The Urgent Need for Telebehavioral Health: Bringing Mental and Behavioral Healthcare to a Pandemic-Weary World

Even before the pandemic, millions of Americans were living with unmet mental and behavioral healthcare needs. As COVID-19 continues to ravage communities, we need to ramp up our telebehavioral health capabilities to combat worsening mental health.

It’s no secret that the COVID-19 pandemic has had a profound negative effect on our nation’s mental and behavioral health. The inescapable uncertainty of a once-in-a-century event, combined with skyrocketing unemployment, sociopolitical strife, and restrictions on gatherings with loved ones, have all created an atmosphere of ongoing trauma with no end in sight.

As a result, approximately 4 in 10 adults have reported symptoms of anxiety and depression – three times as many as before the pandemic started, according to the Kaiser Family Foundation. Twelve percent have increased their alcohol consumption or substance use. Furthermore, young adults are more likely to report substance use and suicidal thoughts.

Young adults (and essential workers of all ages) are also significantly more likely than others to experience suicidal thoughts.  More than a quarter of young adults have reported suicidal thoughts and 22 percent of essential workers have also reported suicidal thoughts.

The steep rise in behavioral health needs is compounding a well-known problem: there simply aren’t enough mental and behavioral healthcare providers to go around. More than 20 percent of adults who have tried to seek treatment haven’t been able to find any, according to Mental Health America. That’s due, in part, to the fact that the current ratio of patients to providers is 504 to 1.

Telebehavioral health can help us dramatically improve those odds. By expanding the use of effective remote care strategies and training more providers to deliver high-quality, accessible telebehavioral health, we can take the necessary steps to address our secondary pandemic of mental illness.

Using telebehavioral health to expand access to underserved communities

Lockdowns, quarantines, and economic stresses have made an already-dire situation even more complex for individuals with mental and behavioral healthcare needs. Fortunately, payers and regulators have recognized the importance of expanding access during the pandemic and have taken steps to relax regulations that previously limited remote care.

These changes, along with improved technologies and ubiquitous smartphone use, have been vital for rural areas and other communities facing challenging social determinants of health (SDOHs).

For example, Dr. Matthew B. Stanley, a psychiatrist in rural South Dakota, has seen an uptick in elderly patients and those living in difficult economic circumstances now that he has integrated telebehavioral health more deeply into his practice.

“My colleagues and I truly underestimated the prevalence of smart phones in this population,” he said, noting a rise in people with suicidal thoughts, anxiety, and other mental health concerns.

“These patients missed appointments because they couldn’t afford gas, get off work, or find childcare. Now, with telehealth, they have easier access to care with their smart phones. Previous barriers disappeared because people now receive care in their own homes. We are more available to patients at the time of the crisis, and many of them don’t want to return to the way it was before.”

Decreasing utilization burdens on a beleaguered health system

In North Carolina, Dr. Sy Atezaz Saeed is seeing similar benefits from telebehavioral health.

In 2012, ten percent of all emergency department (ED) patients were seeking mental health services, he said. That’s twice the national average. So, the state leaned into telehealth as a way to reduce ED utilization and connect patients to appropriate services.

Now, the NC State Telepsychiatry Program (NC-STeP) covers 60 hospitals and is especially focused on the 90 counties in North Carolina classified as mental health shortage areas.

“The program helps mental health patients avoid hospital stays based on access to psychiatric care when and where they need it,” Saeed explained. “Through assessments, proper medication and/or ongoing access to psychiatric care, these patients become informed patients that move forward in their lives.”

“Providing the right treatment to the right patient through evidence-based practice permeates my work as the common thread that ties everything together through telemedicine.”

With emergency departments now full of Covid-19 patients, it’s essential to do everything we can to lessen the strain on scarce resources and keep emergency services available for pandemic-related needs.

Training providers to deliver exceptional, compassionate telebehavioral healthcare

Creating a robust, resilient ecosystem of telebehavioral healthcare will require training for providers who may not be used to working in a remote care environment.

Video conferences, phone calls, and secure messaging have been proven effective and highly satisfying for patients during the pandemic. And yet, there will always be differences in the patient-provider relationship when care takes place outside of the office.

Training and education are urgently needed to ramp up telebehavioral health programs to the scale required to address the pandemic-sized problem we’re facing. Psychiatrists, psychologists, social workers, nurses, therapists, and prevention specialists can all benefit from learning more about the unique challenges and opportunities of remote mental healthcare.

From ensuring privacy and coaching patients to learn new apps to documenting remote consults and projecting a positive telepresence, providers will need to actively engage in ongoing learning to ensure they are maximizing their technologies and cultivating impactful, empathetic relationships.

With highly trained providers and broader national acceptance of remote mental and behavioral healthcare, we can lay the groundwork for a post-pandemic future in which patients can quickly and easily access the help they need through the modality that works best for them.