Almost half of all Americans have received some form of mental-health counseling, and rising addiction and suicide rates indicate more need it. However, as the number of COVID-19 cases climbs in the U.S., therapists are scrambling to help their patients without making a global pandemic worse. The transition to video and phone sessions has worked for some, but it isn’t sufficient for everyone and clinicians are divided on what to do about it.
“There’s been some debate in the mental-health community about the rapid shift toward telehealth,” North Carolina-based counselor Katie Lear explains. “Since many therapy sessions are one-on-one, is it alarmist to cancel them? And could it possibly even constitute client abandonment to do so?”
Teletherapy, or remote therapy via video chat, phone or text message, started in 1997, and it’s become a particularly popular way to consume mental-health services in recent years. During the last week, though, therapy apps like Talkspace and BetterHelp, along with HIPAA-approved video-chatting platforms such as Regroup, have become increasingly important — and for good reason: The coronavirus doesn’t have to infect people’s bodies to bring psychological symptoms to the surface.
While therapists at the American Psychological Association regard telemedicine as a positive innovation, experts also acknowledge that it has many limitations that the coronavirus only exacerbates. For example, numerous states require specific certifications in telemedicine to practice it — credentials not every therapist has. Therapists may also need to be licensed in the state their patient is in, so young adults returning to their parents’ homes elsewhere in the country to ride out the virus might no longer qualify for care. Likewise, many accustomed to one-on-one therapy have concerns about how confidential online sessions are.
“On the technical side, it’s an easy transition, but I’ve found some clients struggle with feeling comfortable making the switch and prefer to cancel rather than meet through telehealth,” Jennifer Agee, a therapist in Kansas, tells me.
Still, despite this discomfort, plenty of people are making the jump anyway. In fact, so many people are making the switch simultaneously that it’s overwhelming the entire telehealth system and creating a host of new problems. “I’m hearing stories from colleagues about losing their feeds or having their clients or themselves booted from servers in the middle of a session,” Virginia-based psychotherapist John Mathews explains. “I’ve moved to a confidential Google application that’s been so far, so good, and I’ve recommended it to area therapists as well.”
The thing is, teletherapy was never meant to replace individual therapy in the first place — it was mostly for stressed workaholics too caught up in hustle culture to show up for appointments. Higher-risk populations dealing with suicidal ideation and psychosis definitely necessitate in-person assessments to understand if a psychiatric hospitalization is warranted. Not to mention, many elderly patients in nursing homes don’t always have access to the technology necessary for remote sessions. To that end, one therapist reported on Reddit that she was still being sent into assisted-living facilities (without a mask) for one-on-one appointments, putting elderly patients at an extreme risk. (Remote sessions weren’t an option because the facility only has one phone available for residents to share.)
“Telehealth assumes a certain amount of financial security and privilege,” Lear explains. “It’s hard to meet for a virtual session if you don’t have consistent access to a computer, Wi-Fi and a private room. Clients, for example, who are in therapy due to an abusive relationship may not be in a safe space to speak about the issue in their homes.”
Plus, as many people lose their jobs as a consequence of COVID-19, the biggest barrier in the transition to teletherapy will be the cost. Although many therapists offer remote sessions at lower rates than in-person ones — anywhere from $45 to $75 each — few insurance companies cover teletherapy. And when they do, they rarely pay for more than a third of the cost, Teralyn Sell, a psychologist from Wisconsin, explains. “As we attempt to move to telemental health to maintain care during the coronavirus, it’s becoming clear that mental-health treatment isn’t a priority for the state or federal government,” she says. “The gatekeepers continue to be the insurance companies, and they’ve yet to actively open this for coverage.”
And so, as we flatten the curve — and make countless sacrifices along the way, including mental-health care that we can either no longer afford or engage with in our preferred manner — therapists like Sell warn that another crisis looms in the future. Or as she puts it, “After COVID-19 is over, we’re sure to experience a mental-health pandemic.”