W H AT W E MI S SE D
the question then becomes how to better
serve those still not getting the mental-
health care they need. Calhoun says any
real solution needs to take a step back-
ward and investigate why many people
either cannot or choose not to seek help.
For people of color, centuries of neglect
and mistreatment by the medical institu-
tion are not easily forgotten. In the 1700
and 1800s, influential American doctors
coined since-discredited diagnoses like
“drapetomania” (psychosis or madness
causing an enslaved person to run away)
and “negritude” (essentially, the “dis-
ease” of not being white). Many contem-
porary providers aren’t aware of those of-
fensive diagnostic frameworks, Calhoun
says, but the cultural legacy of that racism
is still widely felt in communities of color.
Training more clinicians from under-
served backgrounds is the single most
impactful way to encourage people of
color to get help, Calhoun says. But that
process takes time. In the interim, she
says, all clinicians need to be educated
about psychiatry’s problematic past so
they can acknowledge and understand
why some patients may not feel comfort-
able seeking help, and then hopefully ad-
dress those issues in their own practices.
Looking beyond telehealth and focusing
on community-based programs—like
church-run mental-health groups or the
Confess Project, a nationwide initiative
that trains barbers to be mental-health
advocates—may also help build that trust.
Case studies also suggest teletherapy
can work well when it’s integrated into
the traditional, in-person medical sys-
tem. For the past decade-plus, Massa-
chusetts has run a program that allows
participating primary-care providers to
teleconference in a psychiatrist during a
child’s checkup, for example. Such pro-
grams don’t eliminate mistrust of the
medical system, but they can at least
make it easier to introduce people to the
mental-health system.
Mental-health apps—while not appro-
priate for patients with serious diagno-
ses, and clearly not an option for those
without a smartphone—can also provide
a cheap (or even free) stopgap measure
for people struggling to find or afford an
appointment with a clinician, Rauch says.
And in some cases, adds Dr. Adrienne
Robertson, a family medicine physician
who works with the online medical
startup Nurx, through which people can
request prescription medicines and diag-
nostic tests simply by filling out a form,
eliminating face-to-face interactions with
providers can actually put patients of
color at ease, because they can “just [be]
a patient like everyone else.”
Policy also plays a role. Nordic coun-
tries, like Sweden, have among the most
robust and widely used telemedicine
programs in the world, boosted by af-
fordable, state-sponsored medical net-
works. Unlike in the U.S., where insur-
ance limitations and out-of-pocket costs
are roadblocks for some patients regard-
less of platform, many people in Nordic
countries have a public option for virtual
care. Last year, the Centers for Medicare
and Medicaid Services made it easier for
Medicare holders to use telehealth ser-
vices, a policy that allowed more than a
quarter of Medicare beneficiaries (and
more than 30% of Black and Hispanic
beneficiaries) to use telehealth during
the fall and summer of 2020, but it’s not
clear what will happen after the pan-
demic ends. Permanent federal action
for Medicare and Medicaid holders—
many of whom are low-income or el-
derly adults—could open up therapy to
millions of people who can’t currently af-
ford it. And changing federal policies that
currently limit clinicians to treating pa-
tients located in the state where they are
licensed could help even out distribution
of the mental-health workforce.
All of these fixes are considerably
more complex than bringing appoint-
ments online; they require rebuilding
the system, rather than simply shifting
it to a new platform. That work needs
to happen sooner rather than later, Cal-
houn says. Already, according to TIME/
Harris Poll data, many people are return-
ing to in-person medical appointments,
both psychological and physical. In May,
more than half of respondents who’d re-
ceived mental-health care said they’d had
an in-person appointment since the start
of the pandemic, up from 37% in Febru-
ary. While some patients and clinicians
are sure to stick with teletherapy after
the pandemic, much of the system will
seemingly revert back to how it was—and
without concerted effort, the same prob-
lems may persist for years to come. •
The first human-
monkey chimera
—
In an April study published
in the journal Cell, professor
Juan Carlos Izpisua Belmonte
created an embryonic chimera
that combined human and non­
human primate cells, designed
for research purposes only, and
unable to advance beyond the
embryonic stage. The research
has two purposes. The first is
to study the process known
as gastrulation—the point
two weeks after conception
when embryonic cells begin
to differentiate into the body’s
more than 200 cell types.
The second goal is to help
scientists develop better
systems for growing tissues
and organs—intended for
transplantation into humans—
in other animals, including
pig embryos, which are less
ethically controversial and
more accessible.
Bone-marrow
transplant cures HIV
—
For blood­cancer patients
who are not responding to
chemotherapy, a bone­marrow
transplant is sometimes an
option. For one such patient in
the U.K., the transplant proved
to be a treatment for a second
disease, too: HIV/AIDS. The
patient received marrow from
a donor who had a mutation in
the CCR5 gene, which prevents
HIV from effectively binding
to cells. After the transplant,
circulating HIV disappeared
from the formerly positive
patient’s blood. What’s more,
18 months after the patient
stopped using antiretroviral
medications, the virus had not
yet reappeared. However, the
doctors involved stress that
such transplants can carry
more risk than simply staying
on retroviral medications.
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