The Virtues of Virtual Behavioral Health

• By:  Joan Kaylor
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By now, many of you have probably seen media (or social media) stories about telemedicine. Maybe you or a family member or friend are part of the 20 percent of the population that has already benefitted from “virtual health care.” As I am reviewing and updating this article during the COVID-19 pandemic, many more people are getting their first taste of telemedicine due to social distancing and stay-at-home rules. (For additional insights on COVID-19 and mental health, see the sidebar to the right, or on mobile devices at the end, of this article.)

Even ardent supporters wouldn’t say telemedicine can replace all health care interactions, but I do believe that the increasing availability of virtual options — supported by advances in technology, more providers offering virtual services, and more insurance plans covering them — is good news for all.

I see the value of virtual visits every day as a Licensed Professional Counselor (LPC) in Pennsylvania and an Energy Wellness Coach & Consultant who works with people all over the world. Since I am an in-network therapist for Highmark health plan members, I am glad that Highmark also sees that value and has been a leader in covering and promoting the use of telemedicine.

In my practice, virtual visits occur through secure videoconferencing technology that is compliant with all provisions of the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). On the patient side, that means someone can connect with me from anywhere, through their computer, smart phone or tablet, and trust that they have a safe, confidential connection.

Virtual visits are convenient — no worries about driving or traffic, no need to reschedule appointments every time something comes up that would prevent you from getting to my office in person. Having a virtual option also gives you a broader pool of providers to choose from — if I’m the right specialist and “fit” for someone, we can work together even if you live hours away. And, regardless of location, some people just feel more comfortable getting mental health services in the privacy of their home or office.

I’ll share two stories that illustrate how these advantages play out for real people — with names and locations changed to protect privacy. Both stories involve trichotillomania, one of my areas of specialty, but I’ll emphasize that I use videoconference visits successfully for a wide range of patients and conditions. People choose a virtual visit option because it makes it easier to fit therapy into a busy schedule, or allows them to work with a specialist far away, or eliminates practical or emotional obstacles associated with in-person visits, or because they travel a lot for work or are a student who wants to keep seeing a hometown therapist while they’re away at school, or many other reasons. But it all starts with knowing that the option exists and, for Highmark health plan members, is covered!

Kristi: Specialized Care and Convenience

Kristi is a busy young professional in northern Pennsylvania — hours away from my office in McMurray, south of Pittsburgh.

From an early age she struggled with trichotillomania, a disorder that causes people to pull hair from their scalp, eyelashes, eyebrows, pubic area, beard, chest, legs, or other parts of the body. There is no known cause, but it is estimated that up to four percent of the population will experience this condition at some point in their lifetime. From age 11 to 36, I had trichotillomania; in fact, that experience was a primary reason that I became a counselor to help others.

An added frustration with trichotillomania is that it can be difficult to find counselors who specialize in treating the disorder. Sure enough, Kristi explained to me that when her condition began in childhood, her parents took her to provider after provider without finding much help. As a young adult, she began going to a counselor who was trained to treat obsessive compulsive disorder (OCD), but wasn’t familiar with trichotillomania. She continued seeing that provider, but results were limited. For a while, she then gave up counseling altogether and tried to go it alone.

Fortunately, Kristi never gave up searching for specialized support. She finally found a practice in her region that specialized in trichotillomania. Although she was disappointed to find out that they weren’t taking new patients, they referred her to me.

Without virtual visits, our work together wouldn’t have been possible due to the distance between us. But because I offered that choice, and Highmark covered that choice, Kristi was able to begin seeing me on a weekly basis. No matter what else was going on in her busy life, getting to her appointment was as easy as pulling out her laptop and logging in to our secure videoconference portal.

Through therapy and my weekly “homework” assignments, Kristi identified the triggers for her hair pulling, along with ways to handle those triggers without pulling. We worked to understand her struggles and clarify her goals in a larger context, including a strategy for overcoming and then staying free of trichotillomania. I do try to have a first meeting with each patient in person before we go virtual, but the truth is that there is nothing I do in helping someone like Kristi where a videoconference isn’t just as effective as if they came to my office.

A Blessing for Parents: Anne and Emily

Think about the frustration Kristi’s parents must have felt being unable to find help for their child, and now I’ll tell a story of how virtual behavioral health eased that frustration for another parent: Anne.

Anne’s daughter Emily began pulling at her eyebrows and hair at age 8. Her mother also noticed that she was withdrawing from day-to-day activities and seemed distant, so she knew something wasn’t right. When she saw an episode of 20/20 on television about trichotillomania she felt like she might have the beginning of an answer.

But then what? Trichotillomania was only recognized as a disorder in the late 20^th century, research is still somewhat limited, and many health care providers have little understanding about what it is and how to treat it. Anne couldn’t find a provider she was comfortable with in her rural region of Pennsylvania — and she wasn’t sure she could manage the logistics of traveling to one farther away.

She found me on the website of the TLC Foundation, a great resource for trichotillomania and other body-focused repetitive behaviors. Once again, the option of virtual behavioral health visits provided by me and covered by Anne’s Highmark health plan, made the difference.

Virtual visits also meant Emily could get counseling in her own home; many children feel more at ease and are better able to focus on therapy when they’re in a familiar setting. During our sessions, I’d sit in my office in McMurray, and Emily and Anne would be at their dining room table many miles away.

In just a few months of weekly visits, we made progress that Anne called “remarkable.” I give her much credit, first for finding a specialist who understood her daughter’s condition, and then also because, as an occupational therapist, she was familiar with sensory integration and quickly understood how to help with Emily’s exercises and homework assignments. Eventually we got to a point where we felt confident about Emily’s progress and reduced the therapy sessions to once a month.

Virtual Behavioral Health, Real Improvements in Care

Now, virtual behavioral health is not for everyone. Some people naturally prefer in-person counseling. And although I collect emergency information upfront for my virtual patients as an added safety measure, there are conditions, like schizoaffective disorder or severe depression, where I do not recommend a virtual option.

Still, as one choice within the nation’s larger system of health care, telemedicine has too many benefits to ignore. As is true in general, behavioral health doesn’t get as much attention as it should when discussing the virtues of virtual health care. But as someone who has provided behavioral health services for more than 26 years, I see the ability to offer an insurance-covered, virtual behavioral health option as a major improvement to the total health care experience.

In all areas of health care, and especially in behavioral health, we know that some people fall through the cracks of the system and don’t get the treatment they need. Virtual behavioral health helps eliminate some of those cracks: lack of access to nearby specialists, challenges involving transportation or schedule, discomfort with being seen at a mental health services facility or practice. Virtual visits give you a broader range of choices for care — and the care comes to you.