Telehealth for Mental Health
Article originally by Jamie D. Aten Ph.D. at Psychology Today as “Telehealth: A Silver Lining in the Midst of COVID-19”
Telehealth is one way of providing health services and information via electronic communication or telecommunication. Dr. Sean Boileau shares insights into how COVID-19 has affected mental health care, and how telehealth is helping.
Dr. Sean Boileau serves as the Behavioral Health Services Director at APLA. He currently maintains an active role in a multidisciplinary group practice, as well as serving as an adjunct professor at Antioch University of Los Angeles. He earned his Doctor of Counseling Psychology degree with a focus on Multiculturalism and Diversity at Arizona State University. He completed his post-doctoral fellowship at the University of California, Berkeley, focusing on creating outreach programming and providing clinical services for members of the LGBT communities on campus. His specialty areas include ambivalence and poor motivation; internalized homophobia; low self-esteem and poor self-concept; military and combat trauma; and perfectionism and overachievement.
Jamie Aten: How would you personally describe the benefits of telehealth for mental health care?
Sean Boileau: To me, telehealth’s most salient benefit is its ability to foster consistency in patients’ lives amid the chaos of the COVID-19 pandemic. Routines and consistency of conversation with friendly faces cannot be understated at this time, and telehealth is allowing us to maintain these interactions remotely. With patients’ lives uprooted, everything can change—but their therapist serves as a comforting constant. Through telehealth, patients can maintain mental health care routines by seeing the same therapist, at the same time, week after week. Although not in-person, this routine is critically important.
We are currently seeing unprecedented levels of stress due to current events, resulting in a heightened need for mental health care. As a result, my practice has had an influx of new patients. In June of 2020, we saw 729 patients compared to 488 patients in June of 2019. Secure telehealth platforms—we use eClinicalWorks for example—have allowed us to support our increased patient population.
Another huge benefit is the rare ability to see inside patients’ homes, witness their daily routines, and assess their environment. This glimpse into patients’ lives often leads the visit, depending on what they are dealing with at home, and allows me to make observations I would not have seen in my office. The at-home aspect also saves patients from traveling to the visit, which can be anxiety-inducing. For some, telehealth visits make patients feel safe, and allow them to discuss their anxiety, without outside factors causing more worry. Due to the convenience and comfort factors, our no-show rates have dropped increasingly. Hopefully, a silver-lining here that continues after the pandemic is that the stigma around seeking mental health care is reduced, and people can seek help when they need it.
JA: What are some ways that using telehealth services for therapy can help us live more resiliently?
SB: It is clear that everyone adapts to situations differently, with a range of resiliency. In stimulating resilience, it is important to see people we respect practicing what they preach—telehealth is great for creating the experiential bridge between provider and patient. As a therapist, I’m not usually experiencing the same situations as my patients, whether that be a break-up, or another impactful life moment.
Now, we are together in a real-time synchronized event—the COVID-19 pandemic as well as the unprecedented levels of civil unrest across the country—in which the therapist and the patient are experiencing similar fears, concerns, and anxieties. The fact that we as professional care providers are navigating these struggles while maintaining a sense of poise is hopefully inspirational to our patients. Patients can count on seeing their therapist every week, and seeing the therapist live through a similar experience creates a sense of connection and hope for patients.
Engaging in the active process of mental health care allows patients to have a semblance of a sense of control in their life for the one-hour visit, in which they are making the decision to work on themselves. A silver lining of the pandemic is the sense of relatability and awareness of others’ situations—opening up the collective psyche a bit more in this shared experience.
JA: For mental health care, how does telehealth compare to traditional therapy settings?
SB: For mental health care, the at-home telehealth setting is beneficial for many patients. For example, in-person visits with my agoraphobic patient would each begin with 10-15 minutes of deep breathing before he would be able to engage in conversation. Now, I log on to a big smile from him. He is comfortable at home and has not been forced to navigate the outside world for a session.
For patients with mobility issues too, getting to the visit can be painful and time-consuming. Clicking a button rather than navigating Los Angeles public transportation is a game-changer, saving them from painstaking travel—not to mention, telehealth eases time constraints and the financial burdens that come with the commute.
One downside is the lack of privacy due to cohabitation brought about by the pandemic, and stay-at-home orders in particular. It can be difficult for patients to discuss their inner struggles within earshot of their parents, spouse, children, etc. Another concern is safety. Particularly for patients dealing with interpersonal or domestic violence, the home is not always the best place to discuss hazardous situations or abusers. Thankfully, the portability aspect of telehealth allows patients to conduct secure visits from anywhere, so they can leave their home if needed.
Additionally, in my practice, we have started implementing strategies around open-ended questions to keep patients safe—asking, “What would you like to talk about today?” rather than bringing up the patient’s specific issues to avoid putting them at risk. Looking beyond the pandemic, it is clear that a portion of the patients will be better suited for visits at home than others. We will continue using telehealth on a case by case basis, as it provides great flexibility for the practice.
JA: Any advice on how we might use telehealth to support a friend or loved one struggling with a difficult life situation?
SB: Refer, refer, refer. For those not in touch with mental health care, it may not occur to them that we are continuing to operate via telehealth. Many people know very little about the realities of therapy. Mental health is quite often stigmatized, only associated with very extreme cases or the “crazy” mental institutions as portrayed on television.
I like to look at it this way: I take my car to the mechanic not only when it’s broken, but sometimes just because I have not taken it in for a while and I probably should, just to ensure everything is running smoothly and safely. Similarly, early intervention and preventative mental health care are incredibly beneficial in avoiding serious mental illness (SMI).
Another way to support friends or loved ones is to destigmatize and normalize mental health care. It goes a long way when high functioning individuals disclose to others that they see a therapist—whether for routine maintenance or to deal with a difficult time. This creates impactful moments that help people realize that preventative mental health care is okay, and in fact quite powerful.
There is also currently an unprecedented number of mental health groups—support groups, group therapy, and more—that are available to all virtually in light of the pandemic highlighting the importance of maintaining one’s mental health. I would encourage those struggling with a difficult situation to take advantage of the growing number of options available at this time.
JA: What are you currently working on that you might like to share about?
SB: My practice is currently working on upgrading our technology across the board. We are advancing our operations in terms of platforms for communicating across the practice, file sharing and security protocols focused specifically around HIPAA-compliance and avoiding data breaches.
We are also expanding our practice by adding new specialists to our team and building a new clinic. We recently laid the foundation for a new facility that will serve the communities around Compton and will be affiliated with Charles Drew University, a minority-serving and Historically Black Graduate Institution that cultivates diverse health professional leaders dedicated to social justice and health equity for underserved populations. With this development, we are aiming to expand our practice even further with bilingual and Spanish-speaking specialists to better serve the needs of this community.