Assessing the Impact of Telemental Health As We Emerge from COVID-The HSB Blog 6/22/22
OurTake:
The dramatic rise in the incidence and treatment of behavioral health issues with digital tools during COVID has created an opportunity that begs the question of how to better utilize these tools to impact populations going forward. Understanding the implications of these digital interventions will allow public health professionals to better assess when and where these tools could be most effectively deployed going forward, particularly in underserved areas. While research indicates promising early results, this is still a relatively new development only two-plus years removed from the beginning of the pandemic, and longitudinal research is needed to accurately interpret results and findings. Researchers and health professionals are looking for solutions.
Key Takeaways:
According to findings by “Mental Health America” approximately 20% of American adults or about 50 million people suffer from a mental illness.
In a 2021 PubMed review of 735 studies there was an increase in positive health behaviors by about 33% after the uptick in telehealth appointments instead of in-person care.
Mental illness has a prevalence rate of about 14% and accounts for 7% of the overall global burden of disease according to Current Psychiatry Reports.
The pandemic generally precipitated a broad-based increase in mental illnesses such as anxiety and depression often driven by social isolation and fear (both of COVID itself and of its impacts).
The Problem:
Mental illness is a global public health concern but as with many health issues, there is no uniform response to it. Each country has its own cultural views of behavioral health, as well as its own approach to addressing and mitigating some of the impacts mental health issues have on its society. According to the study “Global burden of disease and the impact of mental and addictive disorders” by Current Psychiatry Reports, mental illness has a prevalence rate of about 14% of the population globally and accounts for 7% of the overall disease burden worldwide. With the rise in social isolation, ongoing changes in societies and economics due to the pandemic as well as the continued looming threat of COVID itself, conditions emanating from the pandemic such as increased anxiety, depression, and substance abuse will likely continue to increase over time. In addition, the pandemic created a worldwide increase in demand for mental health services as people struggled with new or exacerbated issues triggered by the pandemic itself.
In addition, one of the biggest struggles for the behavioral health industry during the pandemic was the transition period for clinicians themselves as they learned to move from predominantly in-person services to ones that were almost exclusively via telehealth. The industry changed dramatically almost overnight. In addition, given the impact of the pandemic on caregivers themselves (sickness, caring for loved ones, etc.) there was a strain on the availability of practitioners and supply of services creating issues of access to care for many Americans. Given the almost instant elimination of in-person care, telebehavioral health became a lifeline all over the world as people sought to deal with existing issues and the new strain of a once-in-a-lifetime pandemic. This was particularly important for those receiving their care with the aid of some type of coverage assistance (ex: CHIP, Medicaid, etc.) as many of them could not have afforded or accessed their services without that support.
Background:
To evaluate the impact of telemental health it is helpful to first set the context by understanding the overall state of behavioral health in the country. As noted earlier, according to Mental Health America, 19.86% or approximately 50 million American adults suffer from a mental illness. According to the National Alliance on Mental Illness the most prevalent conditions are anxiety (impacting 19% of U.S. adults), depression (8%), post-traumatic stress disorder and dual diagnosis (both 4%), and bipolar disorder (3%). Moreover, over half of adults with mental illness do not seek out treatment, with current estimates of that population at approximately 27 million Americans. Sadly, almost 25% of U.S. adults report an unmet need for treatment of mental illness and this number has remained fairly consistent for over a decade.
That said, digital health technologies appear to hold great promise for the treatment of behavioral health issues and have the potential to help close the gap to access given their ability to be widely used and broadly distributed in underserved communities at a relatively low cost (assuming broadband access is not a problem). For example, in terms of efficacy, a 2021 study entitled, “Effect of Engagement with Digital interventions on Mental Health Outcomes” which analyzed 35 studies, covering a total of approximately 4,500 participants whose conditions were assessed over a period of 3 to 14 weeks (from baseline to post-intervention assessment). The study looked at three online databases that utilized digital tools to interact with patients via smartphone, tablet, and computer. The authors found that those who interacted with digital tools in the studies showed improvements in a variety of different mental health disorders including anxiety, depression, psychological distress, and various other mental health outcomes. The study demonstrated statistically significant improvements and concluded that not a single one proved to be ineffective. All of this leads us to conclude that the application of telemental health has demonstrated positive outcomes and has additional potential in the treatment of mental illness.
Implications:
Implementing digital health technologies can be a daunting task when it comes to behavioral health. For example, while the increase in the delivery of telebehavioral health has dramatically lowered the rate of cancellations and no-shows for providers, the ability to access care at home has created certain privacy issues such as accessing care in multigenerational homes (ex: when discussing topics such as sex, and gender issues) and patients’ abilities to discuss concerns without fears of being overheard (ex: relationship issues with parents or partners or even domestic abuse). However, despite these tradeoffs, academic methods do allow us to determine whether or not digital tools can effectively assist in the treatment of mental health for populations. For example, according to a recent article in MobiHealthNews, “Data science provides quantitative information on current health statuses and its near-term implications”. These data points, in addition to a person’s usage of the digital intervention method, provide key insights into health behaviors. Continuous feedback loops between health behaviors and data can allow public health professionals to gain a better understanding of mental health illnesses as well as how it is trending.
Along those lines, the rise in mental illness during the Pandemic sparked a significant increase in the development and deployment of digital tools for mental health illnesses. In a recent article by “Frontier in Digital Health”, an Australian longitudinal survey of 1370 participants showed that about 70% of the participants reported at least one positive effect of digital methodologies for treatment. Recent research on interventions like Mind Spot treatment courses were shown to have a reduction of adverse health symptoms of about 50%. These courses were sustained over a course of a minimum of three months and utilized telehealth calls for clinicians to meet with patients. Telemental Health has been shown to make strides in the health of populations and has been consistently shown to reduce and mitigate adverse health effects, however, it should be noted that more research still needs to be done over longer treatment periods to assess and measure the true longitudinal effects of treatment.
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