Expanding mental health services via telehealth requires more than technology

Mental health loomed as a major theme at the ViVE Conference in Nashville even before the deadly shooting at the Covenant School.

Healthcare leaders talk about expanding mental health services during a discussion at the ViVE Conference in Nashville.

But in light of the fatal shooting of three children and three adults at the private school just a couple of miles from the digital health conference, the discussions of mental health gained an even greater sense of urgency and gravity.

Healthcare leaders at ViVE talked about the importance of expanding access to behavioral health, and there’s widespread agreement that telehealth is a critical ingredient to enabling more people to get help.

“Technology is going to play a fundamental role in expanding in mental health services,” Danny Gladden, director of behavioral health and social care for Oracle Health, said during a panel at ViVE.

Healthcare leaders have increasingly touted telehealth as a vital tool to help more people get mental health care. They cite the dearth of clinicians in mental health. Over half of all U.S. counties are without a practicing psychiatrist, according to the University of Michigan.

In an Epic analysis of telehealth use among various types of specialty care, mental health and psychiatry had the largest volume. Even so, most of those patients (85%) using telehealth for mental health and psychiatry didn’t need a follow-up in-person appointment within 90 days, according to Epic’s research.

• Read more: Where telehealth can help patients and providers avoid in-person care

The Cooper Health System in New Jersey offers on-demand walk-in programs and on-demand telehealth services, said Kaitlan Baston, Cooper’s medical director of addiction medicine. Cooper also offers telehealth options for those who miss an in-person appointment.

Even as Cooper aims to offer more virtual care options in behavioral health, the system also is aiming to provide services for those who want treatment in person.

“While we are building on-demand telehealth, I want to make sure we have both,” Baston said at ViVE.

“It’s not one-size-fits all. We have to bring both forward,” she added. “We don’t want to get into a false binary of ‘either/or’. It’s ‘both-and.’”

• Read more: Using telehealth to improve equity and access

Even as healthcare leaders at ViVE touted the importance of expanding digital health options, health systems agreed that there should be more clinics available for people who want care in-person, including in neighborhoods and communities that are underserved, Gladden said. Patients who want to see a professional in-person for mental health or addiction shouldn’t have long drives.

It's also critical to get more providers in behavioral health, and a more diverse set of mental health professionals. Patients want to see providers who look like them.

At Cooper, about 40% of the providers for addiction treatment are people of color, but Baston said, “We’re still not fully representative of our community.”

Kate Steinle is the chief clinical officer of FOLX Health, which offers treatment for anxiety, depression and trauma from clinicians who specialize in mental health for LGBTQ+ patients. Steinle, who participated in a discussion on mental health at ViVE, said the company was founded to help those who often experience discrimination in seeking mental health care.

“They’ve had really horrible experiences in seeking medical care, so they stopped going,” Steinle said.

Gladden said the difficulty in LGBTQ+ patients have in getting access to behavioral health is a significant problem.

Health organizations “must be trauma-responsive, must be culturally humble,” Gladden said.

Telehealth leaders and advocates have criticized the Drug Enforcement Administration’s proposal that would tighten regulation on prescribing certain medications remotely. Under the DEA’s plan, providers could prescribe a 30-day supply of some controlled substances for mental health and substance use disorder, but they would need an in-person evaluation for another prescription.

• Read more: Telehealth advocates say DEA plan could limit access to certain medications

The rules could make it harder for people to get prescriptions they need, said Steinle. She criticized the DEA for drafting regulations without examining clinical evidence.

“Look at the data and clinical safety that we now have for the last three years in the care we give through telehealth and use that,” Steinle said.

Some studies show promising results from telehealth. Researchers found that telehealth services for those battling substance use helped reduce the risks of overdoses requiring hospitalization. A Mayo Clinic study found a high degree of accuracy in diagnoses through telehealth, particularly in psychiatry.

At the same time, a federal report released in February 2022 suggested some members of minority groups were less likely to use video telehealth services than white patients.

Even with the potential of telehealth, Gladden said, “We can’t leave folks behind.”