Telehealth: A Response to the Mental Health Crisis?

For the World Health Organization (WHO), the pandemic exhibits the growing need for mental health support, and, sadly, many countries are failing to offer the services that people need. Every three years, WHO publishes the Mental Health Atlas, information from its members on "policies, legislation, funding, human resources, availability and use of services and data collection systems in mental health matter." The newest version was released this year on the eve of World Mental Health Day, which was celebrated on October 10.

Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, expressed that "It is extremely worrying that, despite the evident and growing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not accompanied by investments. We must heed this wake-up call and act on it by drastically accelerating the increase in investment in mental health because there is no health without mental health."

In making the Atlas, the WHO found that none of the goals came close to being achieved. Only 51% of members reported that their mental health policies or plans were in harmony with international and regional human rights instruments; the goal was 80%. Similarly, 52% of the countries met the goal of mental health promotion and prevention programs, and the plan was the same, 80%. The organization also reported global estimates of people receiving care for mental health problems to remain below 50%. Most worryingly, the world average of people with psychosis who receive support is only 29%.

With the arrival of the Coronavirus, access to help with mental health issues was greatly affected as many psychiatrists, psychologists, and doctors, in general, chose not to have face-to-face sessions for fear of getting infected. To continue serving those who need it, many professionals decided to start consulting by telephone or videoconference; they adapted to telehealth.

What is telehealth?

Telehealth, also known as telemedicine, is when technology, such as computers and mobile devices, is used to access healthcare services remotely. Sometimes when it is about mental health, it is also known as telepsychiatry telepsychology. Due to COVID-19, the need to offer virtual services has increased, so this way of diagnosing has become a desirable option. In the United States, for example, its use increased dramatically. In 2019, only 11% of Americans used this option; by 2020, it was 46%, and doctors see between 50 to 175 more patients through telehealth than before.

A UC San Francisco (UCSF) study reported that San Francisco Health Network (SFHN) physicians overwhelmingly support the use of services, with nine out of ten doctors responding that they felt comfortable providing care by phone and/or video. Anjana Sharma, assistant professor of Family and Community Medicine at UCSF, said that "that transition was painful for many people: finding a new way to provide health care." In the UCSF study, doctors confessed they were concerned about not knowing whether they could accurately diagnose patients remotely. Nearly 60% of them question the safety of diagnosing over the phone, and 35% about identifying health problems over the phone. Furthermore, around 44% reported that telephone use is impractical as it involves many cognitive, auditory, and speech barriers. Still, 90% said they would continue to use the technology when the pandemic ends.

One of the advantages offered by telemental health is that it is not necessary to travel anywhere, which is convenient, especially for those people who have a complicated schedule or do not have the facility to travel easily. It also provides a more flexible schedule. Another positive side is that it allows aid to be broader in scope. Because technology is a tool many already have, it makes care more accessible for those who could not access mental health services, including people in remote areas or emergencies.

The downside is that, when it comes to technology, quality levels can vary. For example, if you have a poor internet connection, video conferencing can hang, look or sound bad, affecting how these services are offered and received. The quality of the video depends on the device; it is not the same to have a session on a computer as on a cell phone. Also, the meeting is at the mercy of the platform where the videoconference will take place; If it has a problem, it may have to be canceled. Another important issue is privacy.

For one thing, the cameras are in users' homes which can make them feel exposed. Also, if the person lives with others, they may not have a private space to have the date without being heard, causing them not to speak freely. Also, the patient may have problems configuring access to video, installing the platform for the session, or even how to access the session. This can be due to language barriers or because they do not know about the use of the technology.

More and more countries are looking to telehealth as a tool to correct the lack of face-to-face care. According to the WHO, 70% of its members have adopted telemedicine or teletherapy; however, this figure depends on the income of each country. For those with high incomes, 80% reported that they saw technology to mitigate the challenges of offering mental health services. Less than 50% of low-income countries reported using telehealth. With less than 50% of people being cared for mental health problems, all countries should take advantage of the ease of consulting online to help those in need, not just high-income countries.

As said by Casey Tallent, director of telebehavioral and collegiate health initiatives at Pathlight Mood & Anxiety Center: "Telehealth has allowed us to continue providing care to thousands of patients, who otherwise would not have been able to receive the mental health care they needed," and it is something that must be taken into consideration.