GAO: Behavioral health providers report higher demand, decreasing staff size under COVID

A woman in a face mask appears upset
A new Government Accountability Office report examines the impact of COVID-19 on behavioral health conditions and access. (dragana991/Getty Images)

Data suggest that the prevalence of behavioral health conditions has increased under the pandemic, but in-person access to needed services has decreased in tandem, a new GAO report finds.

The Government Accountability Office reviewed survey data and interviewed regulators in four states. Data from the Centers for Disease Control and Prevention shows that the number of adults reporting symptoms of anxiety or depression averaged 38% between April 2020 and February 2021.

By comparison, about 11% of adults reported such symptoms between January and June 2019, the CDC found.

Two-thirds of behavioral health providers surveyed by the National Council for Behavioral Health said demand for their services was higher due to COVID, GAO found. However, 27% of NCBH member organizations reported that they laid off employees, and 45% reported closing some programs.

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In addition, 35% said they decreased hours for staff. The report says the findings should spur discussion about the enforcement of mental health parity requirements. 

"Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services," the report said.

Insurers are obligated to cover behavioral health services without any greater restrictions than they would place on medical care. The study data was inconclusive on whether payers were skirting these requirements, however, as in one state reports of issues with behavioral health claims were lower than for medical claims.

GAO warns that the lack of complaints doesn't necessarily mean that there are few violations, as both consumers and providers struggle to identify and report mental health parity violations.

"Specifically, in 2019, GAO found that complaints were not a reliable indicator of such violations, because consumers may not know about parity requirements or may have privacy concerns related to submitting a complaint," the group wrote in the report.

"GAO recommended that the federal agencies involved in the oversight of mental health parity requirements evaluate the effectiveness of their oversight efforts," GAO said.