In-person mental health services are being scaled back due to the COVID-19 pandemic. Some groups are making a transition to telemedicine to compensate.
When it comes to therapy and psychiatric care, telemedicine isn’t new. It involves a videoconference or phone call between patient and caregiver. It has proven useful in rural areas, where it may not be feasible for the patient to make regular trips to the doctor in a faraway city or town.
But telemedicine differs in some respects from face-to-face care. Dr. Alan Singer is a clinical social worker at Northwestern Medicine in DeKalb. He says successful therapy requires three elements. Trust, confidentiality, and what he calls building a “clinical friendship.”
“Clients must like and trust therapists or therapy will never work, period,” he said.
Developing this rapport, Singer said, includes more than just what goes on in one’s allotted appointment.
“I’m used to talking to people for a few minutes in between appointments or reaching out through other ways. What we need to do is help people succeed. No matter what crisis, we’re going to make a plan to overcome.”
Singer says in-person contact allows therapists to see certain things that can’t be readily spotted virtually.
“Certainly sometimes if triggers occur and a person begins to cry, I can’t see that on the phone as I could in person," he said. "Even on video, it may be difficult to see some of those triggers.”
These signs allow therapists like Singer to show proper empathy and talk through a patient’s problems more effectively. Not knowing these signs beforehand can present difficulty in telemedicine.
“I think we must have an established relationship first," Singer said. "I think that is the largest drawback, starting with people who might need help right now that I might not know.”
Keeping these drawbacks in mind, Northwestern Medicine and other health care providers are moving to telemedicine to ensure continuity of mental health care. One example is the DeKalb County Youth Services Bureau. Clinical Director J. J. Wett says they work with youths 8-18, including mental health services.
COVID-19 restrictions pushed the Youth Services Bureau to branch into telemedicine for mental health care, particularly with in-person appointments being curtailed. He said youth are a particularly vulnerable group in these circumstances.
“This pandemic has caused adult anxiety, but it also really causes youth anxiety and sometimes it causes the anxiety in the youth more than it does with the adult populations," he said.
Youth mental health treatment, whether in person or through telemedicine, can also provide for a safe space to speak about concerns within a family.
“Some of these youth share things with our therapists that are pretty sensitive in nature and tend not to want to be disclosed with the parents,” Wett said.
That’s why with physical and virtual therapy sessions, confidentiality is key for the Youth Services Bureau. In addition, like with any video or phone connections, Wett said tech disruptions are something that will need to be dealt with.
“Obviously it may take some time to reestablish, first off your connection, and then second off, the rapport you’ve built with the youth so they can resume sharing the sensitive information.”
The one obstacle that mental health patients may still run into is insurance. DeKalb County has resources for those of limited means, such as the Ben Gordon Center, but access to therapy and counseling still varies based on medical benefits.
Wett said telemedicine will be invaluable during this pandemic, particularly if families starting to feel “cabin fever.”
“So I think if we do have a full lockdown, our services are more essential, almost, than what they are right now.”
In the meantime, Northwestern Medicine is expanding its telemedicine offerings. Singer said the full benefits and drawbacks will require more research, but he’s optimistic about future care.
“My plan, personally, is to offer help, and continue to use any technology to move forward with help that people need,” said Singer.
For many, that attitude is helping them stay focused on their physical and mental health during uncertain times.