Despite obstacles, telemedicine offers a lifeline for patients seeking mental health care during pandemic

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“You don’t have enough effort in yourself to say, ‘You just think badly. “That doesn’t allow you to do that,” said Bastin, who works as a data scientist for the Minnesota branch of the National Alliance on Mental Illness. “When you have severe depression you can talk to yourself about all kinds of things. “

In the early months of the pandemic, Bastin’s therapist was not offering in-person sessions in her Minneapolis office, where Bastin is also based. During this time, Bastin’s mental health deteriorated dramatically. Finally, she was able to see her therapist remotely, using a video telehealth system – a resource she sees as potentially vital.

Sharon Bastin, who works as a data specialist for the Minnesota branch of the National Alliance on Mental Illness, received treatment for her mental illnesses through telehealth. She sees the service as potentially life-saving. “When you have severe depression you can talk to yourself about all kinds of things,” she said. (Courtesy of Sharon Bastin)

Behavioral and mental health treatments were ahead of other specialties in terms of the use of telemedicine before the pandemic, but patients have turned to these services more and more in the past year.

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One to study found that telemedicine care for mental health or substance abuse disorders increased from 1% of visits before the pandemic to 41% in October 2020.

For most of the people who provide and receive medical care, the growing adoption of telemedicine is one of the silver liners amid the devastation of the pandemic. The funds injected into the technology reflect its increased use. Investments in telehealth technologies in the first half of 2021 were higher than in 2020, according to an analysis by management consultancy McKinsey & Company.

While the benefits of telemedicine have been particularly appreciated by people with physical disabilities or mental illness, telehealth has also created new barriers for users at a time when medical support was vital.

A lifeline that avoids stress

For over a year, Alexis’ anxiety kept her from driving. The Rochester resident, who requested that only her first name be used, felt relieved when she was able to begin receiving remote care for her mental illnesses during the pandemic.

“It saved me the added stress of having to make an on-time appointment in person,” she said. “I could just sit in the comfort of my own home and just click on my computer. “

The accessibility benefits for people living with mental illness are huge, said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness.

“It was much more convenient to access than before,” she said.

A NAMI survey found that telehealth visits provided a connection in a time when people were hungry for them, especially when struggling with mental illness.

“It’s great to be able to connect to services directly from my home. Being able to continue to be in visual connection with my therapist during the most isolated days / weeks of this pandemic was crucial. It’s nice to see people without masks! one respondent wrote.

Several respondents said they appreciated the relief of not having to arrange transportation for in-person appointments. Others wrote that they believed it was the safest option for themselves and their families during the pandemic, and it allowed them to stay in a comfortable environment on days when they were not feeling well.

“Love! On days I would cancel because I didn’t feel up to a date, I would stick to (the) appointment because I can use telehealth,” another respondent wrote.

Providers in all specialties have noted fewer missed appointments during the pandemic for those receiving care via telehealth, Abderholden said.

Technological barriers

During a painful week in May 2021, Alexis lost her access to telemedicine when her computer stopped working.

“I noticed that I was getting a little more excited, a little more nervous,” she said after missing several appointments, which could have prevented her from having her prescriptions refilled.

Feeling helpless, Alexis turned to the Southeastern Minnesota Center for Independent Living. The SEMCIL team donated a repository of 20 iPads and 50 Chromebooks to those who needed them during the pandemic, fueled in large part by CARES law dollars.

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“The intention would be to contribute to social isolation,” said Chanell Calhoun, SEMCIL Independent Living Program Supervisor and Assistive Technology Specialist. She added that while some used the tablets to connect with family members or attend virtual workshops, many used them to access medical care.

When Alexis used her iPad to fill in the gaps when her computer was down, it gave her a sense of support at a time when she was feeling very lonely.

“You are more isolated; you feel like you’re alone and you’re kind of spinning, ”she said.

While some patients have been able to find solutions to their technological problems, others have been stuck.

“The elderly and children have probably lost the most ground in terms of the pandemic and having to switch to telehealth,” said Abderholden.

A investigation conducted by the Minnesota Department of Health also revealed that these were the groups most affected by technological barriers.

Older patients seeking treatment for mental illness have often encountered technological challenges, sometimes not accessing their telehealth services until after a provider instructed them how to download the software. Some users have found themselves with audio-only services, a lifeline for those who live in areas with poor internet access.

Even for those tech savvy, telehealth posed a different problem: the exhaustion of screen time.

School-aged children who spend all day in front of their computers taking distance learning courses often don’t feel like delving into emotional issues in the same setting.

“The technology worked fine, but my kid was exhausted from doing it all via video and started ending sessions earlier. I’m not sure how to improve engagement, ”wrote one NAMI survey respondent.

There were also privacy concerns for people who shared spaces with family members and could not find a discreet place to openly express their difficulties with a mental health professional. Bastin found herself moderating what she said and when, even as she tapped into her therapy sessions in the privacy of her bedroom, because she feared her family members would overhear. through the walls.

“It’s not soundproof. So if you speak too loudly, they will hear you. But I would still rather have that and be able to talk to my therapist than sitting there with my own depression talking to me about stupid things, ”she said.

Lasting changes

Minnesota has passed a telehealth law since 2015, after much debate between patients and providers over costs, fraud and quality.

“We had the law in the books saying that with health plans, you have to cover telehealth if it’s medically appropriate, and you have to pay the same as you would have paid if that service was in person,” said Dave Renner. , director of advocacy for the Minnesota Medical Association.

For years, advocates have tried to ease restrictions on access to telemedicine. When the pandemic led to widespread use of telehealth services, legislative changes eventually followed.

The location where patients are eligible to receive telehealth services was expanded in spring 2020 under an emergency power authorization, allowing home care, not just hospital or clinic care. . A second change enabled audio-only care, a change from previous regulations that limited telehealth visits to video.

Legislation passed in June 2021 as part of the Health and Social Services Bill made these changes part of the law, not just part of the declaration of emergency powers. Coverage of audio-only services is still in question due to concerns about the quality of care, Renner said, but it is protected for at least the next two years.

Doctors in the region hope that telemedicine will remain an essential part of medical care even after the emergency arrangements created in the context of the pandemic. There are always populations that can benefit from having it as an option, especially those with physical disabilities, said Dr. Steve Ommen, cardiologist and medical director of experience products for the Center for Digital Health in Mayo. Clinic.


Dr Steve Ommen, Mayo Clinic cardiologist.  (Photo from newsletter release file)

Dr Steve Ommen, Mayo Clinic cardiologist. (Photo from newsletter release file)

“It doesn’t matter where you live if leaving your home is a challenge. Then being able to connect with your doctor or nurse manager who is managing the care, being able to do it in the comfort of your own home is so much easier for these people, ”he said.

Regardless of its benefits, Ommen pointed out that telemedicine is probably best used in combination with in-person care.

“We believe that virtual telemedicine care will be integrated with on-site care and will switch smoothly between those based on the needs of the patient at that time,” he said.

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