Telehealth-Telecounseling: What We Now Know
Due to the accessibility of teletherapy, more people have felt ‘safe’ in seeking counseling care, which has helped save lives, and prevented struggles from becoming life crisis.
Today, let’s talk about Telehealth in medicine & Teletherapy in mental health.
Telehealth (via video or phone) has been utilized for counseling and medical care for years, but practitioners and clients seldom used it during its initial stages of development. During the onset of the Covid pandemic in 2019, many medical and mental health professionals were forced to move online due to healthcare concerns regarding clients’ exposure to Covid and because no one knew exactly the consequences or contagion of the virus.
Before telehealth, patients often had to wait for long periods, even months, to access critically needed care from specialists or highly trained professionals. Telehealth has helped to address that problem. When patients can seek care quickly, it often results in more significant positive outcomes, less expense for the patient, and less time needed for care.
Through telehealth in the past few years, clients and professionals have discovered some surprisingly unexpected pros, as well as cons, of online medical and counseling care.
Each person must weigh and decide for themselves if telehealth care is right for them.
Data indicates that telehealth and Tele-counseling will become increasingly commonplace in the next few years, especially as new internet access becomes available in rural areas. These areas did not have access that populated urban areas did to internet availability. Rural areas continued to be underserved due to limited access to professionals who office or provide services in many rural areas, contributing to a lesser quality of care. Telehealth has changed those conditions and made needed services more available to rural (or isolated) individuals and families.
However, surprisingly, many patients in urban areas have also adopted and indicate a preference for telehealth due to its convenience and results.
By 2020, telehealth was forecast to become a significant business entity, attracting formerly unavailable professionals.
Patients also have increased their access to previously unavailable professionals.
The Department of Veteran Affairs runs one of the most extensive telehealth programs worldwide and plans to expand its services to veterans. They discovered that telehealth for veterans with depression was as effective as in-office therapy. (Lancet Psychiatry study). Additional research showed that telemental health provided to children, young people, and adults demonstrates that interventions are feasible, acceptable, and effective as in-person services. A recent meta-analysis of telehealth treatments (from Telehealth mental health services during COVID-19: summary of evidence and clinical practice - PMC (nih.gov) )reported its effectiveness for adults (including veterans) with mental health disorders (e.g., depression, anxiety, posttraumatic stress disorder, and adjustment disorder). Most studies consistently find that telephone or videoconferencing therapy has been as effective as standard in-person treatment and superior to treatment. Both interventions showed clear, consistent evidence of beneficial effects. Results were rated as moderate to high.
What are other data and feedback resources indicating?
1. Mental health services will increase telehealth more than medical services.
2. There needs to be more mental health practitioners. (111 million people live in areas lacking mental healthcare providers and services, per Dept of Health & Human Services, April 10, 2020). CMS, Medicare, Medicaid, and other insurance carriers recognize that telehealth can address that shortage by giving patients access to healthcare providers by not being limited to location or scarcity of providers in their area. Currently (as of May 2022), 49 states cover Medicaid for mental health; 30 states and DC require private insurers to provide telehealth coverage.
3. Limitations of physical office location access breaks down former barriers and boundaries to care. Geography no longer limits access to quality providers or plays the significant role it used to play. Consumers can now talk from the comfort of their homes or office. Geography no longer limits patient care to a nearby location to obtain high-quality care.
4. State Licensing laws limit access in some states where states limit professionals providing telehealth services to clients/patients only in their state. Licensed professionals in some states have no ‘reciprocal’ licensure standards. In Texas (as of May 2022), licensed counselors can only provide counseling services to Texas residents (even though those residents may be anywhere in the state, which is still favorable). Even if consults may be allowed for non-counseling issues, counseling out-of-state is not permitted.
5. Insurance companies recognize the cost savings of telehealth in providing both standards and preventive care and are expected to continue coverage for telehealth services. Preventative maintenance (or services provided in the early stages of medical or mental health concerns) results in shorter treatment times and increased outcomes for success.
6. Patients have become more proactive in their healthcare delivery choices, and teletherapy is expected to increase from an estimated 250,000 patients in 2013 to 3.2 million in 2018 and even greater numbers in 2022.
7. Cisco data indicates that 74% of consumers in the United States would use teletherapy services, 70% are very comfortable communicating with their healthcare providers online, 80% had no concerns about submitting medical information online to secure portals,
8. It is more than just Millennials or Gen-Xers who feel comfortable using telehealth. PwC’s Health research showed that 73% of consumers aged 18-44 prefer telehealth, and 43% of patients 45 and older prefer virtual mental health sessions via telehealth rather than in-office appointments.
9. Even baby boomers are now welcoming telehealth, as they are familiar with FaceTime, Skype, or Zoom video meetings with family, friends, and especially grandkids!
10. Factors in preferring telehealth include accessibility, patients don’t have to take off work or alter their schedules as much to acquire services, substantial environmental savings (gas, transportation, uniforms/clothing, meals, etc.), the ability to schedule online rather than having to book via secretary or office administrators, ability to use the phone to schedule appointments easily, no boundaries such as in former ‘brick and mortar location access, increased time savings (not having to travel to/from offices, high-traffic-issues, not having to wait for extended periods in an office lobby…and not having to read out-dated magazines in the office lobby?:)
11. Many clients book appointments before or after work hours, before going home in the evenings, or before work begins. It provides an uninterrupted space and time for healthcare without interrupting normal family activities and privacy. High-traffic time delays utilized previously drive to/from medical/mental healthcare providers’ offices before/after work.
12. During the pandemic, many people began to work from home. This convenience flowed into telehealth services, as well. This continues to be a cost-effective system for workers and businesses in many cases.
13. Elderly individuals with limited mobility or access, housebound individuals, handicapped, or those with mental health issues (who fear or have anxiety regarding travel, Agoraphobic, PTSD, etc.) also benefit from regular services accessible via telehealth.
14. Continuity of care is greater with telehealth, especially in addressing depression, anxiety, PTSD, phobias, and other chronic conditions.
15. The stigma of seeking mental health care (or being seen in a physical office by others) is removed with telehealth. This increases the likelihood of seeking needed care and may also increase confidentiality.
16. In the past, consumers may have been unable to access needed healthcare as they could not take off work for appointments. With telehealth, especially if providers provide extended evening or weekend hours, these issues are often addressed for those clients. When care doesn’t affect the ability of a consumer to earn their salary, and they are not docked for missed work times, it can make a big difference in seeking needed care.
17. Video telehealth is preferred over the phone (by both consumers and practitioners), providing more personalized care. Mental health professionals prefer video telehealth as it allows them to communicate directly and see and respond to patients’ body language indicators unable to be seen in phone calls.
18. With written permission (by HIPAA laws) and knowledge of who will be attending a session, patients now have the option to allow their sessions to include healthcare providers while also having other professionals (providing continuity of care for the patient, such as s psychiatrist, physician, counselor or an attorney) to be ‘added via phone.’ This allows patients to see the counseling professional while hearing continuity of care plans and discussions between professionals for their care. This must be agreed on by all parties, in writing, involved before the session.
19. In telehealth, climate or weather difficulties do not hinder care as much. If storms occur, telehealth is often still accessible, even if a patient cannot physically travel snowy or icy roads, if raining outside, or if significant highways or roads are under construction (or have wrecks causing) shutdowns).
20. A negative: Telehealth is dependent on internet access. Legislators and funding are being passed to address that issue to increase internet access across the United States, allowing greater telehealth access.
21. Telehealth allows access to personal patient, insurance, and provider savings costs for delivery and services.
22. Research indicates fewer cancellations or no-shows s reported in telehealth than in-office sessions.
23. Telehealth often utilizes HIPAA-compliant systems that include secure patient messaging, secure document storage and retrieval, automated appointment reminders, and even access to schedule appointments in available times 24/7 (even provider’s offices are closed). Patients reported less time playing ‘telephone tag’ to obtain licenses when they can schedule online.
24. Telehealth often allows intakes and all forms to be done online, enabling providers to review the information before sessions. This saves time for patients and providers, allowing for a more direct focus to address the patient’s specific needs much more quickly.
25. Telehealth may be initially complex for new clients to utilize; clients may have a negative view of the actual success telehealth has been shown to have or may prefer in-person care as that is the method of care they are most used to or comfortable with receiving. For those individuals, in-person care may be the care they should seek. If willing to learn the initial methods of telecare, they are often later happier with telehealth care. They recognize that obtaining necessary care online through face-to-face telehealth sessions may save them time, cost, and energy.
Resources of the above information:
MEDLINE, PsycINFO, Cochrane, and PubMed databases
Continuity of care is greater with telehealth, especially in addressing depression, anxiety, PTSD, phobias, and other chronic conditions, as it allows more readily accessible appointments.
Telehealth also allows for more effective scheduling, such as when children are in school, after work hours, saving travel time & cost.
Video telehealth is preferred over the phone (by both consumers and practitioners). However, phone telehealth is effective for established patients and those unable to access a computer or drive to an office easily.
Rural area populations, elderly or those with limited mobility, housebound individuals, handicapped, those who have anxiety regarding travel, auto-immune individuals, agoraphobic, or those with PTSD also benefit from regular services accessible via telehealth.
“My clients experience changes over time in therapy, find ways to address complex issues, and begin to understand that they can learn to be confident in who they are, what they can do, and to make a plan for success. Life is about how we recover and heal that determines how effective we are in addressing life’s ups and downs. We can feel happiness, even if it is a slow process. If you need help doing addressing issues in your life, please contact my offices to schedule an appointment or to request more information” - Clifton Fuller
Clifton Fuller
LCSW, LPC, LMFT
