Once seen as futuristic, video calls have become commonplace thanks to smartphones and apps like FaceTime and Skype. But seeing a “virtual doctor” can still have a sci-fi feel to it, especially if you’re trying to discuss complicated emotional issues. Still, the approach has numerous advantages, according to clinical psychologist Dr. Julie Futrell, who uses telehealth exclusively to connect with patients in both New York and California. She talks about the advantages of “telepsych,” barriers to widespread adoption, and what we might see ahead.
Health Central: What made you decide to use telehealth with patients, as opposed to conventional, face-to-face sessions?
Dr. Futrell: When I had my practice in New York City, I was working mainly with career women who had families, and I began to see that although counseling helped them, it also stressed them out to try to make time in their busy schedules for it. The last thing that counseling should do is make you feel bad in some way. So, I began to think about how to connect with them in a different way.
It turned out that phone calls worked just as well as in-person visits, and in some cases, they were better because my patients felt a greater sense of balance in their schedules. After moving to California, and becoming licensed in this state, I moved toward all-telehealth because I could see how beneficial it was. It also gives patients far more flexibility. Some prefer video calls, which are done over a HIPAA-compliant conferencing app, while others prefer a phone call.
HC: What do you see as the main advantages of using telehealth for counseling?
Dr. Futrell: In addition to better scheduling and flexibility, there’s the access issue. People in rural locations, in particular, may not have a mental health provider within a comfortable driving distance. There are parts of the country where you’d have to drive for two or three hours — each way — to get to a counselor. That makes mental health services feel out of reach, but telehealth can give these patients an easy connection.
Patients in rural locations also sometimes feel that there’s a stigma to needing mental health services, a perspective that may not be shared by those in more urban areas. Telehealth gives them more privacy and more comfort. They talk from home, which is an environment where they feel safe, as opposed to a psychologist’s office, where they might have to overcome feelings of uncertainty or discomfort.
Another advantage is simply that telehealth can be done from anywhere. If you’re on a business trip, if you’ve had an injury or you’re sick and you’re laid up at home, if you’re on vacation — it doesn’t matter, you can dial in. That ensures continuity of care.
Although the technology is widely available, telepsych services aren’t yet widely used. Why do you think that might be?
The main difficulties right now are licensing and health insurance. Psychologists are licensed state by state, so if I’m licensed in California and you’re in Minnesota, you can’t be my patient. That’s a huge problem when it comes to expanding telehealth for mental health services, because it significantly reduces the number of professionals you can access.
With health insurance, there’s also varying rules for coverage. Some providers won’t cover telehealth unless you’re in a rural location where a counselor is more than an hour away. But even the definition of “rural” changes according to what state you live in, and how providers define it.
Finally, finding a psychologist who offers telehealth requires research right now. There’s no directory you can access, making them more difficult to find.
In addition to those issues, are there certain patients or potential patients who aren’t a good fit for telehealth?
Definitely. People who aren’t tech savvy might feel frustrated by trying to use the video technology, and although I can email them a link that makes it much easier, that doesn’t work if they either don’t have email or don’t check it.
Also, part of my specialty is geriatrics, and what I’ve found is that many seniors are more tactile — they like me to put a hand on their shoulder, for example, just some kind of comforting touch that makes them feel less isolated. Finally, people who are a safety concern, such as those who’ve had thoughts of suicide, are ones I would want to see in my office as opposed to seeing over a video call. That helps to build a sense of safety.
Despite those challenges, what’s your prediction for telehealth going forward, in terms of mental health?
I’m hopeful that this will get wider adoption, because I’ve seen great results with my patients and the advantages overall are just very compelling. Our professional association is already addressing the licensing issue, so it’s likely we’ll see some changes there, and I hope that insurance companies will realize the value of this approach as well. Mental health should be available to all, no matter who you are, where you’re located, or what kind of coverage you have. Telehealth has the potential to be an important, valued part of our mental health system.