Public health emergencies and disasters often are defined by their impact on human health. When Hurricane Harvey dumped 50 inches of rain in the Houston area and forged a path of destruction across the Texas Gulf Coast in 2017, 20 hospitals were forced to close or evacuate. More than 5,300 Texans were cared for during both the rescue and recovery efforts. The storm displaced hundreds of thousands of Texans and caused billions of dollars in damage.
The physical toll of major emergencies are a deserved focus of emergency preparedness and response efforts. But a hidden epidemic of behavioral health threats will linger for years after the emergency. Exacerbated by the extreme loss of life, environmental destruction, and economic strain, behavioral health conditions are pervasive during and after major emergencies. They arise among individuals previously unaffected as well as in those with preexisting behavioral health conditions. Frontline responders, health care workers and behavioral health providers may be challenged emotionally by their response efforts and are at increased risk of developing behavioral health conditions due to an emergency.
Texas’ public health response to the physical effects of COVID-19 has been strong, but our planning, mitigation and response efforts must also consider the behavioral health effects of this pandemic.
The regulatory landscape has changed dramatically during the declared states of emergency from COVID-19. With the declarations, hospitals and health care providers have new flexibility and discretion to pivot their operations to increase bed capacity, conserve shortages of personal protective equipment and otherwise respond to the growing need for care. They can access supplemental funding to help offset some of the lost revenue and account for patient surges.
At the same time, adjustments to mitigate disease spread may contribute to negative behavioral health outcomes. The state and local governments recently restricted inpatient admissions at state-owned psychiatric hospitals and consolidated community-based behavioral health services. Efforts intended to protect the public's health also exacerbate the challenges Texans already experience to access to behavioral health care and stretch thin the safety net of fragile behavioral health hospitals.
In addition to skyrocketing costs for PPE, behavioral health facilities treating an influx of patients and have dedicated specific hospital units or wings for those infected with COVID-19. They also struggle to discharge patients due to shelters, group homes and other placement locations operating at limited capacity. This bottleneck impedes other patients’ access to timely care and exacerbated the ongoing shortage of inpatient psychiatric beds. Hospitals’ inability to discharge intensifies existing financial constraints, as inpatient facilities often are not reimbursed for care beyond 15 days or when patients no longer meet medical necessity criteria.
Texans’ behavioral health needs will increase in the coming weeks and months. Access to behavioral health care is limited at a time when its needed most, further straining economically pressured hospitals and providers on the frontlines of COVID-19. Behavioral health hospitals and providers are advocating for financial support to keep their doors open, and Texans need a strong outpatient behavioral health infrastructure with access to preventive and intensive treatment. Behavioral health care providers, regulatory bodies and stakeholders must continue to work together to ensure Texans’ needs are met timely and in clinically appropriate care settings.
In these unprecedented times, we cannot underestimate the physical, emotional and financial toll COVID-19 has and will continue to have on our communities. Addressing Texas’ behavioral health needs is a crucial element of individual and community health and productivity, and Texas hospitals are dedicated to that mission.