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By Kevin Dedner, MPH
Telehealth use skyrocketed in early 2020, when much of the country went into lockdown. Two years later, behavioral telehealth is still growing, reshaping the notion of the traditional “therapist’s couch,” with plans like Cigna reporting that virtual behavioral healthcare has eclipsed in-person care.
This is encouraging news for Black and Indigenous People of Color (BIPOC) who don’t utilize behavioral healthcare as frequently as their White counterparts for a multitude of reasons — lingering stigmas, access challenges, and a lack of therapists who can adequately empathize with their needs. A September 2020 survey by the California Pan-Ethnic Health Network (CPEHN) revealed 90% of Black, 89% of Asian American, and 88% of Latinx respondents reported satisfaction with their telehealth visit overall, and equal or greater satisfaction with telehealth than with in-person medical care.
But simply offering telehealth in and of itself — as an extension of the mainstream U.S. behavioral healthcare framework, with no changes in training, education or approach — isn’t sufficient.
In 2022, health plans, telehealth vendors, provider networks and therapists themselves need to do more, starting with approaching care with a more responsive and culturally aware skillset.
A different perspective
It’s one thing to feel the weight of the mental health crisis on the heels of the COVID-19 pandemic and the ongoing stress of global events.
It’s quite another to experience the mental health crisis as a Black, Latinx or Asian American, amid the pandemic and an ongoing racial reckoning. The rate of Black Americans showing “clinically significant” signs of depression and anxiety rose from 36 percent to 41 percent in the week after the video of George Floyd’s death became public. In a separate report, the Substance Abuse Mental Health Services Administration (SAMHSA) noted Black and Latinx Americans are more vulnerable to developing behavioral health issues due to existing impediments to COVID-19 care.
Despite these and other findings, behavioral health treatments are still underutilized among minority cohorts.
While Mental Health America screening data suggests more African American individuals are seeking out mental health treatments, less than 50% are actually receiving said treatments. We see similar trends among other ethnic minority groups: According to data from the National Latino and Asian American Study (NLAAS), nearly one in five Asian Americans have a psychiatric disorder, but this group is three times less likely to seek mental health services compared to their White counterparts.
There are many reasons for this dichotomy, such as cultural stigmas, the presence of social determinants and a lack of nonwhite therapists (e.g., only 4% of psychologists identify as Black). But a bigger factor driving disengagement in behavioral health services lies in the education and training behavioral health professionals are — or aren’t — getting.
The American Psychiatric Association has noted that minority groups are less likely to receive guideline-consistent care and less likely to be included in research.
We’ve come a long way, but we could still do more to rethink behavioral health delivery.
Expanding Behavioral Telehealth’s Potential
Telehealth holds immense promise in supporting a more inclusive, culturally responsive model of care. And emerging evidence suggests it is already being received favorably.
To ensure an optimal experience for all, organizations will need to raise the bar and address barriers to care, such as technology access and consumer education. They’ll also need to consider the following areas:
- Provider education and training. Possessing an advanced degree in psychology or a license to practice might qualify a therapist to see patients, but mental health professionals need a deeper level of training to truly connect to all potential clients, regardless of race, ethnicity or sexual orientation. Mental health providers need to acknowledge and address the implicit biases that impact care, and rethink their own biases and responses to patients. One way to do this is to work with organizations that offer training and continued education around cultural responsiveness.
- The quality of the provider network. While some telehealth vendors frequently stress the importance of convenience in their behavioral health offerings, that’s only part of the story when it comes to ensuring equitable access to quality care. A telehealth network must also employ behavioral health providers with diverse backgrounds, experience and training. Individuals must feel that they can find and connect with professionals they can trust.
- Technology experience. It goes without saying that accessing telehealth needs to be easy for individuals to engage: While the CPEHN survey indicated high levels of satisfaction with telehealth, 40% of consumers reported that they did not receive any instruction from their provider on how to prepare for or access their telehealth appointment. This should be a wakeup call to vendors, as well as health plans, provider groups and employers: Stakeholders need to think carefully about the end user experience, including device preferences (e.g., mobile vs. desktop), privacy concerns and digital access challenges.
Given that telehealth is emerging as the default, or preferred, method of mental healthcare delivery, let’s not waste this opportunity to offer it in the right way. Prioritizing the patient experience and bolstering the training and education of behavioral health professionals so they are attuned to the challenges and needs of a diverse population can ensure more individuals are receiving timely, high-quality, convenient care and the best-possible outcomes.
Kevin Dedner is the founder and CEO of Hurdle Health
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