Updated on January 15, 2020.
Over the past year, historic job losses coupled with fear and uncertainty surrounding COVID-19 resulted in a shadow pandemic of mental health problems. As many people were stretched to their emotional limit, worries about infection and the need for social distancing prevented them from scheduling an in-person visit with a mental health professional.
It’s important to realize, however, that virtual help is as close as your phone, tablet or computer.
Telemedicine includes mental health care. In fact, teletherapy emerged as a vital resource for a growing number of people during the pandemic.
Teletherapy usage on the rise
About half of mental health providers used telehealth in their practice before the pandemic but it surged during the COVID-19 crisis, says Joseph C. Kvedar, MD, president-elect of the American Telemedicine Association, professor of dermatology at Harvard Medical School and senior advisor of virtual care at Partners HealthCare in Boston.
“You could envision a world where we rarely see people in the office for mental health,” Dr. Kvedar adds.
Mary Alvord, PhD, a psychologist in Maryland, has been conducting telemental health sessions for years and has trained thousands of other therapists on how to use technology in their practices. During the pandemic, Alvord’s own practice went completely virtual and she’s seen an uptick in requests for appointments. Overall, she points out that her patients are reporting more anxiety, isolation, depression, family conflicts and OCD (obsessive-compulsive disorder) amid the pandemic as well as related financial distress.
On a national level, a survey of 1,202 U.S. adults conducted by the Kaiser Family Foundation from April 15 to 20 underscores what Alvord has experienced firsthand. The poll showed that 56 percent of participants believe that the pandemic has harmed their mental health in at least one way. For example, 40 percent of the people surveyed said that worry or stress has affected their sleep,15 percent said they’ve had trouble controlling their temper and 13 percent have been using alcohol or drugs more than usual.
Still, the threat of exposure to SARS-CoV-2—the virus that causes COVID-19—has deterred some people from seeking medical care. But in most cases, those with Wi-Fi and a smartphone, tablet or computer can “see” a healthcare provider virtually and keep follow up visits without leaving their home.
Is it really effective?
You may question whether a virtual session with a mental health professional will provide the same benefits as an in-person, face-to-face appointment.
In some cases, telemental health can be even better, Kvedar asserts. “The physical exam in mental health is talking to the patient. So not only can we accomplish everything from an exam perspective that we could in the office, we get more information,” he explains. “We see the person in their environment and so much that goes on in that environment is relevant to their mental health.”
An April 2020 paper published in Telemedicine and e-Health argues that evidence shows that telemedicine is effective for a number of conditions, especially depression, anxiety and post-traumatic stress disorder (PTSD). Videoconferencing, smartphone apps, online forums, text messaging and emails have been shown to be useful ways to deliver mental health services.
One of the clear benefits of telemental health is that technology can provide services to people without having them travel to an office and risk exposure to SARS-CoV-2. But even before the pandemic gripped the world, receiving teletherapy helped people avoid having to miss work or school to travel to their appointments. It’s also beneficial for those who need a mental healthcare professional who specializes in a specific problem, such as OCD, but don’t have access to a provider within a reasonable traveling distance of their home.
Possible limitations to consider
Teletherapy isn’t a “one size fits all” solution. Some people simply respond better to virtual care than others.
Those who are already adept at using technology are typically more open to telemental health sessions than people who aren’t, Alvord points out. It’s often a generational divide—with younger adults feeling more comfortable with it than older people. Alvord says she asks reluctant patients to try teletherapy for “just five minutes” to see if they can become more comfortable with it. She notes that, in her experience, many older people find that it’s better than they thought it would be.
Still, some mental health services can’t be done virtually, including full psychological testing, Alvord says. These tests are done for a variety of reasons. For example, a child who’s having trouble with schoolwork may be assessed for learning disabilities. A psychological battery taken in person at the psychologist’s office is what’s called norm referenced. That means the test has been standardized so that test-takers are evaluated in exactly the same way regardless of where they live or who conducts the test. Online tests aren’t normed in this way, so there are many variables that can’t be controlled, Alvord explains.
Other types of therapy are harder to do online, but not impossible. Alvord says group therapy for children on the autism spectrum, for instance, needs to be pared down to smaller groups during the pandemic.
Privacy issues may also be a concern. Before COVID-19, mental health providers were mandated to provide services only on secure online platforms that complied with federal privacy laws. During the pandemic, those rules have been temporarily eased to enable more people to access care. As a result, providers can use less-secure consumer-friendly platforms, including FaceTime and Skype, to see their patients.
In many cases, however, the benefits of teletherapy for those who need the support of a trained healthcare professional outweigh worries about privacy.
Ensure a smooth virtual visit
Teletherapy visits can be scheduled by calling to request an appointment, or downloading the app that your mental healthcare provider uses.
Before your appointment begins, take these steps to ensure a smooth experience:
Troubleshoot tech problems. Make sure you’re connected properly to the internet and the camera and microphone on the device you plan to use are working well. If there are any issues that you can’t solve, let your provider’s office know before the session.
Provide backup phone numbers. Alvord asks for backup and emergency phone numbers as part of her telehealth agreement, for two reasons:
- Sometimes, technology gremlins get in the way of the best-planned telemental health sessions. Screens may freeze or the electricity could go out. A backup phone number allows the session to continue.
- An emergency number is also needed if there’s a mental health crisis or the potential for one. “We’ve had teenagers get mad and slam their laptops shut and then not answer their phone,” Alvord says. Your mental healthcare provider needs to know who to call in situations like that.
Find a private spot. Conduct teletherapy visits in a private room and wear a headset or earbuds, if possible. Make sure your family knows you’re on a private call, so no one barges in. During the pandemic, people are getting creative, using their cars or patios as private zones.
Avoid distractions. Turn off notifications on your phone and wait until after your session to check emails. As much as you love your pets, keep your four-legged friends outside of the room during your virtual meeting.
