When the pandemic began, virtual mental health care was the only way providers could safely connect with their patients. Almost three years later, even with the return of in-person office visits, most people still prefer virtual visits regarding their mental health, according to results from a new Zocdoc report.
Mental health is the sole health care field in which patients more commonly book telehealth and online therapy appointments as opposed to in-person appointments, according to the report from Zocdoc, which surveyed around 400 patients and 200 providers and analyzed appointment booking trends from May 2020 through May 2022. In May 2020, 74% of mental health–related bookings were virtual, compared with 85% in May 2021 and 87% in May 2022.
For providers, virtual therapy was crucial during the pandemic. “We had to immediately shift to, ‘Okay, how can we reach everyone that needs us more than ever now and can’t come visit?’” said Kristy Randall, a behavioral therapist at Brightline, recalling how her work shifted during the early days of the pandemic.
Now, mental health experts say, teletherapy is largely here to stay. “[Patients] don’t have to deal with transportation,” Randall says. “They don’t have to leave work. They don’t have to take time off. There are just so many things that make it easier to engage in therapy now.”
About 60% of patients cited quick and easy access to providers as a reason to opt for virtual therapy; 56% highlighted not having to take off work or other responsibilities to travel to appointments; and 31% noted access to providers who were far away. For providers, 57% appreciate the easier access to patients, with 55% citing the flexibility of remote work, and 43% saying they could serve patients in more rural or remote areas.
Still, in-person appointments remain more common for non-mental-health-related concerns, according to the survey. Zocdoc found that the percentage of in-person appointments increased for other health-related specialities from May 2020 to May 2022. Certain medical fields deem in-person visits crucial, whereas mental health can operate differently, says Richard Fine, Zocdoc’s chief commercial officer.
Convenience and comforts of home
Survey respondents cited convenience, the comforts of home, and a perception of increased intimacy as reasons to use telehealth for mental health care. Being able to see where someone lives their day-to-day life and feels comfortable can help give a provider more of an authentic sense of their identity, experts say.
“It humanizes it for both the mental health practitioner and the patient,” says Fine. “It’s a little bit of context on the person to see their house and to see their pets and all the fun things…I think that is helpful in mental health.”
Randall was able to conduct a mindfulness meditation accompanied by her client’s favorite music after seeing a poster of a favorite band in the background. She was also able to manage parent-child dynamics in real time.
“You could see the parent and the young child have the outburst in the room,” Randall says. “There you are with them in their challenges in the moment.”
Reasons for therapy
One in five U.S. adults lives with a mental health condition, but experts think this doesn’t fully reflect the prevalence of mental health conditions exacerbated by the pandemic.
“Whether it be the pandemic or political unrest amongst the world right now…a lot of people are just going, ‘What is going on?’” notes Ryan Culkin, chief counseling officer at Thriveworks, which provides both in-person and virtual mental health counseling. “It’s causing people I think to need an outlet, so they’re not constantly ruminating over it and their thoughts.”
Across all health specialities (from January to May 2022), the most common reasons for booking a Zocdoc appointment were mental health, including relationship struggles, family and marriage therapy, cognitive behavioral therapy (CBT), borderline personality disorder (BPD), couples therapy, and bereavement or grief counseling, the survey showed.
Experts say many mental health challenges surfaced or worsened as a result of the ongoing pandemic, specifically, the grief and loss people have experienced coupled with changes in childcare responsibilities, work life, and finances. This underscores the nation’s mental health crisis and the need for services that are easily accessible and readily available.
Fine also says the demand for mental health services dovetailed with a massive cultural shift in which people are more open to accessing care.
“That [destigmatization] has had a huge effect on people’s willingness to search for mental health services,” Fine says.
The patient vs. provider view
There are differing opinions on the benefits of telehealth for patients and providers. Thirty-one percent of patients surveyed said it was “easier” or “much easier” to build a relationship with their provider remotely versus in person, while only 7% of providers said the same. Thirty-seven percent of providers said it was “more difficult” or “much more difficult” to examine patients remotely versus in person, noting that this data is for all health appointments made and not solely for mental health.
Providers may be missing the chance to be in person with other providers and collectively grow and manage their patients with the help of one another, Culkin says, sharing that he’s observed burnout with some of his clinicians from solely providing virtual visits.
“Maybe you’re burning out because you don’t have that collaboration, that consultation, that sense of belonging that the in-person piece can give,” Culkin says, referring to the clinicians he leads who predominantly work remotely. “You can still have that remote, but it’s just tougher.”
Further, experts highlight that some patients’ conditions may warrant in-person visits to connect and ensure their safety. A lot of this is done on a case-by-case basis.
Overall, the survey found that 77% of patients “agree” or “strongly agree” that they will use “a combination of telehealth and in-person care in the future,” and 83% of providers “agree” or “strongly agree” that “the future of health care will include a combination of telehealth and in-person visits for most patients and providers.”
“Really what it comes down to [is] do you think you can build a relationship in a remote environment and be vulnerable and give back to the counseling process, which is needed to recover?” Culkin says. “We as clinicians are trained to meet the client where they’re at, build the relationship in a way to make them feel safe.”
