N EW HOPE
A FO
RH E
EA LT H CAR
understandable, given elevated levels of
anxiety, depression and stress during the
pandemic, but it also suggests telether-
apy is not a panacea. And that means the
harder work is still ahead.
There are loTs of ways to think about
access to care. The most obvious—
making it easy for a patient to speak di-
rectly with a clinician, either in person or
via a device—is only one.
There are also financial barriers. A sin-
gle therapy session can easily top $100
(without insurance) in many parts of the
country, and telehealth has done little to
change that. Rightly so, argues Dr. Joe
Kvedar, a former president of the Amer-
ican Telemedicine Association, since
there’s no evidence to suggest virtual
therapy is lower quality than face-to-face.
Be that as it may, high price tags mean
both therapy and teletherapy remain un-
attainable for many.
Another limitation: there are simply
not enough therapists to go around. More
than 125 million people in the U.S. live in
an area with a shortage of mental-health
practitioners, according to U.S. Health
Resources and Services Administration
estimates. Whether they’re seeing pa-
tients virtually or in the flesh, there are
a finite number of mental-health profes-
sionals with a finite number of hours in
their days. Rauch, from McLean Hospital,
says telehealth can increase appointment
capacity somewhat, mainly because pa-
tients are less likely to cancel or no-show,
but “as long as it requires an hour of cli-
nician time to deliver an hour of clinical
service, expanded access won’t be drasti-
cally enhanced.”
To meet demand, the U.S. needs not
only more therapists generally, but also
more therapists from diverse back-
grounds. A 2020 study concluded that
just 10% of U.S. psychiatrists identify
as Black, Hispanic, American Indian,
Alaska Native, Native Hawaiian or Pa-
cific Islander. That means many patients
of color can’t find a therapist whom they
trust and with whom they can form a
close rapport, a barrier that dissuades
many people from getting the help they
need or prevents them from reaping the
full benefits of therapy, says Dr. Amanda
Calhoun, a psychiatry resident at Yale and
a fellow on the APA’s Council on Minority
80 Time June 21/June 28, 2021
T EL E H EA LT H’S UNE V E N GR OWTH
During the pandemic, telehealth usage in the U.S. increased across the board, with the
greatest percentage rises in the middle class, older Americans, women and white people
Anytime pre-pandemic During the pandemic
25% 30% 49%
Utilized Utilized
telehealth any kind of Utilized
mental- telehealth
health care
Increases in telehealth usage,
broken down by demographic groups
129% 131%
71% 66% 51% 72%
36%
MEN WOMEN WHITE BLACK HISPANIC 18–34 35–44 45–54 55–64 65+
S O U R C E : T I M E / H A R R I S P O L L O F 3 , 2 14 T O TA L R E S P O N D E N T S TA K E N O N F E B . 17, M AY 4 A N D M AY 27
Mental Health and Health Disparities.
“There are many patients who want a
Black therapist and they can’t get it,” Cal-
houn says. “If we truly want to reduce the
gap [in mental-health care usage] we need
to make it a trustworthy system where
people feel they can connect with their
therapist or psychiatrist.”
Patients who do not speak fluent Eng-
lish, or who feel more comfortable using
another language, may also struggle
to find a therapist with whom they can
communicate freely. Increased use of lan-
guage interpretation could be an essential
tool for expanding access, Calhoun says.
It seems naive, or at least wildly opti-
mistic, to think telehealth could overcome
some of these entrenched structural is-
sues. And in some cases, virtual care ac-
tually worsens disparities. Some people
don’t have a reliable Internet connection
or a smart device, for example. About 7%
of American adults don’t use the Internet
at all, according to Pew Research Center,
and those without advanced education
and people of color—i.e., those already
often underserved by the mental-health
system—are least likely to be “digitally
literate,” according to a 2020 Health Af-
fairs article. Further, elderly adults, an
60% Did so
over video
22% 47% Did so
over audio
Utilized 39% Did so
any kind of in person
mental-
MORE THAN ONE OPTION
health care COULD BE SELECTED
230% 211%
125% 141% 135%
106%
70%
<$50K $50K– $75K– $100K+
$74.9K $99.9K
estimated 20% of whom have some sort
of mental-health condition, may struggle
to navigate virtual platforms even if they
have quality Internet access. And online
platforms aren’t perfect. Some people feel
uncomfortable sharing their most inti-
mate thoughts through a screen, and any
digital system runs the risk of malfunc-
tioning or being hacked. That recently
happened in Finland, when a data breach
led thousands of patients’ sensitive ap-
pointment notes to land in hackers’ hands.
Plus, teletherapy is only convenient if
you’re able to step away from work and
other responsibilities to conduct the call
in a private place. While the pandemic
has many white collar workers drowning
in time at home, surrounded by devices,
that’s far from a universal experience.
For essential workers, a disproportion-
ate number of whom are people of color,
it may be only slightly easier to steal away
for a teletherapy appointment than it
would have been to schedule an in-person
visit with a clinician. Perversely, telether-
apy may be making it easier than ever for
people who already had access to mental-
health care to get it, while leaving behind
the people who arguably need it most.
If teletherapy isn’t doing the trick,