According to Carolyn Witte, the founder of Tia, a women’s health clinic in New York City, this is only one example of the types of texts that flooded the company’s digital platform around March 2020, the month that COVID-19 took hold across the United States. Practically overnight, she says there was a 400 percent increase in the number of behavioral health-related messages that Tia received after the virus hit NYC, highlighting the immense effect that the pandemic has had on our collective mental health.
The mental health crisis in the U.S. is not a new one—the National Alliance on Mental Illness (NAMI) estimates that one in five adults in the U.S. live with a mental illness—but COVID-19 has made things worse. Pros have been outspoken about the pandemic’s potential for triggering mental health disorders including depression, anxiety, substance abuse, and eating and exercise disorders, and the numbers speak for themselves. In March of 2020, calls to the “Disaster Distress Helpline” run by the Substance Abuse and Mental Health Services Administration (SAMHSA) jumped 891 percent year over year. And according to the America's State of Mind report released by the doctor prescription tool Express Scripts, 78 percent of prescriptions for all antidepressant, anti-anxiety, and anti-insomnia medications during the pandemic's "peak week" of March 15 were new prescriptions.
This is a huge issue considering the massive barriers many people face in receiving mental health care. Seventy-seven percent of U.S. counties have a shortage of psychiatrists, and on average, there are 20 mental health professionals for every 100,000 people in America. Such shortages make it hard to get appointments; a 2015 study found that the average wait time to get an appointment with a psychiatrist in Boston, Houston, and Chicago was 25 days, with some people waiting as many as 93 days for their first appointment. Other research has found that mental health patients are twice as likely to wait for more than six hours in the E.R for care compared to medical patients. And these statistics all existed before COVID-19 upended our health-care system.
Even when you are able to get an appointment, there's a significant financial burden that comes along with it. Exorbitant costs (in New York City, for example, the average therapy session costs $220) and limited insurance coverage have forced many people to go without mental health treatment. According to a 2017 report from the National Institute of Mental Health, of the 46.6 million adults in the United States with a mental illness, only 42.6 percent (less than half!) had received care that year.
The only silver lining? Thanks to increased offerings in tele-mental health services, getting help for your mental health might be getting easier.
Digital mental health services come in where traditional services fall short
Digital services, which take place via text or video chat and include both cognitive behavioral therapy and psychiatric treatment, make access easier and more affordable. While these services naturally require internet access and/or cell service, they don't require in-office visits and are often available on-demand, making them potentially more accessible options for people who have disabilities, illness, or who otherwise are unable to easily leave their homes. They also tend to be cheaper than traditional mental health care: Talkspace, one of the leaders in the space that offers text and video therapy, charges between $260 to $396 for a month of care depending on a person's subscription. Cerebral, a digital mental health provider that launched in January, touts a $99-a-month price tag that includes appointments with a psychiatric provider, unlimited messaging and monthly video visits with a care provider, and medication. These costs, while still expensive for many, are still a far cry from what one would likely normally pay going through more traditional channels.
Many teletherapy services can also see patients more quickly than their in-office counterparts. “With the wait time to see a psychiatrist being [so high], people are only going to seek help if they really, really, really need it—and those are the ones who are in crisis, the ones who are so down and distraught that they’re going to need a whole slew of medications in addition to therapy,” says Ho Anh, MD, the co-founder and chief medical officer of Cerebral. “We’ve lowered our wait times from three to six months down to a couple of days to a week at most, [which means] we’re catching patients much earlier, before they’re in crisis.”
Plus, teletherapy and other digital mental-health services are effective at providing care. A 2018 review found that online cognitive behavioral therapy treatments can be effective in treating anxiety and depression, and another study found that it can also be helpful in treating post-traumatic stress disorder (PTSD) in veterans (and potentially even increase access to care).
With all of these assets, the tele-mental health boom has been a long time coming—last year, 16 digital behavioral health companies made up for 8 percent of overall digital health funding —but the pandemic has planted the seed to kickstart their growth. Along with the above-mentioned increased demand for mental health care, loosened restrictions on telemedicine during social distancing can make it easier for people to access care. The Coronavirus Preparedness and Response Supplemental Appropriations Act passed on March 6 allows mental health professionals to practice across state lines and waive insurance reimbursements for telemedicine services. Additionally, psychiatrists are temporarily able to prescribe benzodiazepines (a commonly prescribed treatment for anxiety disorders, alcohol dependence, and insomnia) without an in-person visit thanks to the appropriations act.
COVID-19 has created opportunities in the digital mental health space
All of this has driven a number of companies to ramp up their offerings, making it possible for people to get the care they need when they need it—something that’s particularly important as we face a global pandemic. “Because a lot of people are coming in in crisis, there’s a lot of immediate need stabilization," says Amy Cirbus, PhD, LMHC, LPC, director of clinical content at Talkspace. "... So whereas six months ago, we might have been getting people with a very diverse striation of needs, right now the majority of people are like, ‘I just need to figure out how to reduce my anxiety enough to concentrate, to actually sleep at night, and to get through my day.'" Talkspace has responded to these immediate needs by offering free services on social media in addition to its usual teletherapy options. Users are able to ask licensed therapists questions via Instagram live, and the brand has also created a COVID-specific Facebook group that has more than 4,000 members.
Other health-care brands who have never provided mental health services are expanding their offerings specifically because of COVID-19. While Tia had been planning to add mental health services to its New York clinic at some stage in the future, the brand decided to make it happen ASAP after overwhelming demand from clients. Now, it's offering in-clinic and virtual (aka text and video chat) psychiatric care and cognitive behavioral therapy to give patients the tools they need to manage their behavioral health. Similarly, Hims and Hers, which have offered digital health services for men and women since 2017 and 2018, respectively, launched their first foray into mental health-care in April 2020. They’re currently serving up free online support groups led by licensed therapists, and have plans to roll out personalized psychiatric care (including digital one-on-one talk therapy sessions and psychiatric consultations) in the future.
There are also new players in the digital mental health space that have launched during the pandemic. A new California-based startup, called Frame, touts itself as the “Classpass meets Peloton for mental health,” and offers free workshops with mental health pros in addition to individualized therapy. (Therapy sessions range from $75 to $200, with sliding scale options for increased affordability.) And Real, which intended to launch a membership-based brick and mortar mental health clinic in New York City in April, pivoted its services online and is now hosting free mental health “salons” and check-ins with mental health professionals.
Will digital mental health services become the new normal?
Social distancing practices have made us realize just how much we can do online, and mental health care is no exception. Traditionally, providers have been hesitant to go digital because of their unease treating depressive and suicidal patients remotely, but this experience has led many to realize that there’s inherent value in being able to treat a patient in their home. “We can see their environment, and how they naturally present themselves,” says Dr. Anh. "We can see the dirty pans behind them, that their hair is all messed up, and they're comfortable in their skin, and that’s valuable information. The amount of information that I get from just talking to someone for 5-10 minutes can tell me more about them than how they present themselves than I would if they were outside.”
As for patients, Cerebral co-founder and CEO Kyle Robertsons expects that we’ll see a “paradigm shift” in regards to the general comfort people feel with receiving mental health care online. “I think there’s a huge possibility that we’ll see [a shift toward digital], especially because people who were previously going to therapy face-to-face are now seeing a therapist online,” adds Cirbus. “So not only do you have it introducing therapy and its benefits to new people, you also have people who would never have thought about tele-therapy now using it.”
As the pandemic persists, we find ourselves in the midst of a digital mental health boom. It thus remains to be seen whether more people will truly be able to access these expanded teletherapy options, or whether these companies (and others) will be able to scale to meet the massive need for mental health services. But for the first time in a while, there's hope that more of 46 million Americans dealing with mental health issues can finally (finally!) get the help they need... without having to wait months to get it.
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