iPhotoCOVID-19 is having a devastating effect on the emotional, psychological, and social well-being (as well as the physical health) of people around the world. Risk factors for addiction, mental illness, and “deaths of despair” are growing while behavioral health resources are lacking for many who need them, especially among vulnerable populations. Racial inequities, laid bare by the pandemic, and social unrest provoked by recent police killings have escalated tensions.
In the course of writing Problem Solving: HBS Alumni Making a Difference in the World, and more recent conversations specifically about COVID-19 impacts and responses, we spoke with several Harvard Business School alumni committed to reducing the impact of mental illness and addiction on individuals and communities. Here are some examples of how they are working today to overcome challenges and seize opportunities.
Prevention programs disrupted
"The pandemic threatens to dismantle all the gains made in the US in the recent six-year fight against opioids and heroin,” says Jim Langford (HBS MBA 1984), Executive Director of the Georgia Prevention Project (GPP). "Grief and trauma, job loss, and economic uncertainty, self-quarantine in sometimes unsafe home environments, anxiety about the virus and re-openings, and disconnection from treatment all are triggers and will contribute to substantial increases in substance use disorder (SUD) cases, overdoses and deaths.”
"The pandemic has made mental health a concern for everyone and also highlighted the important link between research, discovery, and cure."
The GPP is a statewide prevention program aimed at reducing the use of dangerous drugs among teens and young adults through awareness campaigns, educational programming, and partnerships with national- and community-based organizations. COVID-19 has disrupted GPP’s school-based activities, which include teacher training and the Teen Advisory Council, a program that supports students as they educate their peers about the dangers of prescription drug misuse and experimentation with heroin.
GPP now offers weekly Zoom meetings with guest speakers, game-based messaging, positive social norming exercises, and the promotion of “protective factors” such as staying connected to others, being physically active, and taking breaks from social media. Recently, it hosted a "virtual drug take back day" that encouraged and instructed teens how to safely dispose of unused prescription medications in their homes. “Several thousand teens participated online or watched replays,” Langford says.
SUD treatment providers are also searching for ways to alleviate barriers to patient care by, for example, providing at-home services or take-home medications under the close supervision of a treatment professional. Many are taking advantage of the easing of telehealth restrictions to expand access and deliver services more efficiently.
Still, many treatment centers are facing financial collapse, with patients staying away or unable to pay and rising costs for personal protective gear and new technology.
“Compounding the problem, SUD treatment and prevention programs risk draconian cuts to public funding as states experience economic downturns and budget pressures,” Langford says. “Strong advocacy for ongoing state support and federal emergency aid will be required to avoid a crisis.”
Telepsychiatry may increase patient access
David Theobald (HBS MBA 1991)’s interest in mental health technology commercialization has led him to Genoa Telepsychiatry, where he works with new federally-funded Certified Community Behavioral Health Clinics (CCBHCs) and other providers to build their telepsychiatry programs and meet the needs of under-served populations.
“Our support allows patients to see providers remotely over video conferences,” he says. To help clinics meet surging demand and adapt to COVID-19 limitations, Genoa is offering assistance setting up telemedicine services free of charge until July 15, 2020 at a minimum.
Theobald is impressed by how quickly many providers have switched almost entirely to telemedicine during the pandemic. While convinced of the benefits of telepsychiatry to both providers and patients, he acknowledges its limitations. “Treatment of people with severe and persistent mental illness, who represent about 6 percent of the population and drive over half of total medical costs, has been compromised by the lack of in-person support services.”
Part of Theobald’s work at Genoa involves communicating with state agencies about remaining regulatory obstacles to telehealth care. He also is a national advocate through Mental Health America, which is using its free online screening program to monitor COVID-19’s impact on mental health. “I try to support my local community through board work at Rising Ground and Service Program for Older People, both of which have rallied to help New York City through the crisis,” he says.
Pandemic exposes underlying weaknesses in health care
In Canada, mental health became a special focus for Jamie Anderson (HBS MBA 1980) in the late 1990s. “The issues were pervasive but few people were willing to talk about it,” he says. Today, he serves as chair of the Centre for Addiction and Mental Health (CAMH) Foundation.
“The pandemic has exposed and amplified existing concerns about mental health in Canada: lack of access to quality, publicly funded treatment and support; poor data infrastructure; and inequalities related to social determinants of health,” Anderson says. “It has made mental health a concern for everyone and also has highlighted the important link between research, discovery, and cure as we all await a COVID-19 vaccine.”
CAMH is Canada’s largest mental health teaching hospital, with a 550-person inpatient facility and a 24/7 dedicated psychiatric emergency room. Its staff of more than 3,000 physicians, clinicians, researchers, educators and support staff provide clinical care, conduct research focused on brain science, personalized care and policy and prevention, provide expert training to health care professionals and scientists, develop health promotion and prevention programs, and advocate on public policy issues at all levels of government.
At the onset of the pandemic, CAMH quickly implemented safety measures at its facilities, launched online resource centers for different populations affected by COVID-19 such as frontline workers, ramped up telemental health care, and created training programs to help hospitals and community-based providers build virtual care capacity.
“From March to April 2020 alone, CAMH’s virtual care visits went from approximately 350 per month to almost 3,000—an increase of over 750 percent,” Anderson says. “We also have increased the number of telemental health providers across Canada by 1,400 percent since the start of the pandemic.”
"We also have increased the number of telemental health providers across Canada by 1,400 percent since the start of the pandemic."
CAMH has launched a COVID-19 Mental Health Resiliency & Coping Fund to meet emerging needs. “Canada’s health care system operates quite differently from the US,” Anderson noted. “Hospitals get an annual budget from the provincial government but philanthropy still plays an important role in funding new programs and research and augmenting services.”
The Foundation, which is one of Canada’s largest charities, provided $48.5 million in grants to CAMH during the fiscal year ended March 31, 2020. COVID-19 has caused some decline in fundraising, such as cancellation of CAMH’s annual gala and door-to-door fundraising, but also has seen new corporate partnerships come forward as attention to the mental health impacts of the pandemic increase.
Looking to the future, Anderson sees two silver linings to COVID-19: “The first is that mental health will be prioritized in the same way as physical health; the second is that the care advancements we’ve made through innovation and technology will be permanent and we can continue to scale them to help Canadians regardless of where they live.” CAMH, he is confident, will be leading the movement.
Unspinning the COVID web
These three stories provide yet another example of how COVID-19 has mushroomed into multiple interrelated crises and revealed underlying systemic weaknesses even while accelerating the innovative use of technology to deliver essential services.
The problems remain severe but with concerted efforts across public, private, and nonprofit sectors and the leadership of committed individuals, there is an opportunity for overdue and lasting change.
About the Authors
Howard Stevenson is Sarofim-Rock Professor Emeritus of Harvard Business School. Shirley Spence is a writer, educator and former partner at Oliver Wyman, a global management consulting firm.
[Image: iPhoto]
Other Stories in This Series
- How Leaders Are Fighting Food Insecurity on Three Continents
- These Entrepreneurs Take a Pragmatic Approach to Solving Social Problems
- Find Your Pragmatic Path through Radical Uncertainty
This article is part of a research series following up on issues and stories presented in Problem Solving: HBS Alumni Making a Difference in the World, by Russ Banham, Shirley Spence, and Howard Stevenson.