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December 7, 2020

Pandemic shapes future of mental health, addiction therapy, from a distance

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The COVID-19 pandemic may have forcibly ushered in a new era for mental health and substance-use disorder therapy.

While the pandemic forced providers to close their offices in spring 2020 and quickly replace in-person appointments with video and telephone sessions, those telehealth services now appear set to play a major role in treatments moving forward.

 Todd Molfenter
Todd Molfenter

In national surveys of treatment providers conducted by federally funded regional mental health and addiction technology transfer centers, 65% of respondents report they plan to continue using telehealth across a variety of therapies and services after the pandemic is over.

Todd Molfenter, who directs the Addiction, Mental Health, and Prevention Technology Transfer Centers for the Great Lakes region based at the University of Wisconsin-Madison, says he’s pleasantly surprised by the broad acceptance of telehealth among providers.

“The technology has been out there, but the uptake has been slow,” says Molfenter, who’s the deputy director of the Center for Health Enhancement Systems Studies (CHESS), an interdisciplinary research center based in the Department of Industrial and Systems Engineering at UW-Madison.

Previous CHESS research into telehealth adoption in substance-use disorder treatment showed roughly a quarter of treatment providers had telehealth capabilities of some sort. But less than 10% were actually using it.

Some of the hesitancy to actually employ telehealth came from financial and administrative roadblocks such as how those offerings would be reimbursed by insurers, Molfenter says. After the start of the pandemic, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services made several policy changes to improve telehealth access, while many private insurers modified their cost-sharing policies—making telehealth more affordable and viable for patients.

And CHESS has helped enable its adoption. Through its regional mental health and addiction technology transfer centers, CHESS has hosted webinars and virtual workshops for providers throughout Wisconsin, Minnesota, Illinois, Indiana, Michigan and Ohio, covering the basics of delivering telehealth, nuances in serving different demographic groups, and applying different approaches and techniques in a virtual environment.

“We’ve seen our participation triple,” says Molfenter.

When offices and clinics are able to safely reopen post-pandemic, the CHESS team is advising providers to offer a blend of in-person and telehealth appointments, based on both patient preference and the type of service. While treatments such as individual adult cognitive behavioral therapy translate fairly easily to video sessions, others like pediatric psychotherapy, group therapy or intake appointments for opioid-use disorder treatment don’t adapt quite as well.

“We’re advising providers to screen which services they want to give patients the option to choose,” says Molfenter. “And then have the flexibility in their work systems to be able to accommodate for that.”

Other barriers could limit the scale of telehealth usage. In both the mental health and substance-use disorder surveys, providers identified insufficient internet and device access among patients as the biggest weakness of delivering treatments via video.

There’s also the question of whether the medium of treatment affects results, which could be a topic for future studies.

“Research that’s been done on telehealth up to this point has shown that the outcomes are similar,” says Molfenter. “But those are in smaller trials. We haven’t seen it used on this large of a scale.”

CHESS houses technology transfer centers for mental health, addiction and prevention, all funded by the Substance Abuse and Mental Health Service Administration in the Department of Health and Human Services. The research center is one of two institutions nationwide to lead regional efforts in all three focus areas.