Public health advocates and advocates for the poor seem prone to view the glass as half empty rather than half full. This is about teletherapy. Therapy over the phone was supposed to expand access to mental health care to needy people but so far that hasn’t happened, experts say. Online therapy is booming, but the poor and needy don’t seem to use it.
In fact, the researchers found, the shift to teletherapy has exacerbated existing disparities.The increase in psychotherapy has occurred among groups that already enjoyed more access: people in higher-income brackets, living in cities, with steady employment and more education, researchers found in a series of studies, the most recent of which was, published Wednesday in The American Journal of Psychiatry.
Seeing a doctor is often a pain. I read about research a few years ago that estimated an in-person physician visit takes about three hours to complete when travel, waiting, being seen and driving back home are all considered. However, not every doctor’s visit needs to be in person. Consider mental health counseling. Your therapist does not need to take your weight, measure your blood pressure or look down your throat. If all you plan to do is talk, why not do it over the phone? That’s the beauty of telemedicine.
As an aside, I suspect some mental health counseling is more effective in person. Just as I’ve found text messages are not always an effective way to discuss delicate matters with my wife, and miscommunication is common over email, so too I suspect online therapy may lose something in translation. That said, sometimes you don’t have time or the desire to drive across town to lay on a therapist’s couch, spilling your guts about childhood trauma when you didn’t receive a 10-speed bike for Christmas in 1977. Or perhaps you found a counselor you like, who takes your insurance or accepts a modest cash rate but lives clear across the state.
Digital and telephone counseling has a place in the care continuum. It boosts access to mental health care and can make it more convenient. Teletherapy can even lower the barriers to entry for young therapists who lack the funds to rent a brick & mortar office suite. I read that some forms of email counseling were beneficial because you could go back and reread the conversation after it took place. For that matter, since I’m always writing about group therapy, Yahoo! used to have what were called news groups. People would subscribe to a news group and all chats were viewable and archived for all members to see. You could learn not just from your own discussions, but the discussions of others in the group, but I digress. Back to the New York Times article.
Among those who have not benefited from the boom, the team found, are children from low-income families, Black children and adolescents, and adults with “serious psychological distress.”“Telehealth did not live up to the hype,” said C. Vaile Wright, senior director of the office of health care innovation at the American Psychological Association. The reasons, she added, are no surprise: Many Americans lack access to reliable broadband, and insurers do not adequately reimburse providers, who, in turn, choose to treat privately paying clients.“If you can’t afford it, no matter the modality, you just can’t afford it,” Dr. Wright said. It may be, she added, that weekly therapy sessions are simply not scalable to a broad population, and the field should explore light-touch alternatives, like single-session interventions and digital therapeutics.
The telephone and the Internet make it easier to connect with other people, whether it’s on Facebook with old grade school friends or talking on the phone with a therapist across town. The study found that if you can’t afford to sit in a counselor’s office, you probably can’t afford to talk to one on the phone. Most therapists do not accept insurance and health plans often do not cover as much care as some patients need. The mental health counseling industry has been relatively accepting of technology that makes their lives easier but has not embraced modalities of care that might expand access to more people by grouping them with others. The authors mention lack of broadband access as one barrier, but the root cause is money. To many poor people, money for rent, food and transportation is more valuable than, say, dental care, physician visits or improving their mental health by paying to talk to a counselor. That is unlikely to change unless the price is brought down to a level they can afford.
Read more at NYT: Online Therapy Boom Has Mainly Benefited Privileged Groups, Studies Find