Online Therapy and the COVID-19 Pandemic: Two Years Later
By Jose Alonso, David Espinosa, Jake Frederico, and Mia Petruccelli
At the beginning of the COVID-19 outbreak in the US, many individuals faced with mental health challenges driven by financial insecurity, isolation due to quarantine, increased levels of anxiety, and more. Alongside these mental health issues, access to therapy was limited, as counseling and psychologist offices were forced to close as the coronavirus spread. In-person meetings were not doable, so mental health professionals resorted to telehealth.
Telehealth was incredibly necessary, as many Americans were struggling with their mental health, but it came with advantages and disadvantages. Where does it stand two years later?
In a survey conducted to analyze mental health provider perspective on telehealth, 29 mental health providers were questioned on the advantages and disadvantages of telehealth. All providers stated that the use of telehealth was extremely limited prior to COVID-19. According to the respondents, advantages include increased accessibility, attendance, and patient disclosure. More individuals were able to access therapy or counseling without a need for transportation, childcare, or parking.
Mental health providers reported that attendance rates increased with telehealth because it was less of a challenge for patients to turn on their laptops rather than get dressed, travel, and make it to their appointments on time. A number of providers reported that the ease of attending online therapy sessions seemed to lower the energy required for patients to start or re-engage in therapy. Providers also stated that they felt as though their work-life balance was greater when they were able to work from home.
Telehealth also came with several disadvantages for providers. Many reported that telehealth resulted in increased distraction, technological issues, privacy concerns, and no access to nonverbal communication. Distraction increased as some patients were distracted by notifications appearing on their screens, or would participate in activities such as laundry or dishes while in session. Providers also expressed concerns for their privacy as working from home requires that the patient sees parts of their personal life, such as a baby crying or parts of their home. Patients also had privacy concerns as they were occasionally attending sessions around family members.
At the Red Sox Foundation and Massachusetts General Hospital Home Base Program’s veterans’ clinic, telehealth was largely well received. A study involving 127 patients conducted in March of 2020, just after the clinic closed in-person appointment, found that they liked not having to drive to their sessions, and were comfortable conducting sessions from home. The number of telehealth sessions on a weekly basis overtook the amount of in-person sessions before the clinic closed due to COVID-19 within three weeks of the clinic’s closure. While most patients agreed on the convenience afforded by telehealth and were satisfied with the quality of treatment, a significant amount had trouble communicating or faced technical problems.
In a study conducted by doctors from the University of North Carolina on the desire for mental health among underresourced adults, researchers found correlations between the types of sessions people prefer and factors that might affect these preferences, such as mental health symptoms, coping mechanisms, stress due to COVID-19, and geographical location.
According to the report, depression was the only consistent factor in predicting peoples’ desire for mental health services, though there was also a strong correlation when it came to venting as a coping mechanism. The researchers believe the correlation with venting may have to do with people misunderstanding the purpose of therapy, or lacking a support network, which would be exacerbated by isolation during the pandemic.
The survey of 155 people predicted the desire for mental health service and specific types of services as the COVID-19 pandemic went on. Being aware of this desire for mental health services informs community organizations and service providers about the influence of and desire for services during the COVID-19 pandemic. The results suggest that people are more likely to seek out mental health services when experiencing depressive symptoms, high levels of COVID induced stress, and if they live in an urban-outlying region.
Mental health providers have also sought greater education on proper telehealth practices since its large-scale adoption. A survey by Dr. Jonathan G. Perle at the West Virginia University School of Medicine of 404 mental health providers found that while 74% were already in the process of learning about telehealth before COVID-19, the sudden and necessary movement towards it saw an increase in time spent learning about it. More spent time taking classes or reading books about telehealth, though priorities seemed to shift depending on the type of education and amount of hours spent on each.
Overall, telehealth use seems to have turned out for the better. As the only mental health service really available at the start of the pandemic, it eased many of the worries that came with in-person appointments, such as making the drive to them, but it also came with its drawbacks, including issues with the technology that makes it possible. Patients and doctors alike mostly approve of it, and with more research on the subject, it’s likely that many of the problems that came with the sudden switch over will be overcome in time. Telehealth has cemented itself as important infrastructure in the mental health field, and is here to stay as COVID-19 remains present.
