Fears about the novel coronavirus, the economic meltdown, and prolonged self-isolation are taking an emotional toll on Americans. Calls to the federal mental health crisis hotline are 900 percent greater than this time last year.
In normal times, one in five American adults deals with mental health issues. Anxiety is the most common mental disorder; 6.8 million people in the U.S. — roughly 3 percent of the adult population — suffer from generalized anxiety disorder.
Anxiety increases in response to global events. There is evidence that Americans felt increased anxiety after 9/11 and suicides increased during the Great Depression and World War II. Financial stress can also exacerbate anxiety and depression and 40 percent of Americans don’t have enough savings to cover a $400 emergency.
But in the unique moment of time we find ourselves in today, Americans are currently dealing with increased stress, decreased cash flow, and an inability to leave their house to seek mental health services.
Tele-health poses an opportunity to address some of those issues.
Through tele-health, Americans can access mental health providers from their homes. Many therapists and psychiatrists have adapted, moving their appointments from their office and meeting virtually with patients online. And there is evidence that tele-health provides benefits to patients with anxiety and depression. Virtual care can help people feel less isolated, learn coping tools, develop goals and routines, and provide emotional support for people struggling during this difficult time.
But while providers may be eager to meet patients where they are, laws, insurance coverage and public infrastructure need to catch up.
In response to the COVID crisis, the Trump administration changed Medicare rules to allow providers to bill for tele-health services at the same rate as in-person visits. It also announced Medicare would cover rehabilitation, office visits, mental health counseling and home visits, among others via tele-health. Furthermore, Medicare will cover care provided through audio-only channels when previously it required video conferencing.
But changing Medicare rules, while a good start, is not sufficient.
States regulate how tele-health can be used within their borders — so even if Medicare will reimburse for services, it doesn’t mean providers can perform them. States can limit access to telemedicine by prohibiting state licensing reciprocity or requiring special tele-health licenses, as Nevada does.
Other states have adapted their laws for the public health pandemic. Arkansas, for example, has suspended a law that requires real-time video appointments and is now allowing for store-and-forward tele-health services which allow people to send photos or videos of themselves to be reviewed by a physician later. It may not make sense for mental health services but it can help a patient get information on a mole or renew an ocular prescription. But not all states have made such adjustments. During a time of physical distancing, states should expand access to services like mental health via tele-health and track the outcomes to study its efficacy.
Health insurance coverage also matters. Health insurers have notoriously narrow networks when it comes to mental health services. While some health plans have agreed to cover mental health services via tele-health, it’s a patchwork system that can leave patients — and providers — scrambling. Some insurers require preauthorization or won’t cover mental health care delivered via tele-health technology.
In this crisis, insurance companies should cover all medically appropriate care, regardless of how it’s delivered. When writing this, I spoke with one man who has United Healthcare insurance through his employer. He had an existing relationship with an out-of-network therapist that he was able to move online. He pays out-of-pocket for his care and seeks marginal reimbursement after the fact. Another woman I spoke with had Kaiser Permanente. She did not have an existing relationship with a therapist but sought treatment for increasing anxiety during the COVID crisis. Kaiser connected her via tele-health with an in-house therapist and psychiatrist at no out-of-pocket cost to her. The only tradeoff was she had to wait a few weeks to get an appointment.
Finally, in some areas, broadband coverage is not strong enough to host a video chat. One in five Americans live in rural areas and a third of them don’t have access to broadband internet. While we might not be able to address this during the pandemic, it is vital that we invest in rural communities in the long-term. Despite evidence that there is a greater need in rural areas — suicide rates are higher there — there are fewer mental health providers and tele-health could help people access needed care. Evidence shows that with better mental health screening and treatment, we could prevent more severe depression and other mental health disorders; physical health problems such as heart disease; and even suicide.
We should be cautiously optimistic about the potential of tele-health to improve access to health care services. Tele-health is not a panacea for all medical care — certain types of care like surgery or intubation cannot be delivered remotely. And the burgeoning tele-health sector needs more oversight
Though a return to normal will be slow, we should speed up progress on tele-health, particularly for people in rural areas who may not have as much access to health care services. This can be done by:
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Getting rid of rules on where a patient must physically be to access a tele-health appointment
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Allowing patients to renew prescriptions renewed online
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Expanding the type of providers who can deliver services via tele-health to include counselors, occupational, speech, and physical therapists who all provide services that can be delivered via video
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Broadening the treatments and conditions that providers can bill for through a tele-health appointment
We are in a time of crisis — people are trying to hunker down in their homes and reduce unnecessary contact with others. But mental health needs intensify in stressful times. Tele-health provides an opportunity to get people the care they need in a timely fashion. The federal government has done a good job in reducing barriers for people covered by Medicare. But states, private insurers, and providers can and should do more.
Arielle Kane is the director of Health Policy at the Progressive Policy Institute. Her research focuses on what comes next for health policy in order to expand access, reduce costs and improve quality.