COVID-19 has brought an abrupt halt to typical daily life and has transformed our reliance on technology beyond what we imagined possible. This could not be truer, perhaps, for mental health supports.
In the United States alone, millions of Americans live with mental illnesses, and less than half of them receive the support they need. The COVID-19 impact exponentially amplifies this concern, given lack of physical access to providers due to stay-at-home orders across the country. Hospitals are overwhelmed by the influx of infected patients, and so other health issues such as psychiatric concerns, while still ever pressing, become a challenge to address. This raises the critical question: Will COVID-19 transform mental health care in the United States? We think so, and we hope it is here to stay.
Telehealth has long been viewed as a viable solution to addressing access and engagement barriers to mental health supports. The implementation of the technology, however, has been slow and stubborn due to a number of bureaucratic hurdles in the private and public sectors.
Empirical studies consistently find that telehealth services are well received and can facilitate engagement in care, but insurers and policymakers have stood in the way of expansion. Until the COVID-19 crisis, the federal government had yet to align any incentives, and most states had yet to pass any legislation promoting expansion. In Texas, small steps were made to implement telemedicine during the past two legislative sessions. During the 85th Texas legislative session, Senate Bill 1107 removed the requirement for a physician to first meet with a patient in person before establishing virtual care; additional physician Medicaid billing barriers were removed during the 86th Texas legislative session. While virtual physician services ramped up during the past three years, Texas legislation did not allow for mental health services beyond psychiatry.
What seemed like overnight, providers started implementing a functional telehealth system. For Texas, Gov. Greg Abbott waived certain regulations and directed the Texas Department of Insurance to allow reimbursement for a number of behavioral health services ranging from psychotherapy to case management to Texas Medicaid managed care organizations, to ensure continuity of care in light of COVID-19. This crisis has also supercharged interest and opportunity in telehealth in the private service sector, and providers nimbly began delivering virtual care.
Although the past few years have seen a growth in the use of private pay therapy applications such as Talkspace and BetterHelp, the impact of COVID-19 has catapulted the services, where even private insurances are authorizing telemental health when they typically have not. Last year Talkspace reported more than 1 million users and brought in nearly $110 million since its 2012 inception. The popularity of these services not only emphasizes the need for traditional brick-and-mortar mental health providers to find ways to provide a mix of in-person and virtual services, the current pandemic requires it.
Swift policy adjustments are cutting the red tape in opening telemental health access, where long-term systems change is inevitable. The excuses provided by opponents of telehealth expansion, such as that not seeing someone in person diminishes the standard of care, have been discredited, and protectionism cannot stand in the way of the implementation of telemental health. The industry must now rapidly innovate and adapt to a broad range of services in psychiatric crisis care, prevention and intervention services, and even home- and community-based care.
The Texas Health and Human Services Commission has provided uniform guidance on data tracking on the use of virtual care within the public sector allowing for examination prior to the 87th legislative session. Texas lawmakers must now craft a bill to cement the temporary billing of services conducted over the phone or computer to become a permanent policy that will allow for greater access to virtual mental health care statewide. Policy and programming shifts that take years of effort to transform are now being tested in a naturalistic experiment to prove what providers have long argued is effective — telemental health is here to stay. And it could be far more reaching than it ever has been.
Cohen is a research assistant professor in the Steve Hicks School of Social Work and Dell Medical School department of psychiatry at The University of Texas at Austin. Morris is a coordinator of local and state mental health initiatives in the department of psychiatry in Dell Medical School at The University of Texas at Austin. This opinion piece was produced for Texas Perspectives and represents the views of the author, not of The University of Texas at Austin or the Steve Hicks School of Social Work.