Once the COVID-19 pandemic is over, a lot of things will go back to normal. We'll stop wearing masks. We'll crowd into restaurants. We'll walk whatever direction we want to down grocery store aisles. But some changes that the pandemic spurred might be here to stay. Among them: the expansion of telepsychiatry.
"This will be part of the new normal," said James Berry, a clinician with the West Virginia University School of Medicine. "The genie is now out of the bottle, and it isn't going back in." After West Virginia's stay-at-home order took effect in March, Berry was part of the team that transitioned outpatient behavioral-health visits to telepsychiatry at WVU's Chestnut Ridge Center. These visits included group therapy sessions for people with opioid use disorder.
The expansion of telepsychiatry may outlast the COVID-19 pandemic that caused it.
Products and exhibitors around telemedicine
Exhibitors and products related to this topic can be found in the database of MEDICA 2020:
"Behavioral health issues are very treatable and manageable problems," said Berry, who chairs the Department of Behavioral Medicine and Psychiatry and directs addiction services at CRC. "Whatever we can do to create access for people who need help is something that we need to prioritize. People don't have to suffer."
In a new letter published in the Journal of Addiction Medicine, Berry and his colleagues explain how large-scale deployment of telepsychiatry is possible for both individual- and group-based visits.
His team of School of Medicine researchers and WVU Medicine clinicians includes Erin Winstanley, Laura Lander, Wanhong Zheng, Kari-Beth Law and Ashley Six-Workman. Before the stay-at-home order, virtual care and therapy was offered for rural clinics only; however, during the week that the stay-at-home order began, CRC moved 75% of its on-site therapy sessions to Zoom. Soon after, 98% of the sessions had gone virtual.
Prior to the pandemic, the department was conducting pioneering telepsychiatry services to rural areas across West Virginia through funding from the Health Resources and Services Administration, as overseen by Law. With this experience, Law was able to lead the transition at CRC to virtual care.
Looking at a screen - instead of directly into someone's face in the same room - didn't make patients more reticent to participate in therapy sessions. If anything, the opposite was true. "I don't know if it's because they were in the comfort of their own home or because they didn't feel like all eyes were on them, but one of the things I noticed early on is that people seemed more comfortable sharing details than they would have been in person," Berry said.
Even before the pandemic, CRC had been planning to expand its telepsychiatry options. They just didn't expect to do it so quickly.
"Our five- to 10-year plan was to allow access for much of our care into the virtual world, but there were many barriers," Berry said.
One of those barriers was patients' and clinicians' unfamiliarity with telepsychiatry. Another was some insurers' unwillingness to pay for virtual therapy--or therapy in a patient's home--even when they would cover comparable in-person therapy.
Regulations and legislation have hindered the adoption of telepsychiatry, too. "As a physician, for instance, you're licensed to practice in a particular state," Berry said. "I'm licensed to practice medicine in West Virginia. Pre-pandemic, that meant that in order to treat somebody who was in a state that doesn't participate in the Interstate Medical Licensure Compact--for example, Ohio--I would have to have an Ohio license, or there would have to be an arrangement made between our two states that would allow me to do that. You can imagine the difficulty that would have presented when it comes to treating patients across state lines."
Social distancing has been linked to declines in mental health outcomes, increases in substance use and upticks in crises such as suicidal ideation. For these reasons, telepsychiatry can be crucial during the pandemic.