I first met a patient I will call Madison during a virtual consultation. Madison had been struggling with depression for many years but had never been referred for treatment. Following her virtual consult, we brought her in for evaluation. We realized she needed a higher level of care and admitted her for inpatient treatment.
Madison’s parents had learned about Sheppard Pratt’s Virtual Walk-In Clinic, created to provide increased access to mental health care during COVID-19. The virtual clinic’s convenience, plus Madison’s growing distress, were among the factors that caused her parents to reach out for help.
This patient anecdote brings to life one of the real-world reasons why I am an ardent advocate for telepsychiatry. If there is a silver lining for the COVID-19 crisis, it is the dramatic increase of telehealth services. Sheppard Pratt and other mental health care providers now offer a multitude of clinical services via telehealth. This includes ongoing psychotherapy, group treatments and more intensive outpatient programs for substance use and mental health disorders.
Outpatient care has been traditionally viewed as a brick-and-mortar enterprise where a patient arrives in person to receive care. But this delivery method for mental health care creates some real gaps in access. For example, in rural locations, there are not enough mental health providers and people may have to travel long distances to receive care. Through virtual appointments, telehealth providers can close the distance between themselves and their patients. It promotes greater access to those who struggle with receiving quality health care.
Additionally, telehealth allows us to offer appropriate level of care to patients who may feel taxed by attending an appointment in person. It may be easier for some patients with anxiety to use their computer for a virtual meeting, for instance.
The two types
There are two primary ways of delivering virtual care: the first is synchronous, in which the provider and patient conference together in real time. The second type is asynchronous, which is not as often discussed, but just as important. For asynchronous telepsychiatry, the patient reaches out through a secure portal with a question for the provider to answer when she or he has time. This could happen during a break between appointments. This option removes the necessity of having to see a patient in person for something that is very easily taken care of. It also reduces cost and preserves the provider’s availability for patients with more urgent needs.
While I believe in the benefits of telehealth, certainly there are mental health conditions for which virtual care is not ideal. For example, patients in severe catatonia or in an acute crisis state should be seen in person. There are also some limits to technology. Some people may live in a deadzone or lack access to technology. But for the most part, we have seen that most people have access to a smartphone or computer. Another consideration is that providers need to be appropriately trained to take steps to ensure patient safety during emergent situations.
How to receive care virtually
So, how can you take advantage of this convenient and accessible option? Let’s walk through the process with Jane, a fictional patient.
Jane has been experiencing symptoms of anxiety for many weeks, including panic attacks. Her online search reveals that she might have an anxiety disorder and also includes links to various mental health providers. But Jane lives in rural Western Maryland where the closest provider is 45 minutes away. Fortunately, she sees that a provider offers virtual appointments. She calls their virtual clinic and is connected to a trained appointment coordinator who assesses her immediate need.
This coordinator collects health information and creates an entry in an electronic medical record (EMR). The coordinator would also assess if Jane is in an acute crisis. If she is, they would have her hang up and call 911. If she is not, the appointment coordinator would schedule a virtual appointment with a trained clinician. Usually this happens within the same day.
Jane would then log into her virtual appointment via a secure link sent through email and share her symptoms in real-time over video conferencing. The provider then works with Jane to determine the level of care she requires, which could include admitting her to the hospital or ongoing virtual care.
Telepsych and you
Telepsychiatry has been a growing and important component of mental health care and has proven invaluable given the shortage of mental health providers in Maryland. COVID-19 has accelerated the rapid growth of telepsychiatry services and increased access to care for many. I hope long after this pandemic is behind us, our advances in telehealth remain.
This pandemic is a time of great uncertainty. The lack of routine, increased stress of homeschooling, uncertain financesmand disruptions to medical and mental health services have the potential to combine for a real mental health crisis for individuals and their families. If you feel your mental health unraveling, please seek help.
Deepak Prabhakar, MD, MPH is the Medical Director of Outpatient Services for Sheppard Pratt, the nation’s largest private, nonprofit provider of mental health services, located in Towson.