparities in mental health care, with socioeconomic, race, and ethnicity data linked to quality measures. Integration of mental health services with general health services, social welfare, and other institutions eg schools, prisons and community associations. Governmental and non-governmental financial support for mental health and social care services, and for research focusing on the monitoring and improvement of mental health services.

Search strategy and selection criteria In April and May, , an international panel of mental health experts, service users, and family carers from 14 countries, acting in a personal capacity and as representatives of two international patient organizations Global Alliance of Mental Illness Advocacy Networks-Europe and EUFAMI , assembled to assess the potential effects of the COVID pandemic on community mental health and changes to mental health services.

Supplementary Material Supplementary appendix: Click here to view. References 1. Cucinotta D, Vanelli M. Acta Biomed. Economic crisis and mental health in Spain. Trends in racial-ethnic disparities in access to mental health care, — Psychiatr Serv.

Adhanom Ghebreyesus T. World Psychiatry. Multidisciplinary research priorities for the COVID pandemic: a call for action for mental health science. Psychiatry Res. PLoS One. Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the COVID epidemic in Southwestern China.

Med Sci Monit. A nationwide survey of psychological distress among Chinese people in the COVID epidemic: implications and policy recommendations. Gen Psychiatr. J Affect Disord. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease COVID outbreak in January in China. Comparison of the indicators of psychological stress in the population of Hubei province and non-endemic provinces in China during two weeks during the coronavirus disease COVID outbreak in February Coping behaviors associated with decreased anxiety and depressive symptoms during the COVID pandemic and lockdown.

Brain Behav Immun. Zhang Y, Ma ZF. Impact of the COVID pandemic on mental health and quality of life among local residents in Liaoning province, China: a cross-sectional study. Immediate psychological responses and associated factors during the initial stage of the coronavirus disease COVID epidemic among the general population in China. KFF coronavirus poll. March The psychological impact of quarantine and how to reduce it: rapid review of the evidence. J Behav Addict. Providers have an opportunity to leverage emerging technology to enable these interventions as well—but doing so will entail significant shifts in the way behavioral health care is delivered today.

An enormous array of technology options is emerging that can support patient care, such as self-guided, gamified treatment to virtual assistants and AI that can be used to ensure better care for patients through enhanced digital triage processes, augmented and virtual reality treatments, and computational psychiatry.

Care providers can leverage each of these changes—and many more—to deliver better outcomes for their patients. Meanwhile, providers will need to augment workforce capacity through community and in-home behavioral health care to ensure individuals receive treatment as early as possible.

Physicians of all specialties will simultaneously need to integrate preventive behavioral health treatment into care. Both steps will require creative workforce planning and tailored education. To that end, providers globally will need to continue to lean further into value-based financing models that compensate providers based on the overall quality of care.

Such a shift will allow providers to invest in the preventive care required for behavioral health, mitigating any downstream financial consequences for earlier intervention. The challenges of these shifts—from implementing a new culture to aligning workforce incentives with organizational goals—can be tremendous.

Nurturing a collaborative relationship with insurers and aligning on goals to address behavioral health will be essential to succeeding in this context. An array of disruptive technology is already emerging to support—or compete with—major players in the behavioral health ecosystem. Virtual assistants are AI chatbots and emotion-based algorithms that provide psychological support often based on clinical techniques , information, and resources using a natural interaction that is low stigma and scalable.

Emerging example : Tess is a mental health chatbot that delivers emotional well-being coping strategies to its users. Digital consumer experience technologies are platforms that manage the patient relationship, monitor and exchange health information between patient and caregivers, and connect the patient with auxiliary tools to enhance their experiences.

Emerging example : NeuroFlow provides a suite of tools to enable remote monitoring and behavioral health integration across the continuum of care, including psychology, primary care, and pain management settings.

Diagnostic support technologies are screening tools, both self-guided and assisting medical diagnosis, that gather diagnostic data and provide psychological assessment to identify symptoms for early detection and improved classification. Emerging example : Unmind is a workplace mental health platform empowering organizations and employees to measurably improve their mental well-being through scientifically backed assessments, tools, training, and signposting.

Neurological interventions offer improved and new surgical, ingestible, and non-invasive interventional tools to observe and affect brain and body function. Emerging example : WVU Medicine recently launched a clinical trial using deep brain simulation DBS for patients suffering from treatment-resistant opioid use disorder.

DBS, or brain pacemaker surgery, involves implantation of tiny electrodes into specific brain areas to regulate the structures involved in addiction and behavioral self-control. Digital phenotyping systems offer customized treatment, monitoring, and clinical decisions from new biomarkers enabled by wearables and IoT devices to obtain biofeedback, track changes, and deliver new interventions in real time.

Physical, augmented, and virtual reality offers psychological intervention using hyper-realistic virtual environments and real-world robotics for companionship, experiential treatment sessions, and enhanced cognitive experiences. Doing so is crucial to business success: It will be required both to compete effectively for talent and to help workers thrive.

Such an effort might include having employees opt into passive behavioral health data collection that can be leveraged to support employee needs. The greatest challenges employers will need to navigate in this context are ethical and cultural. In the process, employers must also show employees that engaging with their behavioral health at work will not harm their career trajectory.

As a starting point, employers could appoint ethics and health data protection officers to manage and protect data, as is the case with private health information across the world. They can also go beyond traditional employee assistance programs to offer higher quality, differentiated behavioral health support that allows employees to pursue their well-being holistically.

Employers not familiar with the delivery of such services may stumble in implementing them. To mitigate the challenge, they might consider a partnership-based approach that leverages the expertise of other parties in delivering their new benefits and services. Ultimately, these future opportunities indicate that players across the behavioral health landscape will need to work together closely to adapt to current trends. Without collaboration and integration, each player will not be able to fully realize the potential for change.

Policymakers and regulators have an opportunity to play a powerful role in facilitating this integration. They must work across the full ecosystem to build alignment and consensus and ensure individuals with the greatest behavioral health needs have health care coverage and are a part of the integrated system of care.

In the process, they should continuously focus on building trust—both with the public at large and with players across industries. To help make these opportunities possible, policymakers will need to continue to prioritize new investment in behavioral health solutions in both local and national government. While the budget constraints created by the pandemic and its economic fallout are forcing leaders to make difficult decisions, it has become clear that investment in behavioral health is even more important in these trying times.

Ensuring adequate institutional architecture to serve individuals with acute challenges will be a part of this process. Policymakers will also need to consider ways to systematically enable monitoring and care by leveraging new technology.

This process must include creating expansive licensing requirements for behavioral health specialists that allow specialists to leverage telehealth to work nationally or even internationally.

In the process of caring for these changes, policymakers will need to work with other industry players to ensure that there is government-sponsored support for the shifting reimbursement models that will be required to support the future of behavioral health. For policymakers, managing the ethical and regulatory gray areas that exist around behavioral health will be a necessary part of this process. They will need to play a role in making sure that consumers have ownership over their behavioral health data and take steps to create organizations like centers for data ethics that support effective management in an increasingly interoperable world.

Meanwhile, as awareness of behavioral health conditions increases, stigma breaks down, and as significant scientific breakthroughs occur, policymakers will have to consider regulations that guarantee corporations do not discriminate against individuals based on their behavioral health. As always, pursuing such a policy and regulatory agenda will include considering the fine balance between the needs of corporations to deliver on the goals of their owners and shareholders and those of the individuals they employ.

Ultimately, in making policy decisions to create the future of behavioral health, governments will need to focus on integration across insurers, care providers, and employers. The goal to serve all people who are struggling with their behavioral health benefits all stakeholders, but it is much more likely to be achieved if different stakeholders work together.

Doing so will generate value on multiple levels—creating business value, improving health and wellness, and building stronger, more resilient societies across the world. View in article. Paul E. Vikram Patel, Shekar Saxena, et. Nirmita Panchal, et. Key trends in agency, virtual health, remote monitoring, and data-sharing , Deloitte Insights, August 13, We are helping companies reshape the life sciences and health care industry as they prepare for a future of health defined by radically interoperable data, open yet secure platforms, and consumer-driven care.

She is also a Member of the Deloitte Australian Executive. A Consulting Partner, with over 25 years' experience, she leads our most strategic or complex health care projects globally. Stephanie leads our pre-eminent work on the 'Future of Health'. This explores global market trends to , the use of innovative technologies, new pricing models, disruptive entrants, new models of care and the health workforce of the future.

This dashboard brings together health, economic and social data in real time to enable countries to make more informed decisions on the impact of government interventions across multiple dimensions. Prior to becoming a consultant, Stephanie led national reform programs in the health, social care and criminal justice sectors across the UK and Europe. He leads a range of strategy and innovation projects across healthcare and public health. He has deep experience supporting organizations in the United States and globally to better achieve their missions and create impact for patients, communities, and society.

At Deloitte, he has served health plans and providers, life sciences, government and public sector, non-profits and foundations, and innovators and startups, all working to transform for the future of health. Based in Boston, she has extensive experience in helping healthcare companies grow and transform to keep pace with the evolving healthcare landscape.

Specifically, Olga focuses on innovation and growth for health plan, retail health, and life sciences clients. Recent examples include behavioral health clinical product strategy at a national plan, growth strategy for a specialty pharmacy looking to diversify their assets and footprint, pharmacy consumer experience transformation planning, developing options to address the social determinants of health that impact members of a regional plan, and designing market-level provider engagement strategies for a new Medicare Advantage-focused regional plan.

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To stay logged in, change your functional cookie settings. Social login not available on Microsoft Edge browser at this time. Viewing offline content Limited functionality available. Welcome back. Still not a member? Join My Deloitte. The future of behavioral health by Dr. Article 23 minute read 07 January Stephanie Allen Australia. David Rabinowitz United States. Matthew Piltch United States. Olga Karlinskaya United States.

Disruption factors that will create change What types of opportunities will these disruption factors create? Executive summary ThE global COVID pandemic, its economic fallout, and the companion global confrontation with issues of social justice have together caused enormous strain on the mental and behavioral health of people across the globe.

Learn more Explore the health care collection Learn about Deloitte's services Go straight to smart. Four barriers to positive change The four largest barriers to improving behavioral health are gaps in scientific and clinical knowledge , the stigma associate with behavioral health , ineffectual and sub-scale care systems , and siloed health care management. Six disruption factors driving the future of behavioral health We believe there are six disruption factors that will drive meaningful change in the future of behavioral health.

Opportunities for health care players Insurers, care providers, employers, and government policymakers each have distinct opportunities to build on the disruption factors and create a better future for behavioral health. Technology that is set to transform the behavioral health ecosystem An array of disruptive technology is already emerging to support—or compete with—major players in the behavioral health ecosystem.

Cover image by: Gordon Studer. View in article Paul E. View in article Vikram Patel, Shekar Saxena, et. View in article Nirmita Panchal, et. View in article Show more Show less. Global Health Care Sector We are helping companies reshape the life sciences and health care industry as they prepare for a future of health defined by radically interoperable data, open yet secure platforms, and consumer-driven care. Learn more Get in touch. Download Subscribe. Related content Interactive 3 days ago.

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