Warren, Maloney, Porter Release Findings from First Comprehensive Survey of COVID-19 Outbreaks in Residential Behavioral Health and Addiction Treatment Programs

Investigation Findings (PDF)

Washington, DC - United States Senator Elizabeth Warren (D-Mass.), a member of the Senate Health, Education, Labor, and Pensions (HELP) and Senate Aging Committees, Congresswoman Carolyn B. Maloney (D-N.Y.), the Chairwoman of the House Committee on Oversight and Reform, and Congresswoman Katie Porter (D-Calif.), a member of Oversight and Reform Committee, released the findings from their investigation into the effects of the novel coronavirus in residential behavioral health and addiction treatment facilities, and the actions these facilities are taking to prevent and mitigate outbreaks when they do occur.

The lawmakers' investigation, the first national survey of coronavirus in residential behavioral health and addiction treatment facilities, revealed that more than half of residential behavioral health facilities covered by the survey had at least one coronavirus case, while one in seven facilities had larger outbreaks. The investigation also found that limited testing capacity has prevented residential behavioral health programs from conducting routine testing of their patients and staff, that facilities' paid sick leave policies do not provide sufficient coverage for all workers, and that fewer patients have been able to receive inpatient care during the pandemic despite an increased need for services. These findings highlight the need for greater federal support for residential behavioral health programs during the pandemic.

"The economic turmoil and social isolation caused by the coronavirus pandemic has increased the need for substance use disorder, addiction, and mental health treatment. Our investigation confirms that, just like nursing homes and assisted living facilities, residential behavioral health and addiction treatment facilities present significant risks for COVID-19 outbreaks. The federal government needs to ensure that these facilities are getting the test supplies, personal protective equipment and funding they need to prevent outbreaks so that patients can seek safe inpatient treatment and care," said Senator Warren.

"As coronavirus cases continue to spike across the United States, we must make every effort to protect those who are most vulnerable during this pandemic-including those seeking treatment for substance use disorder, addiction, and mental illness. Our investigation has identified areas where the federal government can support behavioral health and addiction treatment facilities in their critical work, and our report makes commonsense recommendations to better ensure that patients and staff in these facilities are adequately protected from the coronavirus," said Chairwoman Maloney.

"The pandemic is attacking both our physical and mental health. Millions of Americans are isolated, while countless others mourn the loss of loved ones to COVID-19," Congresswoman Porter said. "It's essential the federal government fully address the mental health needs of our communities during this challenging time, which starts with providing our behavioral health centers with the necessary tools to treat those in crisis safely, including personal protective equipment and coronavirus testing supplies."

The lawmakers' investigation found:

Residential behavioral health facilities' crucial role in helping individuals in need of treatment for substance abuse disorders is particularly important during the COVID-19 pandemic. At the same time that mental health and substance use disorder needs have increased, providers are operating with limited capacity and resources. Given these needs, federal, state, and local governments should provide all necessary assistance and ensure that these facilities have adequate testing, personal protective equipment (PPE), and other resources needed to prevent and control the disease.

More than half of residential behavioral health facilities covered by the survey had at least one case of COVID-19, and one in seven facilities had wider outbreaks. More than 50% of the behavioral health facilities in the survey had at least one case of COVID-19, and 14% had larger outbreaks of ten or more cases. The surveyed providers indicated that, as of August 2020, 1,785 patients and 2,200 staff members had been diagnosed with COVID-19. This represents an infection rate of 1.8% for patients and 3.3% for staff. While the infection rate for patients is in line with the incidence rate of COVID-19 the general public, staff at the surveyed facilities were 83% more likely than the general public to be diagnosed with COVID-19 as of late August. These cases covered in the survey resulted in 21 total fatalities.

Limited testing capacity has led to a lack of testing and passive testing protocols in residential behavioral health facilities, which places workers and patients at risk. Limited testing capacity is hampering the ability of providers' to screen patients and workers for COVID-19. None of the behavioral health facility operators reported that they conduct routine daily or weekly testing of staff or patients at all their facilities. When tests are conducted, most facilities report experiencing turnaround times of a week or more for test results.

Residential behavioral health facilities are not reporting cases and fatalities to the federal government. Most of the large behavioral health providers indicated that they do not systematically report any COVID-19 case information to the federal government, explaining, "Our facilities are not required to report COVID-19 cases to any federal agency." As a result, federal government officials, prospective patients, and the public do not have a full picture of COVID-19 occurrence and fatality rates in residential behavioral health facilities.

Paid sick leave policies do not provide sufficient coverage for many workers at residential behavioral health facilities. While most of the surveyed providers have adapted their paid sick leave policies to accommodate workers diagnosed with COVID-19, only one makes paid sick leave accessible to 100% of employees. Two providers offer only six days of paid sick leave per year, far short of the recommended two-week quarantine period. Several do not offer coverage to part-time workers, leaving 10-30% of workers with no paid sick leave at all. Every not-for-profit provider surveyed reported providing two weeks of paid leave to employees diagnosed with COVID-19, whereas some for-profit providers failed to offer their employees this comprehensive paid leave protection.

Fewer patients have been able to receive inpatient care, despite an increased need for services. Several providers reported that operational changes to prevent the spread of COVID-19 have limited admissions to their inpatient programs, despite increases in inquiries and other evidence that the pandemic has intensified the need for mental and behavioral health care. Providers have shifted to telehealth to meet patients' needs. This decline in the number of patients receiving inpatient treatment may represent a potential public health problem on top of the ongoing COVID-19 pandemic-underscoring the need to provide inpatient facilities with the testing, equipment, and resources needed to respond to the pandemic.

The investigation makes clear that residential behavioral health facilities and their patients and workers are facing significant challenges during the COVID-19 pandemic. To address these challenges the lawmakers recommend:

• Enhanced federal data collection requirements for residential behavioral health providers that receive federal funding, including regular reporting of data on COVID-19 testing and cases for both patients and staff, which is shared transparently with the public.

• Federal funding and use of the Defense Production Act to increase availability of PPE, testing supplies, and test processing capacity, in order to support safe operation of behavioral health programs.

• Additional federal funding for behavioral health providers, including inpatient programs, to address the increased costs of providing essential care.

• Universal paid sick leave of at least two weeks for all behavioral health staff, including part time workers.

Senator Warren, Chairwoman Maloney, and Senator Ed Markey (D-Mass) previously released findings from a survey showing dangerously high rates of coronavirus infections at assisted living facilities, which similarly are not required to report case or fatality data to the federal government.

Senator Warren has repeatedly called for more detailed national COVID-19 data reporting in order to treat and contain the virus and address how the virus is disproportionately impacting communities of color. She has advocated for better reporting standards and protections in congregate settings like schools, nursing homes, assisted living facilities, prisons, and workplaces such as meatpacking plants.

The House Committee on Oversight and Reform has consistently highlighted the importance of supporting those on the frontlines of America's addiction crisis. In 2019, the Committee held three hearings to examine the federal response to the opioid crisis and the need for robust, sustained funding to provide treatment and wraparound services to those recovering from addiction. In January 2020, Chairwoman Maloney assumed the lead sponsorship of the late Chairman Elijah Cummings' CARE Act-landmark legislation introduced with Senator Warren to provide critically-needed, sustained funding to states, cities, counties, and community-based organizations directly responding to the nation's opioid epidemic. The CARE Act has been co-sponsored by more than 100 Members of Congress and has been endorsed by more than 200 organizations.

Congresswoman Porter has been a staunch advocate for improving mental health care throughout her time in Congress, and she's redoubled her efforts during the COVID-19 pandemic. In June, she introduced the Stopping the Mental Health Pandemic Act to strengthen the ability of mental health providers to deliver care to our community during the pandemic. She has also introduced bipartisan legislation to better enforce laws that insurance companies treat mental health care the same as other types of medical care.