When lockdowns began in the spring of 2020, psychiatrists and psychologists had no choice but to begin meeting remotely with their patients. To avoid interrupting care, practitioners turned to online video chats and telephone calls as replacements for office visits.
Such virtual sessions were not a new idea, but during lockdowns, they became the most viable option for care. Psychiatrist Dr. Jennifer Severe of the University of Michigan (U-M) in Ann Arbor and lead author of a new study recalls:
“We went from not getting much traction with telepsychiatry and encountering a lot of reluctance among providers and patients, to having nearly all our care delivered virtually and offering help to those who need it.”
Dr. Severe’s study surveyed patients who participated in telepsychiatry during the pandemic, to learn how they felt about the experience.
Roughly half of the people surveyed said that they hope to continue virtual mental healthcare even after the pandemic is over.
The study appears in JMIR Formative Research.
The study’s main findings
Dr. Severe and her colleagues conducted telephone interviews with 244 patients or parents and proxies of patients who had originally had in-person appointments scheduled with U-M psychiatrists but who had been forced to switch to remote care when lockdowns began.
A small percentage of the respondents — 1.2% — opted to postpone treatment until in-person options became available again.
Among people agreeing to go virtual with their care, 82.8% chose video chat sessions, while 13% chose telephone sessions.
The survey found that people over the age of 44 were more likely to choose telephone-based care. There was no significant correlation between a person’s sex or type of insurance coverage and the form of therapy selected.
In general, the participants reported that their care had met or exceeded their expectations. Parents of children receiving care found video chats to be specially engaging.
Among the nearly half of individuals who hoped to continue virtual care after the pandemic, those who had received video-based care were more likely to want virtual sessions to continue than those who met with their doctors on the phone.
The convenience of telepsychiatry
“These data,” says Dr. Severe, “suggest an opportunity to turn the experience of the pandemic into an opportunity to improve access to mental healthcare and improve the continuity of care.”
Perhaps the single greatest benefit virtual sessions offer is convenience.
Dr. Severe notes that many of the type of obstacles that commonly prevent a person from getting to an in-person appointment — such as feeling debilitated, lacking transportation or child care, or having trouble getting time off from work — are unlikely to prevent showing up for a virtual appointment.
In addition, while the study did not question individuals on the number of sessions they canceled or skipped, Dr. Severe says anecdotal indications are that these numbers were considerably lower than they were for in-person visits before the pandemic.
For those hoping to continue phone sessions, cost may eventually be a factor, as insurers have been skeptical of their value, often declining to cover them. Coverage has been provided for such care during the pandemic, but it is unclear whether that will continue once the pandemic is over.
Dr. Severe asserts that both phone and video sessions provide equally effective care and that both may be useful as supplements to in-person visits post-pandemic.
Dr. Severe does, however, offer a couple of caveats about phone care.
“For the first visit with a new patient, we try to avoid using phone, as it limits the initiation of the provider-patient therapeutic alliance, reduce[s] communication cues, and limits the mental status exam that includes observing patient facial expressions, interactions, and movement,” she notes.
In addition, Dr. Severe says, in-person visits will always be preferable for some things: “Depending on the complexity of the patient’s situation, we may need to do a physical examination from time to time to assess their balance and mobility and check for medication side effects, to name a few.”
Dr. Severe is interested in investigating factors that have affected acceptance and use of virtual mental healthcare during the COVID-19 pandemic.
She hopes to develop a fuller picture of how a person’s socioeconomic status, whether they are urban or rural, and their access to technology may affect their video versus phone preference and, overall, the degree to which telepsychiatry may provide them with effective care.
