Teletherapy, once only used in small pilot projects or infrequently by providers, has become a critical tool during the seemingly never-ending COVID-19 pandemic to combat mental health issues, depression and substance use addiction.
One of the revelations that has come out of the pandemic is the high use of telemedicine for behavioral health services, especially substance abuse and opioid use disorder syndrome, said Dr. Kimberly Lovett Rockwell, an attorney with Jones Day in Detroit and a family medicine physician.
"It just can't be understated that access to mental health services is so difficult these days and to be able to reach more patients through telehealth in a private, comfortable setting where the patient feels comfortable and safe, it was just incredible," Lovett Rockwell said.
Vicki Bucciere, a sole practitioner therapist with BlueSpace Behavioral LLC in Northville, said her clients easily transitioned to 50-minute virtual care therapy from face-to-face visits in March.
"Prior to the pandemic, I was seeing all of my clients in person," Bucciere said. "And just suddenly, about March, everything changed. And all of my long-term clients have switched over to telehealth. It's been very practical, and I would say it's been very successful."
Dr. Jeffrey Guina, chief medical officer with Easterseals, said from March through December, the nonprofit providing disability services conducted more than 121,000 teletherapy visits, compared with several hundred in 2019.
Overall, Easterseals served more than 15,000 people from last year, an increase of 9 percent.
"Back in 2019, we started doing a telehealth pilot project for intake assessments. Any time a person came for services, we had an intake person do telehealth visits with them," said Guina, adding some limited teletherapy services were offered to those bed bound or distance prohibited.
"Our big goal was to ramp up in 2020. We wanted to improve access to care because people have transportation difficulties, work schedules and problems with child care," Guina said. "Then COVID hit. Everything needed to be telehealth, and we changed over in 48 hours."
Now, after Easterseals received 13 grants and donations totaling $1.7 million, the mental health agency was able to offer clients laptops, tablets, webcams, microphones and good internet connections, about 98 percent of patients use telemedicine.
One of the chief barriers in seeking mental health services for many people has been the stigma of making an appointment and following through with services, experts say.
"There is a huge stigma of going to see a mental health provider. Just going to see a provider is hard to do," Lovett Rockwell. "People with mild symptoms, feeling depressed, overwhelmed, those people are accessing services more. If I am crying, I don't feel as much vulnerable if I am home."
Bucciere said she didn't lose any clients in the switch to teletherapy. "My clients have actually come to embrace this form of therapy. And I think we're gonna have a little bit of difficulty going back to in-person, if anything," she said.
To conduct teletherapy, Bucciere asked her clients to download the Google Duo video calling app. It has one of the best security features in the commercial market, she said.
To encourage telemedicine, the federal government waived some of the privacy requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPPA) that temporarily allows online medical conversations.
"We need to develop some client privacy protections under HIPPA if we continue to use the app," she said.
Bucciere said her clients love the convenience of setting up appointments and simply turning on their computer, tablet or smartphone.
"We don't have the traditional barriers in trying to set up an appointment to find someone to take care of the kids and get in your car and drive somewhere," she said. "You're right in the comfort of your own space."
Michigan data shows families with children struggling during the COVID-19 crisis have suffered mental health challenges as unemployment and stay-at-home orders affected their well-being, according to a report by the Annie E. Casey Foundation and released by the Michigan League for Public Policy.
"We have an opportunity to do more at both the state and federal level to help parents get by during these difficult times, including being able to put enough food on their table, keep a roof over their heads and keep them physically and mentally well," said Kelsey Perdue, Michigan Kids Count project director at the Michigan League for Public Policy, in a statement.
As of October, 34 percent of Michigan households with children said that they have felt nervous, anxious or on edge for more than half of the days or nearly every day for the past seven days, and 22 percent said they felt down, depressed or hopeless for half or more of the previous week.
These mental health concerns have been even higher for Black residents, who also have been at greater risk of contracting and dying from COVID-19 and experience other racialized outcomes, according the Casey Foundation report.
Due to COVID-related insurance access, medical costs and exposure concerns, nearly one-third of Michigan families reported delaying medical care. And a quarter of Michigan households raising kids said that they simply did not get needed medical care because of the COVID-19 crisis, according to the Casey report.
Bucciere said anxiety and mood dysphoria levels have increased across all age groups and income levels.
"There is just a general sense of worry about what's going on, not only in my personal life, but in the world," she said. "People reach out because they're looking for some source of support, emotional support."
The majority of patients are referred to Bucciere through employee assistance programs, she said.
"These are employees who ordinarily are working, but now they're working remotely, and they're experiencing lots of problems in relation to that," she said. "They have relationship conflict, substance abuse and mood problems. Most of these people ordinarily would be going into the workplace every day."
Another major development with teletherapy has been the increased numbers of people with substance use disorders using telemedicine, experts said.
"(The federal government waived) the Ryan Haight Act to get opioid treatment" through telemedicine, Lovett Rockwell said. "One company reported nearly 50 percent of patients seen through telehealth have never been seen before. More people getting treatment now and the potential of reaching drug disorder patients when not in the ER is huge."
Lovett Rockwell said using telemedicine for substance abuse issues reduces the stigma of having to show up in person.
Substance abuse teletherapy expansion is much needed now, Guina said, because drug overdoses have skyrocketed during the pandemic.
"There has been a 42 percent increase in overdoses" in May during the pandemic over the same month in 2019, said Guina, citing the federal ODMAP study. "The direct stress of the pandemic, people dealing with grief and loss and the indirect effect of shutdown, the loss of jobs."
Guina said some people are just bored and using more drugs and alcohol.
"The way I see coping skills, we all have a list of skills. When stressed you go to this list to cope with stress. Once you use up your healthy skills — like going to the gym or seeing friends or family — you go to unhealthy skills like suicide, drug or alcohol use," said Guina, adding that he estimates up to 15 percent of Americans started using unhealthy coping skills last year.
Guina said the biggest surprise he has seen with people using telemedicine services is the high customer satisfaction. Before the pandemic, people complained about technology not working, the quality of service or feeling disconnected during the online visit, he said.
"I've done a lot of telehealth in the past in my own career. And so I knew that it was that sometimes people are a little hesitant at first because it's new and different," Guina said. "Our customer satisfaction surveys were very high. If anything, people were saying: 'I love this new way of doing this. I am so glad I don't have to deal with the transportation issues. I don't have to deal with rounding up my kids and figuring out how to get there. I don't have to take time from work.'"
As thousands of people have been hospitalized from COVID-19, health care workers are facing exceptional stress levels and provider burnout is becoming more serious, experts said.
"I have colleagues who have PTSD symptoms for being on the front lines of the pandemic," Lovett Rockwell said. "Physicians have taken pay cuts and experienced increased workload. This the quintessential formula for burnout. I hope that physicians are getting help for burnout. But physician burnout is a very serious, very real, very big problem."
Shaya said he is hearing from physician friends that burnout is "going through the roof."
"The stress the front-line people are going through, the uncertainty every day, is a new challenge," he said. "A lot of providers don't see light at the end of the tunnel. Even with vaccine, the scare is almost as worse as the pandemic. A lot of people have retired because of the pressures and strain."
Guina said he also is highly concerned about the pandemic's effects on providers.
"Even before COVID, there's been a lot of recognition about physician wellness and health care provider wellness in general," Guina said. "A lot of people in health care are really good at helping other people, but they're not always so good at helping themselves. And a lot of times, they don't necessarily follow their own advice to get help."
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