The Remote Delivery Of Mental Health Services During COVID-19

During the COVID-19 pandemic, a huge range of healthcare services have moved online due to social distancing requirements.  A new study from Virginia Commonwealth University finds that mental health services are no exception.

The researchers surveyed 2,619 licensed psychologists across the United States and found that the number of teleconsultations grew 12-fold since the pandemic began.  This has seen the proportion of consultations performed digitally rise from 7.07% before the pandemic to 85.53%.  Indeed, over 67% of psychologists reported conducting all of their work virtually.

“The shift from 7% of clinical work to more than 85% represents a lot of heavy lifting in a very short time,” the researchers say. “There was a concerted effort among the community to identify and remove long-standing barriers. Psychologists sought out additional training, equipment was purchased, and policies were adjusted at every level to facilitate telehealth and telepsychology.”

An enduring trend

Interestingly, there are signs that many of the psychologists will continue to work virtually after the pandemic ends, with nearly 35% saying they plan to continue operating digitally in the long-term.

“I’m hopeful that these trends show that psychology as a field is able to adapt to the needs of both providers and patients,” the authors say. “Of course the initial wave of telepsychology during the pandemic has been out of necessity, but our findings suggest to me that there are benefits to continue offering it in the future even when it is safe to attend in person.”

As with most telehealth, the advantages of such an approach are wrapped up in the convenience to providers and patients alike.  It’s also widely documented that it helps to smooth any gaps in access to healthcare geographically or due to mobility issues.  Previous research has also shown that some patients prefer receiving mental health support virtually as well as it feels like a safer space.

“I think the flexibility to offer both in-person and telepsychology services is critical in being able to meet patients’ needs and making psychological services more accessible,” the researchers continue.

Uneven adoption

Interestingly, however, what appears fairly uniform adoption across the profession was largely anything but.  For instance, professionals working in outpatient treatment saw a significant increase in adoption, whereas those working in veterans affairs centers saw less of an increase, although the researchers accept this is likely to be because such centers already used telemedicine a lot anyway.

Demographically, there was a significant increase among women, and also among psychologists who had received training in telepyschology.  It was also most common in areas such as relationship and anxiety issues.

“Historically, women have tended to provide the bulk of child care. We think it’s possible that women psychologists with children may have needed to use telepsychology at higher rates in order to continue to provide child care in the home, especially when most schools and day cares were closed,” the researchers explain. “In contrast, men may have had the ability to continue some degree of in-person clinical work, particularly if they had a partner who was able to provide child care.”

The lowest increases came from psychologists operating in rural areas, especially if they worked in the treatment of antisocial personality disorders, rehabilitation patients, or were performing testing and evaluation.

“No other event in modern history has altered to this extent the landscape of psychological service provision,” the authors conclude. “Many of the barriers to telepsychology use that have been touted for years have now been dramatically lessened or even fully removed, and we are seeing an unprecedented rollout of technology-based mental health treatment. The field of psychology has put forth a substantial effort to adapt to the demands of the pandemic and unmet mental health needs that are being uncovered across the U.S.”

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