By Anja Maciagiewicz
Coming out of the pandemic, it’s hard to think of mental healthcare without telehealth. Currently, we’re suffering a shortage of mental health professionals, which is impacting the availability of care for many.
De-identified claims data from 2019 through April 2022 shows that there was a spike in mental healthcare services during the pandemic, which coincided with a spike in anxiety-specific claims. Though the increase may not be surprising, it shows the additional burden put on an already stressed system of care. Moreover, though the numbers of mental health medical claims (as well as anxiety-specific claims) have been trending down recently, they have not returned to pre-pandemic levels.
Who’s using telehealth?
The data indicates that the largest group using telehealth for mental healthcare is patients 18–44 years old (50%). Patients 45–64, as well as 1–17, come in second with 22% of each using telehealth. Among patients 65+, just 6% are choosing telehealth over a traditional in-person appointment.
The benefits of telehealth are obvious through the lens of the pandemic. Many people still prefer to limit their exposure to others. Getting to an in-person appointment can be tough, especially during work hours. Travel time means additional time away from work or other obligations. A telehealth appointment sidesteps all these concerns. For the smallest group of telehealth adoptees, ages 65+, there are other potential benefits.
“I work with persons in that age group, and they just need a little extra support to get logistically set up and comfortable with teletherapy,” says Abbey Jo Schrage, an Iowa-based psychotherapist who uses teletherapy exclusively. “I have found that after the initial stages, they report feeling less stressed about concerns of driving and the possibility of picking up illnesses.”
Telehealth therapy claims have decreased as the pandemic wanes, but telehealth has made therapy available to a new group of people. “I had a lot of existing [patients] that were transitioning from in-person therapy, but since COVID has eased, I’ve had a whole new population reach out that has never done therapy because they’ve been too busy or getting to a location was difficult,” adds Schrage.
How effective is telehealth?
Mental healthcare might seem to be less effective over a video call compared to an in-person interaction, given its personal nature. But in truth, it can work very well, depending on the individual.
“I evaluate the person-to-person connection and determine if there [are] any barriers—for example, if someone is hiding the view of themselves or not focusing,” says Schrage. “Overall, I’ve found telehealth an effective medium for counseling.”
Therapists undergo special training for telehealth therapy that teaches them how to pick up on the subtle signs of feelings over video versus in person. “Because there are some physical cues that may be lost on a video camera, as a therapist, I have to focus in on facial movements and voice fluctuations,” Schrage notes.
Though effective for many, telehealth isn’t for everyone. “I find the age group younger than 17, younger adolescents, difficult to work with. They are passive in their sessions and seem to lose focus,” says Schrage. Other, more complicated diagnoses also may not be suited for telehealth appointments. “I’ve found that the more extreme cases of borderline personality need a grounding presence in person,” she adds.
Telehealth probably won’t ever be the only medium used for therapy sessions, for the above reasons and more. Some patients have poor internet connections that don’t work with a video call. Raising the issue with their internet service provider might or might not solve the problem. Additionally, privacy is not always available when a patient shares a household with others.
The future of technology-enabled mental healthcare
Telehealth has provided a vital service during the pandemic and remains important for people with mobility challenges. However, it’s not really helping ease the mental health professional shortage.
Even since the beginning of the pandemic, technology has offered some new solutions for mental healthcare. Currently there are many “mental health” apps that offer varying levels of help. Some apps are to be used in conjunction with in-person therapy; others promise access to a licensed therapist with text message. Still other apps, like the recently publicized Cerebral, have “licensed psychiatrists” prescribing medications—which landed Cerebral in the middle of accusations regarding poor quality of care. Some feel that technology has outpaced science. Patients must also be wary of their privacy when using mental health apps and pay attention to how an app protects—or, often, does not protect—their sensitive information.
Technology developers often misstep several times before generating something great. But with the right qualified guidance, future advances in technology could be beneficial and take some of the burden from mental health caregivers.
For example, “I could see a positive side” to technology such as chatbots, notes Schrage. “When someone’s in distress and they have a point of contact, it should be a calming, grounding influence,” she says, and chatbots may be able to provide that influence on a basic level, though of course they can never take the place of a therapist. Chatbots’ usefulness might also break down with more complex conversations, such as answering a patient’s question. “A trained professional needs to see the person’s face to see if what they are saying matches what their nonverbal cues indicate. There could be some incongruencies that a chatbot would miss.”
While technological advances continue to work through their growing pains, therapists should leverage lower-tech options whenever they can to extend their reach as much as possible. One such option is group therapy. For the right mix of patients, this approach can get more people help at the same time, in essence extending the hours of a single therapist.
As we continue the journey of finding the most effective and safe ways to offer mental healthcare during a time of technological advancement and mental health professional shortage, I hope I can do my part to help. Let’s all remember to reach out to friends and family, especially those who are isolated.
Anja Maciagiewicz has a long history in healthcare, having spent the last decade at LexisNexis Risk Solutions. Anja began her career as a business analyst, quickly working her way up to leading the life sciences delivery implementation team. The experience led her to become knowledgeable in the pharmaceutical, medical device, and durable medical equipment verticals, before turning her attention to medical claims. She has also worked in specialty pharmacy and health system verticals, working on technologies to improve care quality.