By Mary El Grammer
Telehealth for mental health care has become normalized and widespread recently due to the COVID-19 pandemic. But before leaping into telehealth mental health care as a default option, it's important for us to consider the quality of care offered and the pros and cons of telehealth.
In a rush to accommodate providers and their patients, the Centers for Medicare and Medicaid Services, a federal agency under the Department of Health and Human Services, issued nationwide waivers to ease requirements that would have made telehealth problematic. Two months into the new normal, the American Psychiatric Association called for some of those changes to be made permanent to "ensure continuity of care and continued improved access to mental health and substance use care."
That is an alluring prospect to many providers, as telehealth reduces overhead expenses and is generally more convenient. However, psychiatry is a medical specialty that, at times, requires face-to-face assessments. Telehealth has provided a necessary service during the COVID-19 pandemic; however, providers should still weigh its convenience against what is best for the patient.
Telehealth was originally designed for patients who live in remote locations and have to travel long distances to meet with their provider. Because of the shortage of behavioral health specialists in rural areas, mental health care often falls on primary care physicians. Although they can certainly handle first-line interventions, their skill set reaches its limit in treatment-resistant diseases or complex cases.
That's where sub-specialty expertise should be employed, and that's where the real value of telehealth mental health care is manifested. It brings sub-specialty expertise to people in areas where that otherwise may not be available. If a patient needs to drive two hours for a visit, they are not likely to give the doctor a good interview—and it's especially impractical if the patient is stabilized on a medication and just needs a check-in for a refill. Similarly, if a patient has weekly talk therapy appointments but has to drive hours to get there, their attendance may drop off. In this case and others, telehealth is just as good as an in-person visit.
However, there are also some challenges to telehealth. As many people have experienced during the pandemic, the availability of video telehealth services is predicated upon internet bandwidth, as well as in-home computer equipment. At worst, many people do not have reliable broadband internet access or suitable equipment to have a satisfactory appointment. For those who do have a workable setup, technology issues can still arise, with sound delays, lighting issues, and audio glitches.
What's more, patients often seek mental health care for what they believe is depression, but upon a medical examination, the physician may determine the patient is suffering from a neurological condition that can have a secondary symptom of depression. Without an in-person assessment, the root problem would be missed and the patient would be misdiagnosed.
Another concern about the push for telehealth is that providers may prefer the convenience of remote visits without accounting for patient preference. Telehealth should not be used as a service to the provider, but rather to the patient. At Greenbrook TMS, we offer telehealth mental health care appointments based on clinical suitability and patient preference. If you want to take advantage of telehealth and it is clinically appropriate, we will offer it to better accommodate your needs. If it's not clinically appropriate or if you don't have the resources or preference for that mode of therapy, you have the option of an in-person examination.
Greenbrook TMS has always promoted patient convenience and choice. So although the regulations for telehealth are relaxed, we've retained the option for face-to-face visits using various hygiene and social distancing measures to maintain safety. Because TMS is a hands-on procedure, you will come in for a visit eventually, but we want you to feel reassured with the knowledge that Greenbrook TMS offers the types of appointments that best serve you. If you are considering TMS therapy, you can reach out to us for a consultation, and we will help you determine whether a telehealth appointment is right for you.
If Covid-19 and social isolation are heightening your symptoms of depression, Greenbrook TMS therapy may be able to help. At Greenbrook, we specialize in TMS therapy — an FDA-cleared, non-invasive treatment for treatment-resistant depression and OCD without harmful side effects. See if TMS therapy is right for you by clicking here to take a brief assessment: