The Importance of Between-Visits Appointments and Mental Health

By Loren Larsen

The causes and effects of America’s mental health crisis are well-documented. Easing access to necessary clinical help has not grown in tandem.

A study by the National Council for Mental Well-Being reveals that mental health services in the U.S. are insufficient despite more than half of Americans (56%) seeking help, with limited options and long waits becoming the norm. In some ways, meeting patients where they are is optimized, thanks to telehealth tools such as Zoom enabling 24/7 remote appointments, and wellness surveys becoming accessible anywhere, anytime by patients and providers. Yet, paradoxically, more people are not getting the help they need when they need it.

One critical challenge the U.S. mental healthcare system faces is how to leverage the available tools to accommodate a stressed population, and an even more stressed healthcare system.

Nationwide shortage

During the height of the COVID-19 pandemic, 40% of adults reported symptoms of anxiety or depression, according to data from the Kaiser Family Foundation. That figure fell to 28% as of February 2023—still a sizable jump compared to 11% before the pandemic.

Meanwhile, a nationwide shortage of mental health professionals has exacerbated a nationwide emergency. A 2016 report by the Department of Health and Human Services projected shortages for psychiatrists; clinical, counseling, and school psychologists; mental health and substance use social workers; school counselors; and marriage and family therapists. From 1995 to 2014, the U.S. population increased by 37% and the number of physicians increased by 45%. The number of psychiatrists grew by only 12% during that same timeframe.

The effect is predictable: According to the most recent annual survey by the American Psychological Association, more than half of psychologists reported they have no openings for new patients. Among those who keep waitlists, the average wait time was three months or longer.

The mental health crisis for the general population has been a logistical nightmare for providers. Since there aren’t enough professionals to meet the demand for mental health services, how do clinicians prioritize who gets seen? The nature of mental health issues makes the question perhaps more difficult to answer than for any clinical discipline.

The need for continual monitoring

A patient who sees a doctor for a broken arm at least has the luxury of history. Over hundreds of years of practicing medicine, we know how long it takes a bone to heal, allowing doctors to schedule follow-up visits accordingly. For patients dealing with physical conditions from pregnancy to surgery recovery, knowing when to schedule the second visit is the easy part.

The same is not true for mental health. A patient who feels fine, sounds fine, and looks fine at the time of their appointment might be in crisis the next day. And because of the clinician shortage, the time between each appointment is often longer than desired.

There are many consequences of this phenomenon. If patients with severe symptoms can get to an emergency room in time to seek help between appointments, they can at least be seen by a provider on short notice. However, accessing a psychologist or psychiatrist in the ER is a roll of the dice. There’s no telling whether one of these professionals is on duty, or how busy they are. Not only is ER care not optimized for the patient with acute mental health concerns, but the lack of mental health services also adds to an ER network already overcrowded with patients seeking care for physical emergencies.

As mental health care providers switched their preferred medium from in-person to remote visits, the range of patient solutions expanded. Can further advancements in video and other technologies help meet patients’ needs between appointments?

AI and remote care solutions

The COVID-19 pandemic catalyzed the transition from in-person to remote mental health care, from 39.4% of appointments in 2019 to 88.1% in 2022. Besides making appointments with professionals more accessible to more people, the transition to remote-first care normalized video calling services (Zoom, etc.) in the minds of both providers and patients. According to the National Alliance on Mental Illness, this eliminated the need to find transportation and decreased “no-shows,” resulting in greater continuity of treatment.

Using the same tools, patients can provide short video recordings between appointments—logging acute mental health episodes such as anxiety attacks, or merely recording their thoughts and feelings in real time. These short videos can be sent to the provider and reviewed asynchronously between scheduled appointments. This offers clinicians the opportunity to “see” their clients on a more regular basis. This method also complements written surveys that ask patients to rate their mental health by a variety of measures on a scale, allowing providers to track their patients’ progress over time.

Because a between-appointments video can be recorded whenever a patient feels their need is most acute, it solves the problem of meeting the patient in a time of need—to a point. How can providers sift through their patients’ videos to determine whose care needs are most acute?

Enter AI. Yesterday’s digital tools were trained to scan patient surveys to flag when someone feels like a 1 on a scale of 1-10 or notify a provider whenever their mood drops sharply. Similarly, today’s machine learning scripts can be trained to “read” a video transcript, analyze the audio of a video for specific vocal cues, and find other signals in the noise that could be cause for concern. All these tasks can be done quickly, between appointments, without direct intervention from a clinician or other human.

In this way, AI is not acting as a substitute for human care, but rather doing much of the necessary work around assessing and prioritizing patients’ needs that historically preceded in-person visits. In this hybrid clinician/AI care model, the short-term potential to alleviate human workloads in mental health settings is obvious—while also responding to patients’ needs between appointments, when they might be most vulnerable.


The global shortage of mental health professionals and the increased demand for services is a pain point for providers and patients alike. Applying many of the telehealth tools that have gained acceptance in recent years, and leveraging AI to boost their power, carries the potential to reduce the strain on the mental healthcare system and meet more patients where they are.

Loren Larsen is the CEO and co-founder of Videra Health, the leading AI-driven mental health assessment platform that empowers providers and healthcare organizations to proactively identify, triage and monitor at-risk patients to close care gaps using linguistic, audio and video analysis. Prior to Videra, Larsen was the CTO of HireVue, a trailblazing video job interviewing platform with advanced machine learning algorithms. He also co-founded Nomi Health, a direct healthcare company striving to innovate within the healthcare service and technology space.