Telemental health: A hybrid future for mental health care

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Virtual mental health care has been a standout success. Here is how practitioners in other specialties can build on that success.

The case for teletherapy has been building for years. Studies looking at the use of telehealth for depression, substance use disorder and other mental illnesses show that it can be just as effective as in-person care. Virtual visits are an especially good fit when someone is uncomfortable being seen in a mental health clinicHow well is telepsychology working? (apa.org) or needs flexible scheduling.

During the pandemic, teletherapy found its moment. “Once people had their first experience, they found the care to be quite good. And they liked not having to travel to an appointment and sit in a waiting room,” says Taft Parsons III, MD, Chief Psychiatric Officer for CVS Health®.

In the year before the pandemic, CVS Health provided 20,000 virtual mental health visits. That number grew to 10 million visits in 2021. By August of that year — when most people went back to their doctors’ offices for other kinds of care — about 36 percent of the outpatient visits for mental health and substance use disorder were completed virtually, compared to 5 percent for other medical visits.Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19 Pandemic | KFF

Mental health care is at the forefront of exploring how virtual care works best, according to Parsons, including where in-person visits and smartphone apps fit — and how to solve for new barriers to integrating that care.

Finding mental health apps that fit

The proliferation of apps and services is one of those barriers. As many as 20,000 mental health smartphone apps are thought to exist, and the field is expected to grow 20 percent annually in the coming years.Mental health apps are gaining traction (apa.org); Mental health app market growth | Deloitte Insights This abundance is a good thing, as the tools have been shown to improve symptoms of depression, anxiety and stress.The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials - PMC (nih.gov) But patients may need help to sort out which apps are effective and which are not.

“It’s exciting to have these apps as part of the digital toolbox,” says Cara McNulty, DPA, President of Behavioral Health and Mental Well-being for CVS Health, who notes that an app’s potential can be profound, as long as it is coordinated. “But we vet our partners very, very carefully to make sure they provide sound clinical approaches and have good outcomes that can align to an individual’s overall care plan and experience.”

Matching patients with clinically proven apps is a tall task, but one that can yield life-changing benefits. One app partner of CVS Health, for instance, provides support to young adults who are thinking of harming themselves. Another partner helps people cope with eating disorders. These tools can be used on their own or in conjunction with provider visits, McNulty says.

“Once people had their first experience, they found the care to be quite good.”

— Taft Parsons III, MD, Chief Psychiatric Officer for CVS Health

The need for in-person care

While the future of mental health care likely will include virtual services, practitioners are also getting a better sense of who isn’t a good fit for telehealth. For example, people with severe or persistent mental illness are good candidates for in-person visits. “These patients often require wraparound care, with a team of clinicians, to remain in recovery,” says Parsons.

But even in those scenarios, emerging telehealth tools can help. “A patient might be treated virtually by a telepsychiatrist and have face-to-face appointments with the rest of the care team,” he says.

As in-person and virtual care approaches move ahead for the whole industry, McNulty says there is another opportunity in further integrating mental health services into the general care of every patient. “No one should have to go out of their way to get mental health care,” says McNulty. “It needs to be woven into every aspect of care and provided in a stigma-free, positive way.”

As part of that approach, patients can get same-day depression screening appointments at all MinuteClinic locations, as well as in-person and virtual mental health counseling services in select states. It’s a chance to catch serious mental illnesses such as depression, which goes undiagnosed in more than halfhttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795293 of patients who have the illness.

The big takeaway is that access to health care should be flexible and offered wherever patients need it. “Many people want a combination of modalities for mental health care,” says McNulty. “We don’t make the assumption that everyone’s journey is the same.”