By Jeni Miller
It is well-known that telehealth provided a much-needed service in 2020 and following, especially as people desired to stay in their homes while addressing health concerns. The same is true for mental healthcare. However, did the increase in tele-mental health visits translate into a higher quality of care?
“Patients receiving care from practices that had a higher level of telemedicine use during the COVID-19 pandemic had more mental health visits per year compared with pre-pandemic levels, with no differential changes in other observed quality metrics over the same period,” the authors of a recent study concluded.1
Perhaps patients felt more at ease to schedule and attend these virtual appointments, and it became more mainstream to do so — only it did not necessarily result in better outcomes in terms of quality of care.
“With the pandemic, telehealth helped with access to mental healthcare services and gave providers a chance to treat patients when opportunities for inpatient visits were restricted,” says Vivian Campagna, DNP, RN-BC, CCM, chief industry relations officer for The Commission for Case Manager Certification. “This enhanced access to telehealth was a real positive. The pandemic catapulted us into the future and mainstream use of telehealth, and that’s a good thing.”
Campagna questions whether the increased usage of tele-mental health also affected people in rural areas, such as allowing access to places where there may be few or no providers. However, the study showed that the use of telehealth for mental healthcare services did not increase in rural areas — only in urban areas.
“It may be that it was already in use in rural areas before the pandemic, so the increase doesn’t appear to be where we expected it,” Campagna added.
Among the many benefits of tele-mental health services is the ability to receive care in the home, which Campagna says is a “safe space to talk.” Tele-mental health also often resulted in more efficient connections to crisis services.
“It also helped to reduce provider burnout and allowed providers to stay effective,” Campagna explains. “With the ability to meet clients and not stress about masks or protection, or bringing them into an office, it helped in that sense to give them the ability to work with a little less stress.”
Other benefits include enhanced continuity of care, addressing the treatment gap, overcoming mobility issues and competing priorities (like child care), and helping to mitigate other social determinants of health that otherwise can prevent people from accessing care.
Seniors with mental health concerns may not be able to get out to see their provider, but through video and phone, they have had greater access to appointments. For other demographics, tele-mental health proved beneficial by decreasing no-shows and providing an avenue for culturally specific care, especially for underserved individuals.
“This gave access to providers that may not have been local to the client, but this broader range of providers could meet people where they’re at in terms of language, culture, and values,” Campagna says.
Accessing tele-mental health meant a reduction in the still-present stigma of mental healthcare.
“There is still a stigma attached to going to the providers and dealing with mental health issues,” Campagna notes. “While it’s now more mainstream and more attention is given to mental and behavioral health issues, there is still a stigma. By reaching services from the comfort of their home, providers can treat more consistently.”
Of course, access to technology, especially for seniors and low-income individuals, can be a deterrent to using these services.
“Whether it’s the ability to get the smartphones they need or broadband access for a video session, we need to look at some of the issues that impact a person’s ability to use tele-mental health,” Campagna says. “Some of these are very surmountable.”
To help case managers consider how to better navigate tele-mental health for patients and to mitigate any drawbacks, Campagna recommends reviewing the Substance Abuse and Mental Health Services Administration Resource Guide for Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders. The guide is meant to “[review] ways that telehealth modalities can be used to provide treatment for serious mental illness and substance use disorders among adults, distills the research into recommendations for practice, and provides examples of how these recommendations can be implemented.”2
Campagna also notes how some practices use hybrid models wherein the “provider is doing a lot of interventions or connections, but when care is needed face-to-face, they will bring them in.”
To maintain a high level of care, providers can leverage telehealth to maintain client relationships, more effectively follow up, and touch base, especially with a patient who has had a significant episode or inpatient experience and is discharged.
“This allows the provider to touch base more frequently while not traveling back and forth to the office, and telehealth can help maintain the progress that the patient has made, follow medication and treatment regimens they had, and continue moving in a positive direction,” Campagna says.
For case managers to best help patients who need to access tele-mental health services, Campagna recommends ensuring that patients truly know how to access these telehealth visits.
“The best is for case managers to work with them to do an actual trial run and get them comfortable with accessing it and working through any challenges,” Campagna says. “If we as case managers can start to work with clients on technology and can get them to be more comfortable and address any challenges in themselves or with the technology piece, it can be really helpful.”
Campagna reiterates the importance of patient education and better interoperability in care coordination. “There are so many systems out there and so much information. It’s important to look at the interoperability of systems and how we can best share information without having to go through charts, which in the past could take weeks to get information,” she explains. “Even if the computer systems are not the same, they can communicate.”
Social determinants of health also play a role in access to tele-mental health services. Case managers need to know what might be preventing someone from reaching their provider electronically.
“We think about access to care and transportation, but we don’t always consider whether they have a cellphone, bandwidth, tablet, or computer,” Campagna says. “Technology access and literacy need to be considered mainstream for social determinants of health. When we work with clients, it’s important to note that telehealth is a good alternative unless they don’t have the technology. Case managers should ask whether they have technology access challenges as part of their planning.”
REFERENCES
- Wilcock AD, Huskamp HA, Busch AB, et al. Use of telemedicine and quality of care among Medicare enrollees with serious mental illness. JAMA Health Forum 2023;4:e233648.
- Substance Abuse and Mental Health Services Administration. Telehealth for the treatment of serious mental illness and substance use disorders. June 2021.
It is well-known that telehealth provided a much-needed service in 2020 and following, especially as people desired to stay in their homes while addressing health concerns. The same is true for mental healthcare. However, did the increase in tele-mental health visits translate into a higher quality of care?
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content