During the early months of the COVID-19 pandemic, the delivery of behavioral health care shifted radically along with many other aspects of care delivery. By April 2020, overall virtual care visits had risen to 78 times the utilization of just two months before. The future of telehealth arrived seemingly overnight, and people with mental health conditions and substance use disorders continued receiving vital treatment when in-person care might not have been available.
Today’s environment affords a more flexible approach to behavioral health delivery: a hybrid healthcare approach in which care providers and individuals can mutually benefit. Care providers can combine virtual doctor visits with in-person care to meet mental health needs in a nimble approach, ideally leveraging the best of both — while watching for potential drawbacks and pitfalls that can arise in a shifting landscape.
This evolution is much needed. The American Psychological Association(APA) reports that large majorities of behavioral health professionals, such as psychologists, report sharp increases in demand for treatment of conditions such as anxiety and depression. The same survey indicates that these professionals are also experiencing greater numbers of referrals and longer patient waiting lists. Getting people access to care is crucial, and a hybrid model can help.
“Telehealth can decrease geographic and physical barriers to care,” said Dr. Gary Proctor, Carelon Behavioral Health national medical director for provider partnerships. “It also improves the no-show rate. You might have a single parent who is trying to get to their therapy appointment, but they have to drive 20 minutes across town, and they have to get childcare. But if they can do it from home, they’re going to be more likely to attend.”
APA also points to another urgent trend: More than 4 in 10 mental health care professionals respond that they are unable to meet the growing numbers of people seeking treatment. There are many areas of the country, for example, where there may only be one behavioral health provider to meet the needs of all patients in surrounding communities. As a result, 46% of care providers say they are feeling burned out.
“A lot of practitioners have been overwhelmed by the need, and by the severity of the need,” Proctor said. “With everything that has happened over the past several years, all the different stressors, the severity is worse. There can be a lot more going on in the individual lives of the practitioners as well. They may be experiencing depression or anxiety just as the individuals they are treating.”
For these care providers, hybrid healthcare can be a welcome change. Virtual care can allow care providers to connect with patients in different communities where there is a shortage of behavioral health care options. In addition, telehealth and digital tools can help community-based providers be more efficient, allowing patients with less-pressing behavioral health issues to use virtual care, if they’re able, freeing up in-person capacity for people with more serious mental health concerns.
With more flexibility in where visits take place, care providers can potentially find greater ease in their work schedules. Some have even let go of their brick-and-mortar offices as a welcome cost-cutting measure.
The Future of Telehealth
While there was skepticism about the efficacy of telehealth prior to its expanded role during the pandemic, recent research around virtual mental health visits is encouraging. Research published by the National Institutes for Health indicates that teletherapy sessions are generally as effective as in-person visits. Yale Medicine affirms that virtual care visits for mental health appointments are working well — with the caveat that some populations respond better than others.
“You might have a person who doesn’t necessarily have access to the needed technology or skills to adequately get into the system or know what to do,” Proctor said. “Evidence has shown that telehealth can be just as effective as face-to-face, but you are losing some of the nuances of being there in person. It can be very, very effective, but some people will do better if they are in the office.”
The National Alliance on Mental Illness concurs that treatment “is not a one-size-fits-all approach.” For some mental health or substance use disorders, in-person care is best for a person’s well-being. The hybrid healthcare approach allows for this option, leveraging the best of both worlds in a tailor-made strategy that recognizes the whole person along with all their individual strengths and challenges.
The pandemic created the opportunity for many people and care providers to use telehealth for the first time, with very high satisfaction for both groups, but not all care can be delivered virtually. Telehealth is most valuable in instances where all necessary clinical information can be gathered via the remote setting to evaluate, diagnose, and treat a condition. Continued research can help define how telehealth is being used and when and where it is the best option for care.
Another exciting benefit of hybrid healthcare is the opportunity it affords for integrated, whole-person approaches. Health care silos can be broken down, with technology allowing mental and physical health care providers to meet in virtual spaces to coordinate care.
“For many years, behavioral health concerns have been separated from physical health,” Proctor said. “A lot of that had to do with privacy issues, or stigma. A lot of practitioners even felt uncomfortable communicating with the patient’s primary care doctor. The system was set up to protect people, but there may have been unintended consequences of fragmented care.”
“Now that we can integrate more, the OB-GYN is talking to the psychiatrist, who is talking to the primary care doctor or whoever else is involved in that person’s care,” he added. “This gives a much better window into what is going on in their patient’s life, and in their whole health.”
Care providers, practitioners, and individuals can all benefit from hybrid behavioral healthcare, in which telehealth smartly combines with in-person care to accommodate the evolving care needs in each person’s life.