How Telehealth Can Improve Access to Mental Health Care

Healthcare Management, Health Security, Health Policy Transformation, Pandemic Response Support
A person with a stethoscope around their neck smiles as they look at a phone in one hand and enter information into a tablet with the other hand.

The United States is on the cusp of an unprecedented need for mental health care, with too few providers available to meet the growing need for support. According to the National Center for Health Workforce Analysis, by 2025 there will be a shortage of 250,000 mental health professionals after the pandemic, creating an access to care crisis. During the COVID-19 pandemic, the Disaster Distress Helpline, a government-supported crisis hotline for people suffering from natural or manmade disasters, saw a 1000% spike in call volume, according to data from the Substance Abuse and Mental Health Service Administration. This same data showed that The Crisis Text Line, which provides text-message-based support to any individual, in any crisis, had 9,854 counselors actively responding to text messages during a 28-day period through May 29, 2021, over 50% higher than in the 28 days before the pandemic.

While the country has struggled with the pandemic, the government has increased support to mental health services, and we must continue to do so to help citizens manage long-term impacts of the virus. Many individuals are struggling with extreme financial difficulties, lingering COVID-19 symptoms, traumatic stress, and other issues that will put pressure on the healthcare system for decades to come.  These traumas can cause an uptick in conditions like chronic pain in otherwise healthy people, which often requires lifetime care. On top of this, healthcare providers are already seeing the impact of “long-COVID”, a set of health issues that can include autoimmune disorders, neurological symptoms, and other health problems that will require prolonged treatment. During the pandemic, telehealth served as a lifeline for those who couldn’t get to doctors in person or needed help anew, and its rapid expansion was supported by emergency authorizations that made it possible for providers to expand mental health services. Now, it’s important for government agencies and providers to work together to ensure a consistent standard of care and keep telehealth available for those who wish to use it.

“Telehealth provides a significant improvement for patients with mental health needs by allowing them to receive treatment from home if they live in a rural area or don’t have ready access to a provider,” explains Courtney Wright, Consultant for Policy Analysis and Operations at LMI. “The data on the benefits of telehealth shows that continuing to expand availability aligns with current administration priorities on healthcare equity and value-based care.”

Policymakers need to consider three tactics to optimize telehealth for mental health care:

Align Technology and Payments to Support Patients and Providers

Although citizens are frequently engaging with telehealth in the form of crisis lines, there is continued debate over how best to offer services. Many telehealth patient platforms promote both audio and video by default, and include secure messaging and some form of GPS tracking to ensure that providers are licensed within a given jurisdiction. While such platforms can help provide positive outcomes, policymakers should be concerned about accessibility for low-income users who may not have a phone or computer that supports both audio and video, or users who aren’t comfortable with communicating on video.

Wes Joines, Practice Lead for Compliance and Monitoring at LMI, notes that a recent proposed update to the Medicare physician fee schedule, which closed for comments on September 13th, would allow for Medicare reimbursement of audio-only telehealth coverage under specific conditions (e.g., the patient-provider relationship must already be established). Such an inclusion could make it easier and more appealing for all users to access mental health services, especially those who may not live in an area with sufficient mental health providers. Such policies also support providers as they understand the requirements that must be met for full reimbursement of visits, even if the visit is just a phone call.

Enable Providers to Practice Across State Lines to Ease Staffing Shortages

The twin forces of growing patient demand and staffing shortages are increasing pressure on mental healthcare providers. Often, individual providers can’t practice outside of their home state—including via telehealth visits. Allowing providers to work across state lines could improve access to care, especially in states where there are very few providers.

According to Maureen Merkl, RN, DNP and Senior Consultant for Healthcare Advisory at LMI, the Department of Veterans Affairs (VA) has already created a roadmap for this that has been successful in helping veterans access mental healthcare. Within VA’s system, mental healthcare providers are permitted to practice across state lines. “The program has helped reduce patient backlogs and provided assistance for those in rural areas where travel times may be significant,” Merkl says. Some of these patients have lost their driver’s license, jobs, or cars due to pandemic-related difficulties or mental health and substance abuse issues and don’t have access to transportation. She notes that during the pandemic, some federal waivers borrowed from VA’s template to allow providers to serve civilian patients located anywhere in the U.S. Relaxing licensing restrictions permanently would allow patients to stay with doctors they have already been seeing and improve healthcare access.

Work with Technology Companies to Support Patient Privacy

Audio/video platform access is not the only way technology can impact telehealth delivery. Companies like Apple, Facebook, and others claim to offer secure communications, but providers and insurers have been hesitant to allow patients to access telehealth through platforms like WhatsApp, for example, due to concerns around Health Insurance Portability and Accountability Act (HIPAA) compliance.

“The HIPAA flexibilities in response to the pandemic allowed providers to use popular applications to deliver telehealth services, as long as they were not public-facing. However, privacy and security for telehealth services, especially mental health, is a concern. Technology platforms utilized during the pandemic may not have thought about HIPAA compliance and business associate agreements before now. If the technology platform isn’t designed specifically with telehealth and HIPAA privacy and security in mind, it may be challenging to expand it to all possible users,” explains Kathleen Healey, JD, a Senior Consultant at LMI with more than 20 years of experience supporting federal and state agency rulemaking and policy development. Healey further identifies issues of concern beyond the telehealth visit itself, including the safe and private transmission of patient records, appointment content, patient consent, and treatment plans. State and federal regulatory agencies, technology vendors, patients, and health care providers all will play a key role in telehealth’s future.

Public and private stakeholders need to address the common issues with using large communications platforms. If these can be managed successfully, they could provide new avenues for people seeking help. Many individuals, especially elderly populations, prefer to use applications they already understand and may be hesitant to access care through something that is unfamiliar.

“With telehealth, access and equity go hand in hand,” adds Wright. “If we can create a standard of care for telehealth that expands access, gives people the opportunity to use platforms they trust, and helps providers expand their service area, we could make fundamental and positive changes to the mental health landscape.”

LMI has more than two decades of experience analyzing diverse healthcare data to inform health program and policy improvements. We work at the intersection of science, policy, logistics, and analytics to facilitate innovation in healthcare provision and payment, implement federal healthcare priorities, advance health security, and optimize service delivery and program effectiveness.

Maureen Merkl Headshot

Maureen Merkl

Sr. Consultant, Healthcare Advisory Meet Maureen

Maureen Merkl

Sr. Consultant, Healthcare Advisory

Dr. Maureen Merkl, a registered nurse, came to LMI from the Department of Veterans Affairs (VA). There, she worked with severely injured, ill, or wounded post-9/11 service members to support their recovery, rehab, and transition from active duty to veteran status.

Melissa Wright Headshot

Melissa Wright

Vice President, DHS Non-Immigration Submarket Meet Melissa

Melissa Wright

Vice President, DHS Non-Immigration Submarket

Melissa leads LMI’s engagement with components of the Department of Homeland Security (DHS), including the Science and Technology Directorate, the Countering Weapons of Mass Destruction Office, and the Cybersecurity and Infrastructure Security Agency.