While anxiety and depression were already among the most common medical conditions in the country before COVID-19, demand for mental health services has soared since the start of the pandemic. Prevalence of depression symptoms has tripled since March of last year, and the CDC reported that the 12-month period leading up to May 2020 saw the highest number of drug overdose deaths ever recorded.
It’s also meant that mental health providers have had to make abrupt adjustments not only to current clients’ treatment, but also around initial conversations with prospective ones.
Russ Philpott, therapist and founder of the outpatient practice New Day Therapy in Vienna, West Virginia, works with individuals and families who struggle with conditions ranging from anxiety and depression to relationship stress and addiction.
“Once a lot of my new referrals found out they had to do telehealth, they’d re-schedule or didn’t schedule at that time. There was a real drop in our clientele,” he said about the initial stages of quarantine last March.
“What I found was the people that I’d already had an established relationship with didn’t find it that much different. I think they knew me and my mannerisms, and I knew them and their mannerisms. It wasn’t as weird as they thought it would be.”
New Day clients became more open to teletherapy as the pandemic worsened, but obstacles remained. Many couldn’t find private places to talk due to their newly confined situations, and some lived in rural areas with limited access to a stable connection. The practice also began receiving more referrals for students who were struggling with the loss of routine, particularly around schools’ ever-changing closures, re-openings and virtual learning tools.
“The first thing I’m doing is validating just how difficult the conditions are, because [students] start to question whether or not they’re worthy or if they’re capable of being a good student,” he said.
“But just because it’s been a mess doesn’t mean it’s always going to be a mess…I remind them that they know how to do school. They just don’t know how to do it in the midst of global pandemic, and nobody does.”
Philpott also mentioned that having a supportive staff that is dedicated to helping clients and referrals navigate those challenges was critical.
Beyond accommodating staff and providers, however, lie deeper accessibility issues. Over 115 million people live in government-designated Health Professional Shortage areas, and rural and other non-metropolitan regions have an average of 9 and 13 psychologists per 100,000 people, respectively. The rate for psychiatrists is usually less than half of that amount. Although parity laws enacted over the past couple decades were meant to keep mental health coverage on par with physical conditions, loopholes and haphazard enforcement have not made that a reality in many cases either. Thus many treatments are cost-prohibitive, and wait times to see a therapist can take as long as three to six months in some cases.
“One of the biggest issues with mental health that everyone in the field is grappling with is that there’s just not enough mental health providers in the country to deal with the scale of the problem. Even before the pandemic, 66% of people weren’t getting any treatment,” said Rohan Dixit, a trained neuroscientist and founder of Lief Therapeutics, a wearable device company that collects and helps perform biofeedback on mental health biomarkers.
There’s certainly been reason for optimism in light of relaxed telehealth regulation. Increased funding for mental health startups - which raised over $1.6 billion in venture capital by the end of 2020, compared to $893 million in 2019- are spurring development for cutting-edge apps that oftentimes integrate into providers’ EHR software as well. But as groundbreaking as they are, their impact can only be measured by how accessible they are to those that need them most.
“A lot of startups in the mental health space are only thinking about employer health plans, because those tend to be better funded. What ends up happening is that people who work at Google or Twitter have these amazing health insurance plans, which is great, but they’re the ones that are getting access to all these treatments,” said Dixit.
He said Lief has worked with Medicaid plans and community health providers in rural areas to make sure behavioral health access is more equitable. But just like access, adoption is another key predictor of impact. While the Lief device can improve self-regulation skills, many still crave a human connection with a professional.
“A therapist that does talk therapy and also uses Lief finds that it works really well together, because [patients] are only there for an hour a week, and all of their normal life is happening outside of that narrow contained experience. That’s when you want to build those self-awareness skills and practice what you’re talking about in therapy,” Dixit said. “It actually allows you to have a much more intimate connection with your therapist.”
Based on how many patients adopted teletherapy during the pandemic- even those who were initially reluctant- addressing access barriers coupled with strong client-therapist relationships can multiply the effect of technological tools even further.
“It gives us options where we didn’t have options before. For people who can use telehealth, if it snows or they physically can’t get here, or they’re not feeling well, then they still have access. So for us, it’s been really cool to have that option,” Philpott said.