We have the technology we need to allow doctors to stay in touch with patients they can’t see in person. Now, we must act quickly to remove the obstacles posed by regulations and insurance bureaucracies, so doctors can provide critical mental health care.
Like many psychiatrists, Ken typically relies on in-person interpersonal interaction to help his patients get well. Last week, one of his patients, a doctor herself, estimated that there was a better than 50 percent chance she’d contracted the coronavirus. “I guess I can’t make our appointment today,” she texted.
The patient lived just a few blocks away, but of course they could not meet in person. Still, she needed psychological support and medication management to help her maintain sobriety. She needed another plan. So together, they built a safety net and leaped in.
A virtual session conducted with a cellphone via video conference proved invaluable. The technology and devices that can so often be stressors in their own right, in this instance, were a mental health life raft.
Telepsychiatry isn’t new: For two decades, doctors have successfully counseled their patients in rural areas where there are no psychiatrists, using relatively primitive video and teleconferencing technology to connect patients to psychiatrists for evaluation and treatment. Today’s physicians who have been forced to adapt by the pandemic can learn from their experiences, rather than feel like they are inventing new treatments on their own.
Devised initially to connect doctors with the sickest patients who, for whatever reason, could not be seen in person, virtual therapy is now being used every day to treat mild to moderate mental health disorders, both by phone and over the Internet. Studies show that there is potential for greater use and that the results of telepsychiatry, especially after a relationship has been established, can match that of in-person visits. One trial suggested that virtual visits are actually sometimes superior for treating certain conditions in adolescents.
But while the unreliable and bulky video equipment of 20 years ago no longer presents an obstacle, regulations and reimbursements still do.
Some practitioners avoid using Apple’s FaceTime video calling software because Apple does not provide health-care providers with what’s known as a business associate agreement required by the Health Insurance Portability and Accountability Act, a law that protects patient privacy. Sessions were not always reimbursable by private and public insurers that lacked telepsychiatry billing codes or that failed to alert providers to codes that do exist.
Doctors have been unable to prescribe medicines for new patients whom they only met virtually. Fortunately, federal agencies such as the Centers for Medicare and Medicaid Services are encouraging the use of telepsychiatry. On March 17, they announced that they will not penalize doctors who use telemedicine in a good-faith effort to practice social distancing during the pandemic and expanded coverage for telemedicine. The Drug Enforcement Administration just announced that doctors can prescribe medications virtually, without meeting the patient first.
Medicaid covers telemental health in New York and many other states. The New York State Office of Mental Health, along with relevant agencies in other states, provided a pandemic waiver to speed its adoption, as many other states have offered waivers to support telemedicine. These are critically important decisions.
People are hurting right now. Anxiety disorders are real health emergencies that can cause psychological symptoms such as confusion, heightened senses and insomnia as well as physical symptoms ranging from sweaty palms to heart-rate elevations. A pandemic is the perfect weapon to heighten these disorders or set them off in previously healthy people. So is social distancing, which is the best tool we have to fight new infections but risks leaving people profoundly isolated.
Technology does not yet have a cure for the coronavirus, but it does have the ability to assist us with our mental health challenges, big and small. Doctors can support and validate their patients while helping them to stop the catastrophizing that sends our thoughts spiraling with worst-case scenarios. Counseling and therapy, and gentle support from family, community and friends can help someone struggling with anxiety to regain their equilibrium.
Mental health care was a major concern before this pandemic began, and we’ll need to get people help for coronavirus-related mental health issues long after the physical threat of the disease has passed. We need to help one another avoid infection by staying inside. And while we’re there, we must also help ourselves by staying busy and productive, and finding new ways to stay connected.