The wide and swift adoption of telehealth in the behavioral health space quickly ran into potential issues.

Still, many of those issues loom large over the segment after two years of COVID-prompted growth, potentially limiting its impact in the future, according to Dr. Kari Law, telepsychiatry program director and clinical operations vice chair for the West Virginia University Department of Behavioral Medicine and Psychiatry. 

This requires strong advocacy for solutions from the federal government, Law and others said on a webinar panel hosted by the U.S. Health and Human Services Department.

“It can not be [understated] how valuable our voices and our patients’ voices are,” Law said. “You can’t put that cat back in the bag. For folks who live in an area that’s either financially or geographically limited in resources, it’s unethical not to provide those services.

“As we’ve seen, it’s entirely possible.”

Law said that telehealth visits for behavioral health increased 429% in 2020 compared to pre-pandemic levels. Today, about 55% of all visits are conducted via telehealth, she said.

Law and many of the panelists say telehealth is a key to overcoming nonclinical issues related to accessing care such as transportation, inflexible work schedules and childcare obligations.

Persisting challenges to telehealth

Structural and equity issues such as broadband internet access continue to plague providers caring for patients who struggle with accessing care. Law specifically pointed out that West Virginia is one of the most rural states in the nation. About 51% of West Virginia’s population lives in rural areas and 76% of rural households have access to broadband, according to U.S. Census Bureau reports.

Chris Fore, director of the Indian Health Services (IHS) TeleBehavioral Health Center of Excellence,  said that some rural regions that do have access to the internet didn’t have robust enough networks to support the onset of work-from-home and e-learning all at the same time. 

Similarly, many challenges faced by those IHS cares for are devices that are of high-enough quality to support a video call for telehealth. About 80% of behavioral health telehealth visits — which increased by 238% in 2020 — were provided via phone calls.

“As we pivoted into patients’ homes out of clinic-based settings, we really struggled,” Fore said. “The digital divide in Indian Country is real.”

These issues and others on the patient side — including housing security, child care, post-incarceration reentry and work obligations — as well as issues on the provider side require action from the federal government.

The pandemic prompted the federal government to loosen some restrictions on telehealth — including telehealth prescribing regulations from the Ryan Haight Act — that allowed it to proliferate. However, the regulatory grounds that undergirded the federal COVID response are set to expire around July 16.

Margaret Howard, division director of the Center for Women’s Behavioral Health and psychiatry and human behavior professor at the Warren Alpert Medical School of Brown University, said it’s imperative that national policy support parity between telehealth and in-person behavioral health visits and enable licensure to provide care across state lines, especially for hard-to-access or highly specialized types of clinicians.

“I think we have to be very loud with all of our collective voices,” Howard said.