Virtual Care Can Increase Access and Comfort
As recently as a few years ago, the idea of a therapy appointment virtually with a psychiatrist or psychologist was a rarity. However, thanks to the COVID-19 pandemic and increasing sophistication in remote health monitoring technologies, all that has changed.
According to a study by the Rand Corporation[1], the transition from in-person to virtual care has been dramatic since the declaration of the public health emergency in 2020. The findings of the study reveal that there was nearly a 2,000% increase in the utilization of mental health services via telehealth across all diagnostic categories accompanied by big drops in in-person care.
But putting all the statistics aside, from a strictly human standpoint, telemental
health services have opened a whole new world for people who were otherwise unable or reluctant to engage with a therapist or psychiatrist. Considering the ever-increasing demand for mental health services, improving access to care is a good thing.
What is Considered Telemental Health?
Telemental health is a branch of telemedicine/telehealth defined by the electronic delivery of psychiatric services to clients. Typically, these services include psychiatric assessments, therapy sessions, and medication management. In the broadest sense, telemental health (sometimes called telepsychiatry or telepsychology) refers to mental health treatment that is not conducted in person, such as via telecommunication technology, most commonly videoconferencing, including:
Real-time video visits – Also known as synchronous video appointments, these are the most common type of telemental health appointments. These face-to-face video visits with a provider can be conducted on a computer, tablet, or smartphone.
Telephone appointments (no video) – These visits are simply phone calls without video. While not long ago, it wasn’t possible to have a thorough therapy appointment scheduled exclusively over the phone with a provider, today some providers also offer text appointments.
Smartphone apps – The increasing innovation in smartphone and computer apps and the availability of these digital support tools also fit into the category of telemental health services. Within this category of asynchronous telemental health apps, clients have an increasing ability to remotely interact with their provider’s office. They may complete and submit answers to screening questionnaires for a provider to later review to monitor progress, determine any follow-up appointments that may be needed, or perhaps make modifications in treatment.
The many digital tools for monitoring mental health can be important components in helping an individual refrain from relapsing. There are apps that can:
Help quell anxiety, and/or aid in sleep or relaxation with guided meditations.
Track sobriety and assist in keeping someone on track and aware of their progress.
Calculate cost savings from refraining from using and purchasing substances.
Keep loved ones informed of progress.
Connect individuals to others within the recovery community.
While the COVID pandemic made telehealth in general, and telemental health specifically, more popular, for some individuals, being seen virtually was sometimes the only choice when providers stopped offering in-person appointments at the height of the pandemic. The other enabling factor that opened the floodgates for virtual healthcare was the loosening of restrictions for private insurance companies, as well as Medicare and Medicaid reimbursement.
Also responding to the demand, the US Drug Enforcement Agency relaxed its restrictions on prescribing controlled substances, further prompting telehealth to blossom. Previously DEA regulations prohibited prescribing controlled substances via telehealth appointments, but the surge in demand for telemental health care led to the loosening of regulations so that people could limit their potential exposure to COVID while still receiving treatment and the necessary medications. In the future, as COVID restrictions lessen, there will likely be a shift again, but to what extent remains to be seen. Regardless, telemental health is here to stay.
Is Telemental Health Right for You?
For individuals struggling with conditions such as attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), depression, and anxiety, telemental health can be very effective. Appointments from your home or office sound convenient but the most important question to ask is is it right for you? Does your concern warrant in-person appointments or is it okay to proceed virtually?
Some situations warrant in-person visits; I don’t recommend virtual sessions if someone is:
Having thoughts of suicide.
Exhibiting patterns of self-harm.
Suffering from substance abuse.
Uncomfortable using technology like Zoom or smartphone apps or has limited services such as the lack of appropriate quality technological devices or support, or a poor internet connection.
Not in a situation where they can have the privacy they need to share important sensitive information with a provider.
Conversely, telemental health services may be an easier first step toward treatment than traditional mental health services and can be very effective for:
Individuals suffering from anxiety disorders and/or are reluctant to seek treatment face-to-face.
Populations who have limited providers in their area for in-person visits and may not have had access to mental health services previously, including those in rural or remote areas.
Emergency care situations when help is needed immediately.
Individuals with demanding work schedules. Since telemental health appointments don’t require travel and often mean less time off work they can be an ideal solution.
Those who may need better logistics coordination for things like transportation or childcare.
Individuals who need more flexibility in appointment times.
While these are great guidelines for who should and should not receive telemental health care, providers also need to use their best judgment in each situation and evaluate all the factors when making treatment recommendations around both quality of care and convenience. Overall, meeting people where they are in their particular circumstances, increases the likelihood of them reaching their recovery goals.
As mentioned, someone who struggles with addiction is likely better served in person since it is a good idea to conduct a thorough physical examination to determine the individual’s overall health status. However, there are individuals that we see who may start sessions in person and eventually work their way to a hybrid program where they are seen in person and then virtually the next time.
For individuals who suffer from anxiety disorders and find relief in attending appointments virtually, it can be a balancing act. Part of the treatment that we may suggest can include exposing someone to anxiety-inducing situations, such as in-person visits. Getting them out and moving them through those scenarios can be therapeutic. In those situations, clients may start treatment virtually and as their symptoms are alleviated, they may be better able to transition to in-person appointments.
When individuals suffering from anxiety are better able to face their fears and overcome their phobias with tools they learn in treatment, they can incorporate those newly acquired skills into everyday life in a variety of different situations.
Virtual care is especially comforting for clients who may begin seeing their provider in a residential treatment setting and are eventually discharged yet want to continue care with the same provider that they’ve established their therapeutic relationship with.
Another component of virtual care is the ongoing ability to monitor care and provide access through smartphone apps that are now at our disposal. More and more resources are becoming available in app form that help track medications, monitor cravings, and provide direct access to Twelve Step recovery meetings. In some cases, we can “prescribe” the app so that the cost is covered under insurance. Those of us who have been trained from residency on to leverage innovations that provide remote care and monitoring tend to be more comfortable using today's technological advances.
Ensuring a Successful Telemental Health Visit
Since not all providers are trained to deliver care virtually, choosing a provider who is comfortable using technology and who is trained to conduct virtual appointments is an important consideration. In our practice, our providers have the education and experience and have received comprehensive training in using the various technologies that help build effective therapeutic connections regardless of how care is delivered. The goal is for clients to feel that they are seen and heard and that they are in a safe space that allows them to freely share their mental health concerns. Assessing patient comfort with the arrangement and ensuring that nothing is lost in that kind of therapeutic connection is our number concern.
Once you find a provider who is trained there are things individuals can do to ensure a successful telemental health visit:
Find a quiet place with a reliable internet connection. It is important to be in a safe space so that you can be honest and open with your provider.
Have current medication information, including dosage details, handy for the appointment (or have the bottle handy to refer to).
Have a list of any symptoms, questions, or concerns you want to discuss.
Know the basics such as your temperature or weight.
Keep paper or a notebook and pen nearby for notetaking during the appointment.
Give all your attention to your virtual visit. Don’t eat or drink during your appointment. Don’t drive, run errands, or do other chores at home during this time.
Be aware that you may need to wait as you would in person for your provider to be with you. Be patient and know that like in-person office visits, providers sometimes can run behind schedule.
Increasing Care Access
When college freshman Sienna started her second semester at a large university in Arizona, anxiety was taking over her life. Her struggles kept her from finding a provider who could help her since she didn’t like the idea of trying to find a provider in a city she wasn’t familiar with. In addition, she didn’t have a car on campus, so access was a little more complicated. She was referred to us to consider a virtual visit. Although still somewhat reluctant, the idea of not going somewhere in person was appealing to her and she eventually decided to make a telemental health appointment. During our first visit via Zoom, I evaluated her anxiety and depression levels and together we determined that this would be an effective arrangement for her.
From the privacy of her dorm room, she continued virtual visits and started treatment successfully. Without the worries of leaving campus or finding reliable and affordable transportation, she was not just making progress in treatment, but her parents had the peace of mind that she was getting the care she needed without adding additional anxiety getting it. It was an extra bonus for her when she returned to her small rural hometown in the summer and was able to continue remote psychiatric care without having to find a new provider, start from square one, and possibly regress in the transition.
Virtual care enabled us to not only help Sienna at college, but after her freshman year too when she moved home for the summer. Maintaining that therapeutic relationship created a productive continuity of care which made all the difference in her mental health.
The more that we're able to work with someone, whether it's virtual, or in-person, the more that we can connect with them, understand them, and treat them effectively. For individuals looking for an easy transition into therapy and with the help of tools and technology that can support someone in their healing, it is important to work with a team whose skills translate across different scenarios. Creating a practice with providers who have that combination of skill sets is part of how we built the Clarity provider team.