Since its onset in early 2020, the COVID-19 pandemic has had an unparalleled impact on Americans’ well-being. At the same time, the crisis has precipitated significant changes in healthcare, among them an exponential expansion in the use of online technologies to deliver psychiatric treatment.
Over a period of less than 12 months, the Austen Riggs Center experienced this first-hand. In July 2019 Riggs celebrated 100 years of providing in-person, residential mental health treatment in an open setting. Eight months later, the arrival of the virus in Massachusetts compelled the Center to build online and hybrid treatment systems from scratch in order to protect patients and staff from COVID while continuing our clinical work.
The effort was successful both in terms of keeping the virus from spreading in the Riggs community and enabling the Center to develop its use of Zoom videoconferencing for individual and group sessions.
Riggs is now applying that experience to offer its first-ever Remote Access Intensive Outpatient Program (IOP) for students attending Massachusetts colleges and universities. The new Remote Access IOP is generally well-covered by insurance plans. Based on initial results, the program is delivering treatment that looks beyond mere crisis stabilization to a diverse population well beyond Riggs’ Berkshire location.
COVID: Adding Fuel to the Mental Health Crisis
“Reeling from pandemic disruptions to community belonging, college students are reporting surging rates of anxiety, depression, lonesomeness, and social isolation,” said Spencer Biel, PsyD, director of the Center’s IOP. “For many, the world feels unstable, unpredictable, and impossible to join as an emerging adult.”
His position has been born out through statistics in numerous studies and reports, including:
- 20% of college students responded that their mental health has “significantly worsened under COVID-19,” with 80% saying COVID-19 has negatively impacted their mental health. Source: ActiveMinds
- Asked about anxiety, depression, and feelings of loneliness, almost 84% of survey respondents reported an increase in at least one of those three symptoms. Source: BMC Psychology
- 94% of students seeking mental healthcare reported that COVID-19 has negatively impacted at least one aspect of life, with mental health registering at 72%. Source: Higher Education Today
The need for mental health services in higher education was already on an upward trajectory before the virus arrived, but the situation became so stark during the pandemic that in December of 2021, United States Surgeon General Dr. Vivek Murthy issued an advisory
on the mental health crisis facing youth and young adults. He emphasized that the pandemic is not the cause of the crisis but intensified it considerably. Toward the end of his report, he stated: “This is a moment to demand change.”
Adapting to a New World
Essential ingredients of the needed change include true implementation of mental health parity and the provision of accessible, affordable, culturally competent, outstanding clinical care. To deliver those, Riggs launched the IOP in November 2021, focusing on students at Massachusetts colleges and universities who are 18 years or older. Through connections with counseling offices at several public and private schools, the IOP brings additional services to students and counseling centers facing unprecedented strain – students who need more than their counseling center services or other limited outpatient treatment can provide.
During the pilot phase, the program has established a target census of approximately 10 students. Each student averages 12 hours per week engaging in group and individual treatment overseen by a multidisciplinary team that includes psychiatrists, psychologists, and social workers. Building on Riggs’ residential approach, the IOP integrates psychodynamic psychotherapy, psychodynamic medication management, family consultation, and groups focused on developing self-knowledge and resilience through relationships.
The IOP staff is still in the early stages of gathering data on outcomes, but Biel described some initial anecdotal feedback.
“Patients are reporting feeling less alone with their struggles and clearer that relationships are essential in their efforts to face adversity and move forward. Consistently, they describe developing a fuller picture of their challenges and resources by engaging in our group program and deepening their learning through individual psychotherapy.”
“This program probably saved my life,” said one student. “Initially, it was the structure, having groups to show up for. But then I got really connected to people. I’ve really found a community in this program.”
Impact Beyond the Berkshires
In addition to carrying the Riggs treatment approach to areas in Massachusetts beyond the Center’s base in Berkshire Hills of Western Massachusetts, the IOP was designed to address critical challenges that the entire field is facing, including offering care that goes beyond mere crisis stabilization and extending access to underserved populations.
“Today, in mental and substance use disorder treatment, access to care criteria for treatment at intermediate levels (intensive outpatient programs, partial hospital programs, and residential treatment centers) is under constant pressure from insurance providers seeking to limit coverage to crisis stabilization rather than the generally accepted clinical standard, which looks beyond the immediate crisis to addressing such obstacles to recovery as the impact of underlying or co-occurring disorders, trauma, adversity, and social determinants of mental health,” said Riggs Medical Director/CEO Eric M. Plakun, MD.
“By including multiple group sessions, individual therapy, and a treatment team that puts the pieces together and invites participation by college counselors, our IOP pushes back against this drift toward crisis stabilization and lets patients build upon what they learn through the mix of individual and group treatment to address underlying issues that interfere with making life at college work for themselves—and does so within their insurance coverage,” said Plakun.
Of equal importance in the IOP design was the need to offer access to care for underserved groups.
In January 2001, the office of the U.S. Surgeon General issued the landmark “Mental Health: Culture, Race, and Ethnicity
” report about mental health disparities affecting racial and ethnic minorities, which found that people of color had less access to mental health services, were less likely to receive those services when needed, often received poorer quality of care, and were underrepresented in mental health research. Regrettably, progress to address those disparities over ensuing decades has been limited.
Since its November launch, the IOP has worked with 23 students. Of that number, 23% identify as non-binary or transgender, 17% are Latinx, 26% are Asian or South Asian, and nearly all the students are on financial aid at their schools.
“The diversity in our program is enhancing learning opportunities for everyone,” said Biel. “By grappling with interpersonal expectations and assumptions, including about similarities and differences, perspectives are expanded, social determinants of mental health explored, and personal narratives created. People develop more curiosity about themselves, others, and the community we create together,” he added.
Scalability: The Next Steps
As the IOP aims to serve more people, a major challenge is that telehealth regulations might shift suddenly and substantially. State licensing laws already constrain access to telehealth services, and insurance companies inconsistently restrict coverage and reimbursement. Joining Murthy’s advisory and recommendations, Riggs is using the IOP and advocacy efforts to increase and stabilize access to affordable, excellent care. Fortunately, Massachusetts law already requires insurance policies from the state to offer telehealth as a service covered by insurance and its reimbursement at par with in-person visits.
The IOP is planning to add services in New York state at the start of 2023. Further, we are initiating negotiations to establish in-network status with insurance companies. This will reduce copayment and coinsurance costs for patients and their families. These negotiations are critically important and challenging. While the standard of care supports pursuit of recovery rather than mere crisis stabilization, many insurance companies have incentivized briefer, symptom-focused approaches that often fail to address underlying causes of distress, leaving patients more vulnerable to recurring struggles.
In addition to these obstacles, the IOP is part of a mental healthcare landscape where clinicians are overwhelmed by demand. Establishing partnerships, however much desired, can feel like one more task for which there is insufficient space, time, and energy. College counseling is no exception, and the IOP is working creatively to build connections that alleviate rather than exacerbate strain.
Learn more about the Austen Riggs Center Remote Access IOP
Prospective students and college counselors may also call the IOP directly: 833.921.5700.