By one estimate, as many people experienced serious psychological distress in just the first month of the pandemic as during the entire year before it began. Elevated rates of anxiety and depression have persisted, drawing new attention to the U.S. mental health system—including fault lines that have persisted for decades.

Almost 20 years ago, the President's New Freedom Commission took a hard look at mental health care and proposed solutions bearing an uncanny resemblance to those in circulation today: Expand telehealth to improve access to care, screen for mental disorders in primary care, and launch a national campaign to reduce stigma and prevent suicides. While the U.S. health system has made other strides since then, those three recommendations represent points where COVID-19 might finally galvanize overdue change.

Telehealth has been bandied about by policymakers for decades. A trove of evidence has shown that, for conditions such as anxiety and depression, it can be as effective as in-person care. Nevertheless, adoption has been incremental. Many private insurers decline to pay psychiatrists, psychologists, and counselors at rates comparable to in-person visits, if at all. There are also gaps in available insurance billing codes.

As a result, the landscape of mental health services today looks remarkably different, with treatment by phone or videoconference a staple feature. But this progress could be lost. Absent some federal change, governors could dissolve mandates compelling private insurers to pay for telehealth. Will providers then continue to offer these services? Probably not.

A longstanding priority of mental health advocates has been to ensure mental health and physical health care go hand-in-hand, including screening and treating mental health conditions in primary care—commonly called “integrated care.” Over the past 15 years, there has been overwhelming evidence these models work. University of Washington's AIMS Center has documented over 90 randomized controlled trials showing that a version of this called the collaborative care model (CCM) improves both mental and physical health outcomes for patients. Cost analyses indicate that, for every $1 invested, there is a $12.75 return at the societal level.

Read the full article about how COVID-19 changed U.S. mental health by Ryan K. McBain at RAND Corporation.