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Reasonable Expectations, Educated Guesses: Projecting Behavioral Healthcare's Future Amidst COVID-19

May 12, 2020
Ron Manderscheid
By Ron Manderscheid, President and CEO, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

As we mark three months of COVID-19 mobilization and two months of our stay-in-place odyssey, we must look forward and attempt to develop some reasonable expectations about the future. What can be expected in the short-term of the next three to six months? The next year? The next two years?

This task is extremely difficult because, from today’s vantage point, we understand very little about the future course of COVID-19, its likely hotspots, and what mitigation efforts will be required. We also understand very little about the potential effects of restarting the economy, even if strong mitigation efforts are in place. And, finally, we don’t even really know when improved treatment protocols or successful vaccinations actually will become available. Hence, if we are to develop reasonable expectations, we must make educated guesses about each of these factors.

Another consideration is the level of complexity in actually assuring relative safety as the economy is restarted. We need to consider those who go to an office building, a school, a restaurant, or a retail establishment. Fundamental unanswered questions remain about how these facilities will be sanitized every day, how participants will interact, and how workers will be checked for COVID-19 status prior to entry each day.

The following projections are presented with all of these factors in mind.

The next three to six months. In the short term, it is quite reasonable to assume that pressure to open the economy will outweigh pressure to maintain stay-in-place protocols. Mitigation efforts will be somewhat relaxed, but improved treatment and vaccination protocols won’t be available. COVID-19 flare-ups will be very likely during this period, the number of deaths will remain high, and the majority of citizens will continue to have fears about going to work, shopping, or just being out in the community.

During this period, behavioral healthcare services likely will continue to function virtually rather than in person. Provider entities will continue to suffer great financial stress, some will collapse, and state and county behavioral healthcare programs will be forced to make dramatic adjustments in response to large budget deficits. All of this will occur in a context in which suicide rates are growing, opioid use and other drug use rates are escalating, and an expanding segment of the population is suffering from mental illnesses.

The next year. As the fall and winter months of 2020 approach, major COVID-19 outbreaks again will be likely. This may dictate a return to closing some or all of the economy, as well as implementing mandatory stay-in-place protocols. Businesses and schools will continue to struggle with sanitation, social distancing, and testing issues. Simultaneously, the first successful vaccinations will begin to appear in the market, and improved treatment protocols will begin to be implemented. The speed with which the latter events transpire will determine how severe and widespread the COVID-19 outbreaks are likely to be early in 2021.

Behavioral healthcare will continue to struggle during this period. Most care will continue to be virtual, budgets will continue to be tight, and illness rates will remain very high. If the current national emergency is declared over during this period, some resources currently available to states, counties, and providers are very likely to disappear, thus exacerbating the financial crisis in the field. New resource traunches from Congress may be required to salvage segments of the behavioral healthcare field during this period.

The next two years. Beginning in the summer of 2021 and beyond, vaccinations will be administered on a broad, population-wide basis, and larger numbers of people will develop at least short–term immunity to COVID-19. Concurrently, it also is likely that some herd immunity effects will occur, and more effective treatments will become available on a broader basis. Together, these developments will reduce the fear of infection being experienced by many, and a period of the “new normal” will begin.

For behavioral healthcare, this will be a period for important reassessment: What has been lost during the pandemic? What will need to be rebuilt? How will the field move forward?

Our next steps

Throughout this pandemic, we all have suffered from dramatically inadequate and uncoordinated planning at all levels of government. In behavioral healthcare, we can overcome this problem through better efforts to understand and prepare for what the new normal will be and how we can adjust to it. As this period unfolds, I will prepare relevant updates to facilitate this process.

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