New Haven Register (New Haven, CT)
‘We’re not going backwards’
Telehealth a lifeline for some amid pandemic; therapists want a permanent option
With the rising need for mental health services brought on by the COVID-19 pandemic, the ability to see clients via videoconferencing or even in a phone call is increasingly important, therapists say.
While a bill that passed unanimously in both houses last week and was signed by Gov. Ned Lamont enables telehealth until June 30, 2023, providers want it to be permanent, and they say in two years they will be back to the General Assembly to do just that.
“The tsunami of mental health needs has not even hit us yet, and it will wash us away, and telehealth is one of the few vehicles we have” to cope with the need, said Stephen Wanczyk-Karp, executive director of the National Association of Social Workers’ Connecticut chapter.
Access to care
Telehealth has been a technological lifeline during the pandemic, enabling people to continue their therapy without a gap, experts say. But even as the COVID-19 threat ebbs and people are able to meet in person again, it will be important to provide access to clients who can’t get out of their house or have difficulty with transportation.
Emily Aber, a licensed social worker with a home office in North Haven, said there were some adjustments, particularly with older people, “just the technical aspects of it,” she said. “The biggest risk is when the connection doesn’t work and there’s some disruption in the service.”
When there are distractions in the client’s home, “It’s not as easy to just tune it out. It becomes part of the work, really,” Aber said. It becomes obvious how much parents have to manage, she said.
While the legislation lasts until 2023, “We wanted it to be permanent,” Wanczyk-Karp said. “We’re not going backwards. We know we’re not going to go backwards. … It dramatically has increased access to care. I’ve heard almost no one say this is a bad thing for behavioral health.”
He said mental health needs increased and remained high for years after 9/11, the 2003 SARS outbreak in Toronto and the 2011 Fukushima nuclear disaster, none of which had such pervasive effects as the coronavirus pandemic.
Wanczyk-Karp said a University of Oxford study revealed that 19 percent of people who were diagnosed with COVID were diagnosed with a psychiatric disorder within three months, and that patients with such disorders were more likely to get COVID.
But even in the rest of the population, the pandemic has increased depression and opioid use. “Overdoses have gone up and … it’s among people who had actually stopped using, some for several years or more, and had gone back because of the pandemic,” he said. In addition, “the isolation and the pressures on families” have made it a tough year.
Telehealth has become particularly important for clients who live in group facilities, for those with disabilities or who are homebound and for those who have two or three jobs, Wanczyk-Karp said. And the provision that allows clients and therapists to conduct sessions by telephone alone also is important, he said.
“The audio has really become very valuable for people where internet connections aren’t there; sometimes you have individuals [who] may have their family members or their children around and don’t want them to see what’s going on in the session,” he said.
Legislation
In March 2020, the General Assembly passed the first bill allowing telehealth on par with in-person visits, including a provision that insurance coverage must be the same for both. It would have expired March 15, but Lamont has extended it twice, most recently until May 20. The new bill will relieve the anxiety for those who rely on telehealth, WanczykKarp said.
“One of the big problems we’ve had is the governor waits until the night before an executive order expires to issue a new executive order,” he said. “It’s very disruptive to continuity of care.”
Since telehealth became a necessity in March 2020, “we’re seeing 20 to 30 percent increase in accessibility,” Wanczyk-Karp said. “The other thing our members are telling us is the no-show rate has dropped.”
Lamont issued a statement May 10, saying, “Throughout the last year, patients across Connecticut have found that connecting with their medical providers through videoconference or telephone has been incredibly beneficial and practical for a wide variety of reasons, so it absolutely makes sense to allow for these services to continue. Making it easier for people to connect with their doctors or medical advisors is a goal that we should strive to attain.”
State Sen. Matt Lesser, D-Middletown, co-chairman of the Insurance and Real Estate Committee, which proposed the telehealth bill, said, “I think we’re going to get to permanent at some point. The concern has been a couplefold. One is insurance companies are always looking for cost savings. … This could be a massive change in health care delivery, so what is this going to look like.”
Also, Lesser said, “It’s difficult to make public policy in the midst of a pandemic” so the two-year life of the bill will “give enough time for things to settle down and see what the new normal is.”
“We’re providing enough certainty to providers that we’re serious about this,” he said. “We’re not going to pull the rug out tomorrow.”
Peter Kane, a social worker with a New Haven office, has been seeing his clients via telehealth from his home in Hamden. “I think I certainly was somebody before this who said I would never do this … so then there was this adaptation that had to be done and it is a learning curve,” he said.
While he believes telehealth has been valuable to both patients and therapists, King said, “there are some physical questions to it I still haven’t solved.”
One is eye fatigue from looking at a screen for long hours. “I use eyedrops a lot more than I used to,” he said.
The other issue is more complex. “I’m not sure I
100 percent understand what the other person is perceiving, which is an odd thing,” King said. “I think that it is harder to know if you’re getting quite the undivided attention in a therapy session. If a person’s in the room with you, you’re concentrated on each other.”
Across the video screen, “phones ring or there might be another screen going on or family in the room.” While he won’t conduct a telehealth session using his smartphone he has clients who see him by phone in their cars for privacy.
It is more convenient for clients, Kane said. They don’t have to take a long lunch hour to drive to and from his office for a 50minute session.
“There are also the access questions of just pure distance,” he said. “I had somebody move to North Carolina. I was able to apply for a temporary license based on the pandemic in North Carolina, so I was able to see them.”
Telehealth also increases the options for clients in less-populated areas who want a particular type of therapist, for example, a man or a person of color. “There’s no reason why somebody from Sharon, Conn., couldn’t see me under these circumstances. I’m guessing that Sharon has a much lower access to therapists than New Haven.”
While Kane said, “I think there’s no question that it’s good to have the option. Lots of people have gotten a lot of help,” he prefers faceto-face meetings. “When I get back to the office, and I’m not sure when that will be, I will be overall encouraging people to come back.”
Corinne Seville, a director of adult behavioral health at Cornell Scott Hill Health Center, said telehealth “has actually been very, very helpful with a large proportion of our population,” which includes people from “a broad range” of backgrounds and situations.
“One of the biggest barriers to treatment has been access,” she said, especially for clients who are “not as ambulatory, as well as clients whose insurances don’t cover medical transportation.” Medicaid does cover a van, but “a lot of other insurances don’t, so it’s very challenging for them. Sometimes they’ve had to take a lot of different buses.”
That can mean arriving late to an appointment or missing it altogether, Seville said. “We’ve seen our noshow rate decrease significantly,” and clients have been “maintaining the gains they had made and even make further gains.”
When the pandemic hit, “we transitioned to telehealth pretty seamlessly. The agency was very proactive,” Seville said. “There wasn’t a day that we missed. There were some bumps. We had to make sure everyone had the technology that they needed. We did a lot of step-by-step instructions and we mailed out a lot of information.”
Aber, the North Haven social worker, said when clients feel comfortable in their homes “you can really get quite deep into things.”
And seeing them in their environment is helpful, too. “It’s really a privilege. A lot of people are happy to give me a house tour and show me photographs or artwork that they’ve done,” she said. “It’s been really nice.”