Home Health, Behavioral Health and Addiction: Time to Integrate

By Chris Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers

At the beginning of the coronavirus pandemic, I noted that we’d need to leverage telehealth to bring essential addiction care to people who, by necessity, need to stay home. I also noted that it would not be a bad thing to keep this practice going, at least to some degree, after the pandemic — and that we’d need commitment from government agencies and buy-in from public-private partnerships to make it happen.

Now the pandemic has brought us to a place where two aspects of healthcare that should have gotten married years ago are, to extend the metaphor, engaged: home health and behavioral health. To clarify, I include treatment for alcohol and substance use disorder — a.k.a. addiction treatment — under the behavioral health umbrella.

I should also clarify what I mean by home health. According to Medicare.gov, home health care is “…a wide range of health care services than can be given in your home for an illness or injury.” The Medicare website goes on to say that “…home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital of skilled nursing facility.”

Most recipients of home health care are seniors. Before I continue, I should note that seniors are in a particularly vulnerable position right now. They’re at high risk of COVID-19 complications and at high risk of mental health disorders that can develop as a result of isolation and social distancing guidelines. Those mental health disorders include anxiety, depression, and alcohol or substance use disorder. Data shows that rates of all those disorders are on the rise among seniors — and home-delivered behavioral health care can help them in this moment of crisis.

Here are the types of services typically provided by home health care:

· Wound care for pressure sores or a surgical wound

· Patient and caregiver education

· Intravenous therapeutics

· Nutrition therapy

· Scheduled injections

· Monitoring serious illness

· Monitoring unstable/borderline health status

We need to add one more bullet point to this list:

· Monitoring for behavioral health and/or alcohol and substance abuse

There’s good news here: it looks like this will happen sooner rather than later. The template exists already — in the form of home health provided by Medicare and others — and current demands mean the template is prime for adoption by private healthcare providers as well.

A New Direction for Behavioral Health

I’m about to share a series of statistics with you, but please understand: each one of these data points represents a person or group of people. Real, live human beings — just like your mom, your grandma, your siblings, your friends, your nieces and nephews — everyone you know. If they’re on this list of stats, it means they need help — and they need more help than they currently get.

Here are the indicators we need to consider:

· Around 20 million adults in the U.S. have a substance use disorder (SUD)

o Of those, fewer than 10% received specialized treatment and support

· Around 14 million of those adults also have an alcohol use disorder (AUD)

o Of these, around 14% received specialized treatment and support

· An estimated 8.5 million adults in the U.S. have AUD/SUD and a separate mental health disorder simultaneously, known as co-occurring disorders

o Of those, 9.6% did not receive any kind of treatment or support at all

It doesn’t take a math whiz to read those statistics and understand there are millions of people out there who need help and support but aren’t getting it. Here’s something else I know — home health and behavioral health are inevitable partners.

Collaboration is the Answer

Millions of people need help and support for mental health, alcohol, and drug addiction issues. In the past, our outreach and advocacy efforts for these millions revolved around expanding awareness and education about AUD, SUD, and mental health treatment. Insurance providers and government agencies that manage public health programs found new and creative ways to provide care for those in need or reimburse them for care they do receive.

Now we need to work together not only on awareness, education, and funding, but we also need to rethink and reorganize how we deliver care. The pandemic taught us we can expand telehealth to offer treatment to people who need to stay home to stay safe. We’re doing that right now, thanks to collaboration and cooperation between private organizations and local, state, and federal policy makers.

We can do it with home care, too. It will take time and effort, but it’s an attainable goal. Support staff who work for home health agencies will need training on what to look for and how to spot problems in the home. They’ll need to know how to refer people who need help to the appropriate treatment providers.

Again, we can do this — and we need to. In the words of the Chief Medical Officer of Humana Insurance, Dr. William Shrank:

“We’re seeing just a massive amount of depression and anxiety. If you’re already depressed, there’s a good chance your condition is exacerbated. If you’re anxious at baseline, there’s a good chance that your condition is going to be exacerbated.”

I can add that if you have an alcohol or substance use disorder, you’re currently at higher risk of relapse than at this same time last year. The stress of the pandemic and the isolation related to stay-at-home orders and social distancing guidelines have likely exacerbated the host of emotions that challenge your recovery and sobriety.

What collaboration means, therefore, is that home health providers can learn to recognize the challenges you face. They can identify those of you who need additional behavioral health support and connect you with the treatment services you need. If you have a mental health issue such as depression or anxiety that’s gotten worse during the pandemic, they can ensure you understand your treatment options — i.e. socially distanced outpatient programs or telehealth — and help you find qualified professionals to provide care.

If you have an alcohol or substance use disorder and you’re at risk of relapse because of the pandemic, they can do the same thing: ensure you know you can receive high-quality, evidence-based treatment and support in a safe environment that works for you — and then connect you to an addiction treatment provider that can give you the support you need.

The collaboration will take effort and attention to detail — just like an engagement that leads to a long and happy marriage.

In the end, I know we can get there — because I’m an optimist, and at Pinnacle Treatment Centers, I see hope at work every day.