The profession-wide adoption of telehealth for behavioral health disorders during the COVID-19 pandemic has led to increased recognition that not only is telehealth a safe and easy option for many patients, but that it is effective at eliminating certain traditional barriers to care – many of which are logistical in nature and primarily impact individuals who are lower income.
The Mass. House and Senate have championed the benefits of telehealth for behavioral health by passing bills that ensure that virtual sessions are reimbursed at the same rate as those that are held in person. The Senate bill provides this parity on a temporary basis and the House makes it permanent.
We have witnessed the success of telehealth firsthand.
As a provider of therapy and psychopharmacology treatment to individuals with behavioral health needs and substance use disorder, we recognized the importance of continuity of services to the culturally diverse and underserved communities we work in. While we had long intended on creating a third, virtual clinic, the COVID-19 pivot to telehealth was initially thought of as a stop-gap.
Low-income individuals often have trouble with two key logistical aspects of in-person care: getting to the clinic and getting the time off needed for the session. We recognized that telehealth would lead to some positive changes as we toppled these barriers to access, even while it can create other challenges, such as a lack of privacy. We never expected the success we have seen.
We can point to two metrics from the early weeks of the pandemic, between March 16 and May 16, which demonstrate that telehealth helped us to see people sooner and more consistently. First, we reduced the time to meet with a clinician from seven days to four days, and second, we reduced patient no-shows from 13 to 10 percent (typical field-wide, in-office no show rates vary between 25 and 30 percent).
Over these two months, individuals who were the most vulnerable as well as those seeking help from us for the first time were given appointments sooner than ever before; these patients also became more likely to follow-through on their appointments.
By facilitating virtual sessions, providers like our agency can expand beyond geographic limits. We can now see patients from every corner of the Commonwealth and can more easily grow our clinician team as we take on more clients. This is vital because more people, particularly those impacted by pressures caused by the pandemic or those who cannot rely on a previous provider, are seeking behavioral health counseling and care.
The stress of the pandemic is real and expansion of telehealth is occurring at a crucial time for millions of Americans. In fact, a Kaiser Family Foundation (KFF)poll found that 53 percent of Americans feel like the worry and stress caused by the virus has negatively impacted their behavioral health. KFF has documented clear implications of the pandemic on behavioral health and substance use disorder. It highlights the challenges relating to adolescent depression and anxiety, job loss and front line worker burnout that may linger far beyond the end of this public health crisis. In late June, a CDC survey found that more than one in ten US adults seriously considered suicide, with higher rates among young adults, minorities and essential workers.
We are also likely to see long-term effects from the pandemic relating to the number of active behavioral health providers. A recent National Council for Behavioral Health survey painted a grim picture of patients being turned away, behavioral health clinicians and agency staff being laid off or furloughed, and some providers shuttering their practices permanently.
We will need every tool we can get our hands on to get care to people, and telehealth is one indispensable tool. It is our hope that lawmakers can build on a silver lining from the pandemic – greatly expanded use of telehealth – and come to an agreement on thoughtful policies that will expand telehealth options in the Commonwealth long after the pandemic subsides. By making rate parity between in-person and virtual behavioral health treatment permanent, we can help families and individuals gain access to the treatment they need.
Fewer barriers to care will lead to more opportunities for those across our Massachusetts who are seeking help, but struggling to find it.
Mindy Miller, LMHC is Behavioral Health Services Director of Outpatient Services at Volunteers of America of Massachusetts. Samata Sharma, M.D. is Behavioral Health Services Medical Director at Volunteers of America of Massachusetts.