Over the last decade, the increasing availability of smartphones and high-speed internet has led to an explosion of digital health tools. From primary care and behavioral health to oncology, cardiology, and even the ICU, videoconferencing and innovative apps are improving patient experiences while expanding access to care.
Between 2016 and 2019, the number of virtual visits doubled, the American Medical Association says. By the end of the decade, just under 30 percent of physicians used telehealth to connect with patients. That trajectory has taken an even sharper upward turn in the past few months as the COVID-19 pandemic fundamentally alters the delivery of healthcare, including mental and behavioral health.
Physical distancing and quarantine procedures are changing the way people live, work, and care for one another. As a result, many individuals are struggling with their mental health. Between 16 and 28 percent of people are subject to increased depression, anxiety, and stress due to the pandemic and associated events, such as job losses and feelings of isolation.
Telemental healthcare may be able to help.
During the initial time of crisis, behavioral healthcare providers have expanded their use telemental health tools, such as dedicated apps for videoconferencing that connect individuals to trained therapists, to deliver necessary care while keeping clients and clinicians safer at home.
But even after the first wave has passed, telemental health will be crucial. The long-term impacts of the pandemic are as of yet unknown, but there is little doubt that adjusting to a new normal will be a challenge for almost everyone. Behavioral healthcare providers should prepare for increased demand for their services – and they will need virtual care tools to help them keep up.
With the right strategies and approaches, providers can begin to lay the groundwork for expanding the use of meaningful, personalized, and data-driven digital tools in a post-COVID-19 world.
Continuing to encourage adoption among clinicians
Behavioral healthcare is an incredibly personal and sensitive area of practice, and conventional wisdom might suggest that most patients would prefer to discuss these topics face-to-face. Yet that is not always the case. Even before the COVID-19 pandemic, behavioral health was one of the fastest growing areas of telehealth service adoption, with about half of behavioral health providers offering videoconferences or other digital services.
Psychologists, however, are somewhat less likely to engage in virtual care, with only 43 percent of psychologists using longer-distance techniques, a 2018 survey found. Of those, most stick with the telephone or email and do not typically recommend other apps or communication methods.
Survey participants noted that legal barriers and privacy concerns often prevent the use of telemental health solutions in daily practice. Other respondents expressed concerns that videoconferencing would negatively affect the patient-provider relationship – yet studies show that many patients are just as satisfied with remote visits as they are with in-person care. Some actually prefer the convenience and personal comfort of telehealth to an office visit.
During the COVID-19 crisis, regulators have made special efforts to remove many of these barriers, including offering full reimbursement parity for telehealth visits and allowing providers to use non-HIPAA compliant communication services if the tools are used in good faith.
While these changes are designed to support the immediate response to COVID-19, positive responses from patients and providers may generate momentum for more permanent policies that safeguard privacy while encouraging broader use of telemental health strategies.
In conjunction with greater acceptance on the part of patients, these developments could encourage reluctant behavioral healthcare providers to explore the ways in which virtual care can enhance their relationships with clients.
Establishing measures to gauge the effectiveness of interventions
Measurement-based care, or the use of validated metrics to monitor patients and guide decision-making, is just as important in telemental healthcare as it is in other areas of clinical practice.
Behavioral healthcare providers already use a number of effective measurement-based care strategies, such as standardized questionnaires, to gather information about patients. Digital health tools could grant even more visibility into an individual’s wellbeing, especially when combining self-reported mood information with other “digital biomarkers,” such as sleep quality and physical activity.
Although mobile apps and sensors embedded in smartphones or wearable devices are becoming highly sophisticated, they still require study and validation before they can be deployed at scale.
Researchers and clinicians will need refine these digital health technologies before merging the tools with existing assessments and other telemental health strategies. Doing so could create a powerful communication ecosystem that goes far beyond even the acknowledged benefits of measurement-based care and videoconferencing individually.
Promoting positive lifestyle changes during COVID-19 and beyond
Lifestyle changes are often key to improving mental and behavioral health, yet sustaining progress between sessions is often a challenge for patients – especially during times of widespread stress and uncertainty.
While many behavioral health clients are interested in using digital tools to track stress-reducing behaviors such as getting enough sleep, eating well, and exercising, relatively few clinicians routinely recommend lifestyle monitoring apps to their clients.
Integrating these apps into the care process could help to maintain patient engagement and cement positive new habits for individuals.
Combining lifestyle monitoring apps with measurement-based care tasks, such as filling out an electronic questionnaire at regular intervals, could create a digital safety net for individuals who are struggling with the feelings of isolation, helplessness, and fear that can arise during quarantine. Putting those same principles into practice after the quarantine period ends will allow clinicians to expand their ability to help more individuals in increasingly effective ways.
As the world begins to ponder what will happen after COVID-19, telemental healthcare will play a key role in safely opening up society while helping individuals cope with the long-lasting impacts of this traumatic period.
Reducing barriers to telemental health adoption, integrating measurement-based care, and developing new ways to monitor lifestyle changes will be crucial for adding digital mental health tools to the clinical toolkit on a scale appropriate to the challenges that lie ahead.