Virtual Mental Health Could Help Patients and Providers | Deloitte US has been saved
By Jennifer Caspari, Ph.D., specialist master, and Elizabeth Baca, M.D., M.P.A., managing director, Deloitte Consulting, LLP
The holidays are now behind us. However, the stress of family gatherings, travel, financial issues, and loneliness—combined with the shorter, colder, and often gloomier days of winter—may have contributed to some mental health (MH) difficulties (e.g., depression, anxiety, substance misuse, and physical illness) for many people.1 MH difficulties can increase around the holidays, and a severe shortage of MH professionals is making it increasingly difficult for people to get the care they need.2 And it’s not just patients who suffer. Provider shortages can also lead to higher burnout rates among clinicians (see our new report, Addressing health care's talent emergency).
Nearly 40% of people feel stressed during the holidays, according to a survey conducted by the American Psychological Association. Moreover, a survey from the National Alliance on Mental Illness (NAMI) found that 64% of people who live with a mental illness say their conditions get worse around the holidays.3
MH issues were on the rise well before COVID-19 emerged, but the pandemic exacerbated an already difficult situation. Over the past three years, cases of depression, anxiety, and other MH issues have led to a surge in demand for counseling and care. However, the pandemic also raised awareness of MH as a multi-faceted challenge. Roughly 50 million adults experienced some form of mental illness in 2022, and more than half of them received no treatment for their conditions, according to our report, A human-centered vision for improving the mental health care ecosystem. Moreover, the percentage of adults who reported symptoms of anxiety or depressive disorders nearly tripled from 11% before the start of the pandemic, to more than 30% by June 2022, according to the Kaiser Family Foundation.4
Integrate mental health into the care team
Millions of people in the US live in areas with too few MH professionals to meet the needs of the population, according to the Department of Health and Human Services. The agency expects this shortage will worsen over the next decade as patient demand continues to climb.5
Increased adoption of virtual and digital options could help ease the MH provider shortage and shrink ever-growing waiting lists. There are essentially three types of virtual MH care—digital therapeutics (self-directed, without a human involved), asynchronous care (like text or chat), and synchronous care (video therapy or psychiatry). They can be used individually or in combination with each other to reduce the burden on MH professionals’ limited time. They can also be used as part of a stepped-care model, where digital therapeutics are combined with provider interaction, depending on the patient’s needs and severity of the condition.
Here’s a hypothetical example of how this might work:
Robert is a 45-year-old who has long struggled with his weight. Blood taken at his annual in-person physical indicates that Robert has diabetes. During a follow-up virtual health visit with his doctor, Robert completes the Patient Health Questionnaire-9 (PHQ-9). The test identifies some symptoms of mild depression. (Almost half of people living with diabetes experience mental health challenges, according to the American Diabetes Association.) A MH provider, who is part of the care team, is looped into the virtual visit in real time. The physician, MH provider, and Robert discuss the diagnosis and offer Robert several treatment options. He can use a digital therapeutic app starting today and/or see a therapist virtually to start synchronous (live) care, in about a week. He chooses the digital therapeutic option and starts it that day. The MH provider from his clinic checks in on Robert two weeks later, via phone, and determines Robert may benefit from a higher level of care for his depression. They schedule a 30-minute live session for the following day.
Virtual MH could help improve access and equity
Virtual MH care can meet people where they are, improve accessibility to broader range of MH providers, and expand options for prevention and treatment. If MH care is conducted virtually, it can more readily be woven into existing care models, in addition to standing alone (see Jennifer’s blog, Why have we been slow to integrate physical/mental health?).
- Access: It can be difficult to find MH professionals who specialize in treating some specific conditions and populations. Consider a patient in a rural area who suffers from an eating disorder, but the only MH provider in the area is a generalist who specializes in depression and anxiety. According to data from the Robert Wood Johnson Foundation, 30% of the nation’s population lives in a county designated as having a shortage of MH professionals. A virtual option could help connect that patient to a professional with expertise in treating eating disorders.
- Equity: The suicide rate among Black Americans is 60% higher than it is for white Americans and Black Americans are also 20% more likely to have serious psychological distress than white Americans.6 Moreover, many Black Americans find it difficult to access MH services.7 Helping patients connect to MH providers virtually could make it easier to make patient/provider connections based on patient preferences for providers of a like race, ethnicity, or cultural group.
- Seamless stepped care: Asynchronous care can be used as a bridge while waiting for synchronous, provider-involved options for care, or in conjunction with provider-led care- leading to a need for less frequent live patient/provider visits. Evidence-based digital tools can help to improve access while reducing costs.
Not treating MH challenges can have a negative impact on overall wellbeing, including significant impacts on physical health. And because people largely do not exist in isolation, it can also adversely impact family members, and friends. In addition, it could be expected that the cycle of not getting appropriate care could further aggravate other MH, social, and substance use challenges.
For many people, the holidays might not be the most wonderful time of the year. Paying close attention to MH challenges after the holidays, and during other stressful times, is incredibly important. Virtual mental health can be a valuable option for ensuring that people have access to the care they need when they need it.
Endnotes:
1 Recognizing holiday triggers of trauma, Substance Abuse and Mental Health Services Administration, April 4, 2022
2 A growing psychiatrist shortage and an enormous demand for mental health services, Association of American Medical Colleges, August 9, 2022
3 Maintaining mental health during the holiday season, National Alliance on Mental Illness
4 Adults reporting symptoms of anxiety or depressive disorder during the COVID-19 pandemic, Kaiser Family Foundation, June 13, 2022
5 HHS Roadmap for behavioral health integration, Department of Health and Human Services (HHS), December 2, 2022
6 Mental and behavioral health-African Americans, HHS
7 Bridging the black mental health access gap, Health Affairs, November 20, 2020
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