Improving Access to Care via Telebehavioral Health
For more than 25, years I have had the opportunity to provide outpatient behavioral healthcare services. During that time, I have observed the tremendous benefits thousands of individuals receive through access to care. My colleagues and I have the privilege of being a part of the process in which individuals make changes that significantly improve their quality of life. In some cases, these changes have literally been life-saving. We are becoming increasingly aware of how prevalent mental health disorders are in our communities, and through that awareness, we have come to realize that for each individual who is able to access effective behavioral healthcare, there are many others who are unable to do so.
Access to behavioral healthcare has been a challenge for decades. Dating back to the Community Mental Health Act of 1963, the vision people have had for access to behavioral healthcare has not been matched by the availability of services. The good intention of the community mental health center movement to “deinstitutionalize” individuals led to an increase in the need for treatment in the community. Unfortunately, the community resources were not nearly enough to keep pace with the growing need for treatment.
In addition to the insufficient number of available licensed behavioral healthcare providers and the limitations on insurance coverage for behavioral healthcare, there are many other factors that can influence accessibility of effective clinical services. People who utilize behavioral healthcare services frequently require sessions with their providers several times each month. The effective provision of treatment models such as Cognitive Behavioral Therapy (CBT) often involves dynamic interactions between the clinician and the patient on a regular basis. The application of CBT includes homework assignments that need to be reviewed and analyzed to ensure that progress is being made. Additionally, many psychotropic medications need to be closely monitored for side effects as well as their effectiveness in treating presenting symptoms, especially at the onset of treatment.
For some individuals, transportation to an office or facility in which behavioral healthcare is provided is not consistently available. Thus, they may not engage in treatment at all or receive insufficient treatment if they are required to travel to the clinician’s office. Other individuals may have access to reliable transportation but have young children and do not have childcare arrangements that will allow them to attend appointments at the clinician’s office.
Mental health disorders can affect individuals in a variety of ways. Some individuals suffer from intense symptoms of anxiety or panic. For those individuals, leaving their home on a regular basis is often not possible. Other individuals may suffer from paranoid ideation to the point that sitting in a waiting room among other patients while awaiting an appointment may be more than they can tolerate. Some individuals suffer from profound symptoms of depression and may not have the energy or motivation to leave their homes and travel, even for treatment of their symptoms.
While progress has been made in reducing the stigma associated with mental health disorders, a great deal of bias still exists. Many people elect not to pursue behavioral healthcare due to concerns about how they may be perceived by others if it becomes known they have received such services. In some cases, privacy may be crucial. For example, a teacher may not be uncomfortable sitting in a waiting room with one of their students while awaiting an appointment with an optometrist. However, that same teacher may feel very uncomfortable sitting in the waiting room of a psychiatrist or therapist and have a student walk in. Privacy in behavioral healthcare belongs to the patient—if he or she wishes to maintain it, our field is required to protect it as much as possible.
Over the past several years, I have observed the benefits that are associated with the provision of behavioral healthcare via telebehavioral health. Improved access to care is among the most significant of those benefits. Transportation issues that often prohibit individuals from receiving care at an office can be eliminated. Individuals with young children can often negotiate their childcare needs much more easily if their appointments do not involve travel to and from an office and dealing with a crowded waiting room. At some points during treatment the condition for which an individual is seeking treatment may be the reason why they do not access services. Symptoms of anxiety and/or panic, paranoid thoughts, or depression may be debilitating at times. If care is brought to the individual in their home, they may be able to progress to the point that they will then have the option of services provided at an office as well as in-home treatment. If in-home services are not available when the person is at a particularly difficult point in their ability to function, the risk of an undesired outcome is much greater.
We are continuing to make strides in our understanding of mental health disorders and in our ability to effectively treat those conditions. Expanding access to care for individuals who need behavioral healthcare treatment is not only an option we should pursue, it is an obligation if we are to reach those who may be in the most need of care.
Joel Friedman, Ph.D. is the Director of Outpatient Services at the Center for Family Guidance, PC. He also provides clinical leadership for two organizations within the CFG Health Network: InSight Telepsychiatry and Inpathy. Dr. Friedman is a licensed psychologist with more than 20 years of experience. He has provided direct clinical care, supervision, managerial services, policy development, and consulting services in a wide variety of settings including private outpatient offices, several different correctional systems, hospitals, schools, and corporate offices.