Telemental health provides access and convenience. But can the advantages overcome WiFi woes and the technologically challenged?
Telemental health visits have soared in usage due to COVID-19. Shuterstock
By Julie Whitehead
Mississippi Center for Investigative Reporting
Jen Cornett of Brandon goes for grief counseling to recover from the sudden death of her boyfriend in November.
Latasha Willis of Jackson deals with anxiety and depression and has been in counseling for many years.
Stacey Spiehler of Oxford, diagnosed with bipolar disorder, type II, sees her counselor at Region 2 in Oxford every other week.
Their issues are different, but they share one thing in common: They all have had a positive experience with telemental health visits with their treatment team during the pandemic shutdown that began in March – a mode of therapy that has soared in usage because of COVID-19.
Jen Cornett of Brandon, in grief counseling to recover from the sudden death of her boyfriend in November, started doing her counseling weekly by phone in March because of the pandemic.
Courtesy of Jen Cornett
Cornett started doing her counseling weekly by phone that month. She has been working her way through grieving the death of her boyfriend, Blaine Cauthen, and managing her anxiety.
The couple had been dating for a little more than two years when Cauthen died of a heart attack in November in the lobby of the doctor’s office where he’d gone for a follow-up appointment for recent gall bladder surgery.
“From November to February, I was just in shock,” Cornett noted.
The main difference between telehealth and in-person counseling is the tendency to get distracted during telehealth, Cornett found. “Before, I could put my phone down and just be with her for that hour,” Cornett said. “Now, I’m multi-tasking.
“The other thing -- that’s been nice -- is I may need an extra five minutes or another 15 minutes, so having that flexibility (with telehealth) is good.”
Cornett is slated to begin seeing her counselor in person again but doesn’t rule out the possibility she may continue telehealth. “It’s nice to be able to know that if I couldn’t get there on my day, I could still be available that way.”
How can therapy continue during a shutdown?
Prior to the pandemic, telemental health was primarily provided in areas that lacked other access to therapy. Now it is used throughout the country as COVID-19 has disrupted the delivery of mental health care, noted The Commonwealth Fund on June 18, 2020.
Among those covered by Medicaid in Mississippi, the numbers have soared up 70 percent in the first three months of the pandemic compared with all of state fiscal year 2019.
Until the pandemic, Mississippi’s Division of Medicaid did not reimburse mental health centers for much of the care delivered over telehealth, insisting that the patient be seen in person by a clinician.
On March 20, 2020, it put in place an Emergency Telehealth Policy allowing telemental health visits, a policy that remains in effect.
Stacey Spiehler of Oxford, diagnosed with bipolar disorder, type II, sees her counselor at Region 2 in Oxford every other week but turned to telehealth when COVID-19 shut down in-person counseling in March. Courtesy of Stacey Spiehler
Beyond government-funded visits, there’s an absence of formal data on the growth of telemental health, but anecdotal evidence shows an increased demand for mental health services.
“Even more troubling, modeling has predicted precipitous increases in overdose and suicide,” according to The Commonwealth.
As many as 75,000 more people will die from drug or alcohol misuse and suicide, or “deaths of despair,” because of the coronavirus pandemic, according to new research released by Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care and reported in The Commonwealth.
Mississippi officials reported on June 12 that calls from people in the state to the national Suicide Prevention Lifeline had increased 20% since the start of the coronavirus pandemic.
Willis was proactive in finding out how she could continue therapy even in the pandemic shutdown. “I had contacted her (counselor) to set up an appointment when the whole shutdown happened. I wondered if I would have to reschedule months in advance or what. I called and she said she had telehealth and I was okay.”
Willis said she continued her cognitive behavioral therapy and how to work through stressful situations with healthy coping skills. She still goes to the same counselor she has seen for the past several years. Willis followed her into private practice after she left the University of Mississippi Medical Center.
Before, setting up her appointments was a challenge – taking time off from work, paying for gas to get to her appointment and driving across town for her therapy. With telehealth, her only problem was finding a private place for her session when she scheduled her therapy during her lunch hour. “I may start doing them in my car,” Willis said.
But she sees telehealth’s big bonus in the convenience of being at home if you need to be. “I remember when I first started going to therapy in the nineties. I had panic attacks. I had agoraphobia so bad. My nerves were shot just trying to get there and back. This would help those people.”
Spiehler said telehealth helped her access some issues that she had been unable to approach before in therapy. She and her counselor had challenges trying to do video chat and finally resorted to phone calls. Spiehler began doing adult coloring books while doing therapy and was able to access deeper emotions. “It freed me up to talk about some things that I wouldn’t normally bring up in therapy.”
Telemental health challenges: Poor or fragmented WiFi and discomfort with technology
Angela Ladner, executive director of the Mississippi Psychiatric Association in Jackson, sees telehealth as a useful tool in the established doctor-patient relationship.
“I do not think it takes the place of a comprehensive evaluation, top to bottom,” Ladner said. Crisis situations also call for in-person evaluation, she said.
“For a patient who’s an established patient and is compliant and doing everything right, it can be a good way to continue care,” Ladner said.
Angela Ladner, executive director of the Mississippi Psychiatric Association in Jackson, sees telehealth as a useful tool in the established doctor-patient relationship but cannot replace a comprehensive in-person evaluation. Courtesy of Angela Ladner
Private counselor Jo Hebert of Flowood noted those same parameters in her counseling sessions during the pandemic. “I offered FaceTime and phone sessions,” Hebert said. Of her 20 clients, four opted for telehealth, nine chose to stop counseling and six paused their therapy and have returned to counseling now that she is again offering in-person sessions. Telehealth is “better than nothing, but it is so much better in person.”
Dr. Sudhaker Madakasira, chief clinical director of Psycamore Partial Hospital Service in Flowood, Gulfport and Southaven, said his program underwent major changes at the beginning of the pandemic shutdown. His programs include meeting daily with several groups of patients, individual counseling sessions and specialized group and individual programs for children and adolescents.
“While many patients like the telehealth approach because of its convenience and no need to travel, there are some problems in terms of poor or fragmented WiFi reception and unfamiliarity and discomfort of older patients with videoconferencing technology. We had to donate some patients used smartphones to be able to telehealth. In my practice, I have used videoconferencing with 90% of the patients and had to do audioconferencing with the rest,” Madakasira said.
Difficulty managing the Zoom group meetings mostly involved the technology itself, he said. “At least half of the videoconferencing involves asking, ‘Can you see and hear me now?’ and rebooting.
“A major change for me as a psychiatrist in doing telehealth is enjoying the ease of doing it from home and from out of town and (having) the ability to adequately address by videoconferencing,” Madakasira said.
He echoed the concerns of Ladner and Hebert about its usage as a cure-all. “It is more tiring and time consuming because of WiFi problems, and it lacks the ability to make physical observations and examinations in person,” he said.
“Basically, telehealth lacks certain basic personal human interactions and observations, but it is an adequate adjustment and a great approach for providing services during the pandemic and reaching those who have no access to mental health and have difficulty traveling,” Madakasira said.
Spiehler said the benefits of telehealth for her outweighed the disadvantages. She said her attitude of her treatment team toward trying to communicate with her during the pandemic was a must. A recovering addict 4 ½ years clean, Spiehler called the efforts of Region 2 personnel in Oxford “therapy by any means possible.”
This story was produced by the Mississippi Center for Investigative Reporting, a nonprofit news organization that seeks to inform, educate and empower Mississippians in their communities through the use of investigative journalism. Sign up for our newsletter. Email Julie Whitehead at julie.whitehead.mcir@gmail.com.