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Telemedicine and Mental Health Services

Today’s video results from a disturbing article that appeared in the Wall Street Journal in December entitled “The Failed Promise of Online Mental Health Treatment,” which discusses drawbacks to the digital mental health platforms that saw a surge in popularity and acceptance throughout the pandemic. The article is disturbing in two ways. First, because of the actual issues reported. There were numerous examples of unprofessional providers and poor care. Second, when at the height of the pandemic, so many appointments were conducted via telemedicine, it seemed a technology with great promise in the appropriate circumstances. Hence, to see an article exclusively focused on the failures associated with these services during the pandemic without any recognition of the potential or promise, was disappointing.

There are various issues to address concerning telemedicine. Many licensure requirements were waived or made more flexible during the pandemic so clinicians could work across states. There are also policy issues that must be addressed by providers and the issue of how such visits should be paid.

But with respect to mental health, telemedicine seems to hold promise to improve access to services for some populations. In a previous video about doctors opting out of Medicare, we reported that the highest percentage of opt-out physicians are in behavioral health. We suspect this holds true as far as in-network status is concerned with commercial coverage too. As a result, access to mental health services was challenging prior to COVID and became a much more pressing issue during COVID due to the stress, anxiety and isolation that accompanied the pandemic.

Because there may be additional regulatory issues to address with telemedicine as the public health emergency expires in May, I decided to go to my CIGNA portal and check my benefit as well as to determine whether I could find online telemedicine providers through the provider search tool. To my surprise, the screen populated with many provider choices. I didn’t recognize them, but I am hoping these are reputable organizations which have been vetted by my insurer. Wouldn’t it be positive if some highly reputable organizations evolve and thrive to support those who need help and have difficulty accessing care? Anyway, consider going to your portal to see which providers you find in the search tool.

I once had a physician prescribe my young adult daughter a drug for severe depression. It was early in 2009 and our daughter was a senior in college. 2009 was a very stressful year to graduate because jobs were scarce. I was in the waiting room during the visit but when I saw the prescription I asked to see the doctor and questioned it. I mentioned that my daughter spent nine grueling weeks the prior summer biking across the country for Habitat for Humanity. That didn’t seem like an activity a severely depressed person could undertake and complete. The physician said, “this age group would rather pop a pill than speak to someone about what’s bothering them.” I found that to be a shocking reason to prescribe someone a medication that is not without potentially serious side effects. I am pleased to report (with my daughter’s permission, of course) that she returned to campus and received services through the university’s mental health services department. Most important, the services were very helpful.

My education is in public health so I am not a clinician. Nevertheless, common sense suggests that it’s preferable to speak to someone qualified to help and if that person decides drugs should be a part of the care, consider medication. At any rate, let’s hope most agree that society would benefit if more people who are troubled by a problem could talk to someone about it. High-quality telemedicine has potential to help meet that need. Let’s hope it does.