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Written by Daniel Z. Lieberman, MD
When something jumps by a factor of ten, people pay attention. That’s what happened to telehealth visits for mental health conditions during the pandemic—they increased by more than 1,000 percent—and the post-pandemic rate remains high.
Change usually begins with something small. It’s often ignored because it’s new, and it doesn’t work as well as the old things that have been refined and improved over the course of many years. But sometimes, the new, the untested, and the inferior begin to expand and improve. Maybe it’s more affordable. Maybe it’s more convenient. Maybe it has benefits the old ones don’t. Whatever the reasons, as more people embrace it, it often succeeds. People start to understand the advantages and potential, and after a while, the “new thing” becomes a dominant player.
Growth in telehealth and telepsychiatry, providing psychiatric care with technology (e.g. videoconferencing), is a perfect example. It started out as a novelty. People said it would never catch on because it stripped away the human touch that’s so central to the delivery of mental health care. However, there were so many people without access to in-person psychiatric care, that clinicians chose to use it anyway. They felt that virtual care was better than no care.
When the pandemic hit, everything changed. Remote care was no longer just for people who lived in underserved areas. Almost everyone wanted to receive care from the comfort and safety of their own homes. Fortunately, the tools were in place for a radical restructuring of care delivery. A Boston-area hospital system went from less than 5% virtual mental health visits in March 2019 to over 97% in March 2020.
The switch to telepsychiatry was accompanied by a flurry of research. Would remote care be good enough?
The results were surprising. In an intensive outpatient program, telehealth seemed to be just as effective as face-to-face care. For both, treatment included daily therapy and medication, if prescribed. The researchers wrote, “Contrary to our hypothesis, the small differences in outcomes [greater length-of-treatment and program completion] favored the telehealth-treated patients.”
Telepsychiatry is not only safer than face-to-face care in the context of a global pandemic, it has other advantages as well. For one thing, it’s a lot more convenient.
In my office in Washington, D.C., many patients had to take a half-day off from work to come in to their appointments. They had to clear their calendars, battle downtown traffic, and if there was no street parking available (there never was), they had to pay $15 to use the nearest parking garage. After the pandemic, few wanted to return to face-to-face care.
My experience isn’t unique. All over the country people are getting mental health care virtually. From the August 2023 study cited above, researchers examined 1.55 million mental health insurance claims. Compared to pre-pandemic levels, in-person visits post-pandemic decreased by 39.5 percent, while telehealth visits increased by more than 1,000 percent.
That’s not only a testimony to people’s preference for telepsychiatry—it means a lot more people are getting mental health care.
Providing care to so many additional patients doesn’t come cheap, but it’s a solid investment. People with untreated mental illness cost society far more than treatment does. Some people’s symptoms prevent them from working altogether, and while others are able to continue working, their productivity may be lower than it would be if they were healthy.
According to a 2022 Gallup poll, The Economic Cost of Poor Employee Mental Health, nearly 20 percent of U.S. workers rated their mental health as fair or poor. The economic cost? About $47.6 billion annually in lost productivity. The cost of treatment is a bargain in comparison.
Telehealth exploded in the context of a global pandemic. As a result of its advantages and the finding that it is just as effective as traditional care, it looks like it’s here to stay.
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