Telemental Health: Equity Opportunities and Challenges
By:
Muhammad Murtaza, BHSc ’27
Faculty of Health Sciences, Western University
The rise of digital technology has significantly sped up the rate of innovation in new healthcare tools. More than 350,000 health and wellness applications are available for download, with as many as 90,000 new health apps created annually across the globe (Olsen, 2021). As a result, telehealth services skyrocketed from 2.1 million to 32.5 million in a sample of five U.S. states between 2020 and 2021 (GAO, 2022). However, for such innovations to be effective, they must meet patient needs, outperform alternative methods, and be simple.
This digital revolution has been transformative in mental health services. Over the last decade, we have witnessed a surge in innovative telehealth platforms tailored to mental health needs, offering convenient and accessible support to individuals seeking psychological care. These advancements in mental health technology address the growing demand for remote services and signify a promising shift towards more inclusive and effective mental healthcare delivery.
There are several barriers to accessing health services, especially for people living in rural or underserved areas. For example, people living in rural or underserved areas have challenges accessing healthcare services because of the distance to the nearest health provider. With the introduction of telehealth, which simplifies access to care, people facing mobility and transportation challenges can now access it.
Mental health treatment has increasingly embraced telehealth to deliver services, especially to those residing in rural or underserved areas (Molfenter et al., 2021). In using this approach, mental health services make it easier for more people to access support, enabling greater accessibility and outreach to those facing barriers in accessing traditional in-person care. In the U.S alone, a large percentage of U.S. adults face barriers to healthcare access, with mental health services being particularly difficult to obtain due to affordability issues and lack of sufficient coverage (Coombs et al., 2021). Yet, findings from a study conducted during the pandemic showed that mental healthcare field in the U.S. has been slow in implementing telemedicine services, largely due to insurance billing restrictions and the patchwork of state licensing laws that forbid practitioners from serving patients across state lines. Egede et al. (2020) make it clear that going forward, it is imperative that we make permanent the deregulation laws (with some enactment during the 2020 pandemic) like the ability for practitoners to serve patients across state lines, to continue to allow for telemental healthcare services for those in need.
As someone deeply invested in improving access to mental healthcare, it is comforting to see how telehealth has become a lifeline for many vulnerable individuals. According to a study in Colorado by Shore et al. (2020), telehealth services have significantly improved access to mental health care, particularly for marginalized populations. Similarly, Glass and Bickler (2021) indicate that telemental health offers convenience that traditional in-person therapy cannot match. For instance, patients can schedule appointments at times that work best for them and avoid the time-consuming process of travelling to a physical location. Telehealth is not just a convenience; it’s a game-changer, breaking down barriers that have long hindered access to mental health support. The ability to connect with a therapist from the comfort of our home or during a break at work can make all the difference for someone struggling with mental health issues. Furthermore, it’s encouraging to see research supporting the effectiveness of telehealth in reaching underserved communities (Shore et al. 2020), giving hope for a future where mental health care is truly accessible to all.
Furthermore, telehealth can effectively diminish the stigma surrounding mental health care by providing patients with a discreet and private avenue for receiving treatment directly in the familiar and comfortable confines of their own homes. This significant reduction in visibility enables individuals to bypass the potential judgment or scrutiny they might encounter when physically entering a mental health clinic or hospital, thus alleviating fears of being perceived negatively for seeking help. By offering this level of confidentiality and convenience, telehealth may empower individuals to prioritize their mental well-being without the added burden of societal judgment, ultimately fostering a more inclusive and supportive environment for mental health care.
The future of telemental health holds immense promise, with several developments on the horizon. Advancements in wearable technology and remote monitoring devices will enable healthcare providers to monitor patients’ vital signs and health status in real-time. In a telemental health context, these devices can provide real-time data to mental health professionals, allowing them to identify when a patient is experiencing elevated stress levels or anxiety. This enables timely intervention of treatment plans. Moreover, technological advancements may lead to more user-friendly telehealth platforms: enhanced video and audio quality and streamlined appointment scheduling.
Investment in virtual health continues to skyrocket. Per Rock Health’s H1 2021 digital health funding report, the total venture capital investment into the digital health space across the U.S. in the first half of 2021 totalled $14.7 billion, which is more than all the investment in 2020 ($14.6 billion) and nearly twice the investment in 2019 ($7.7 billion) (Bestsennyy et al., 2021). In addition, the total revenue of the top 60 virtual health players increased in 2020 to $5.5 billion from around $3 billion the year before (Bestsennyy et al., 2021). Platforms like BetterHelp, Talkspace, and 7 Cups have close to 2 million customers. As investment in virtual health firms continues to reach new highs, so does the demand for companies to innovate and discover successful models that will provide a sustained competitive advantage in this rapidly evolving field. Investment is promising news for patients, as we can expect further innovation in virtual care delivery models.
While telemental health offers numerous benefits, it possesses many challenges. Firstly, only a portion of the population has the necessary technology or reliable internet connection to access these services (Vogels, 2021). Disparities in digital literacy and access can also limit the reach of telemental health services. For example, costs associated with home internet highlight the presence of financial barriers for many. Additionally, rural communities still relying on older technology cannot have the same reliable video conferencing experience as those from areas which have the latest internet infrastructure. Policymakers and healthcare providers must address these disparities to ensure equitable access to care.
Furthermore, developing meaningful one-on-one relationships may pose challenges in online conferencing and telehealth due to online limitations such as difficulty interpreting body language (Yousaf, 2024). Critics have expressed reservations regarding the efficacy of videoconferencing and telehealth in facilitating such connections (Akyil et al., 2017; Cowan et al., 2019). However, research by Hilty et al. (2019) positively suggests that a partnership between a patient and their mental health professional can be established effectively through videoconferencing. The study by Hilty et al. (2019) can help us gain a more nuanced understanding of the potential of telehealth to facilitate meaningful connections in mental health care.
In conclusion, telemental health has rapidly evolved from a niche service to a fundamental component of modern healthcare. Data indicates a significant increase in adoption, patient satisfaction, and provider acceptance. Its benefits, including improved access and enhanced convenience, drive its continued growth. Telemental health’s integration into healthcare systems and advancements in remote monitoring will expand its reach and impact on patient care. As we navigate this evolving landscape, ensuring equitable access and maintaining high standards of patient-centred care will be crucial to realizing the full potential of telemental health.
Photo Credit: National Cancer Institute on Unsplash
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