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The future of mental and behavioral healthcare delivery is hybrid and choice is the key

What is clear is that in person and virtual treatment are not oppositional forces to be pitted against one another, but rather two halves of the same coin as both serve an important purpose — getting help to those who need it.

The pandemic upended every aspect of our lives, taking a massive toll on our collective mental and behavioral health. With most of us confined to our homes during the early stages of the pandemic, telehealth demand spiked. Telehealth utilization for office visits and outpatient care reached 78 times its prior levels. With both providers and patients initially slow to show interest in virtual care, what was once unknown territory quickly became the only option available.

Today, as  we continue to inch toward a post-pandemic world,  telehealth is no longer the only viable option for giving and receiving care. One type of treatment delivery certainly doesn’t cater to everyone’s needs. Some patients will thrive in a virtual setting, and some are better suited for in-person care—it’s ultimately up to the patient and their provider to help determine the most effective path forward.

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The most crucial element here is that there’s a choice. A hybrid model allows both patients and providers to choose whether they participate in in-person or virtual sessions (or a combination of both). This isn’t just the future of care delivery; it’s the now.

Hybrid meets the needs of today  

Offering virtual access to mental and behavioral healthcare providers has many benefits. It expands the availability of treatment options for people living in rural areas, for people who have difficulty traveling, those serving as full-time caregivers with no time to leave, and parents who only have an hour to spare—to name a few. It also means patients aren’t bound to the therapists and clinicians within a 10-mile radius of their home but rather their entire state, which helps find someone who truly fits their needs and style.

This expanded access is essential for providers, too. The demand for therapy today far exceeds the number of providers who have the capacity to provide care; the American Psychological Association reported that many psychologists are working at or beyond capacity, with 41% reporting that they’re unable to meet the demand for treatment, an 11% increase from the year prior.

When the pandemic started, in-person treatment was considered the gold standard. Today however, the advantages of virtual treatment can often outweigh the benefits of in-person treatment, simply based on availability alone. Prior to the pandemic, for many parts of the country mental health treatment options were incredibly limited, resulting in delayed or sporadic care for those with untreated illness. For these people, the limitations inherent with in-person treatment were greatly eased by accessibility to virtual treatment.

What is clear is that in person and virtual treatment are not oppositional forces to be pitted against one another, but rather two halves of the same coin as both serve an important purpose—getting help to those who need it.

Hybrid serves every stakeholder 

Various stakeholders within the healthcare ecosystem, including providers, patients, and payers, all stand to benefit from a hybrid model. Here are just a few scenarios that showcase why hybrid is the future:

  • Providers

For providers, both in person and virtual have advantages and drawbacks.

Some providers thrive on in-person settings. There are important nuances that providers can pick up on during in-person interactions that are incredibly valuable to the patient journey. It can also feel refreshing and less draining to connect face-to-face, away from screens. The dialogue often flows freely, creating a stronger sense of comfort, so often vital to making progress.Therapists can feed off a patient’s energy and assess physiological aspects that might otherwise be missed in a virtual setting, such as small shifts in their body language or facial expressions.

That said, virtual treatments provide similar opportunities as those noted above, but can give therapists a window into their patients’ environment, which also provides valuable information for the treatment. Seeing their interactions with their pets and their level of relaxation and comfort, can provide insight and indications of how the patient is doing overall.

Providers, like others contemplating a return to the office following a 2-year gap, may be weighing the opportunity—cost of both virtual and in-person work. At an office or in person clinical setting providers will naturally have more frequent and unscheduled opportunities to engage with colleagues and peers, creating a greater sense of community and peer-to-peer support. Providers can more easily connect between sessions, check-in with their supervisors about specific questions in real-time, and gather advice on navigating complicated topics.

It is well known that psychiatrists have been experiencing burnout and depression at a substantial rate in recent years due to the demands caused by the pandemic. The opportunity to work in person with patients and colleagues alike may help ease their mental and emotional load in part or whole, thereby reducing or preventing burnout.

On the flip side, going into the office may mean a return to commuting, dressing more formally than they have been over the last two years, and having less time buffers in their schedule. Being away from their homes and families and attempting to balance responsibilities on those fronts can also create increased stress for providers, especially now when most of them are working more hours than they ever have before.

When weighing the options for in person and virtual work, providers will have to give consideration to their own needs and concerns in addition to that of their clients.

  • Patients

About four in 10 adults in the U.S. reported anxiety or depressive disorder symptoms during the pandemic, which is up from one in 10 in 2019. The need for mental and behavioral healthcare is obvious, but the best type of care can depend on the patient’s needs and concerns.

For example, lack of privacy at home or in confined spaces can impact how openly patients talk with their providers during a virtual visit. If someone doesn’t have a private, comfortable space in their home, they might try to go outside or sit in their car instead, potentially leading to a poor internet connection that distracts from the session. Some patients also might have difficulty navigating the technology platform or app required to do a virtual session, and it can not only eat up time but serve as a distraction—or worse, another stressor.

While clients of all ages can experience distraction from messages, emails or other goings-on in their environment during virtual sessions, children and adolescents experience the greatest difficulty maintaining focus with the often-challenging work taking place in therapy. Virtual therapists compete with video games, texting friends, or well-meaning parents coming into the session.  By contrast working in-person, children and adolescents often look forward to the safe and supportive space that is literally created when both therapist and the child are fully concentrated on each other during the session.

But telehealth has its place as well—there’s a generational aspect that should be accounted for with virtual care. Younger, tech-native generations often prefer texting or emailing over speaking on the phone or talking to someone live. According to the American Hospital Association, Gen Z and millennials are now somewhat resistant to in-person care, with 44% saying they might switch providers if telehealth visits aren’t offered. Virtual care also works well for people who are relatively high functioning and find comfort in easy access to their provider via direct message exchanges or quick calls only during times of stress.

  • Payers

Payers simply want to see that their members are as healthy as possible. Healthy people help to lower the overall cost of healthcare, so patients getting healthier both mentally and physically is a win for everyone. That’s why payers are incentivized to support whatever type of care is best for their members, whether in-person or virtual delivery, to achieve improved clinical outcomes.

Both, and

This isn’t an “either/or” situation—it’s about enabling a “both/and” future. Strong, quality therapeutic relationships can be formed both virtually and in person. Though each format has it’s wins and drawbacks, the aim shouldn’t be to replace one with the other, but to identify which works best for the person seeking help. For mental and behavioral healthcare delivery, it’s clear that we need both options available in hope that together they may help address the many challenges facing our communities and our healthcare ecosystem.

Photo: metamorworks, Getty Images

Christine Carville is Co-founder and Chief Clinical Officer of Resilience Lab, practicing psychotherapist and behavioral care innovator. After a decade in entrepreneurship, which included health & wellness publishing, she returned to school to train as a clinical social worker to help people address the root causes of their suffering and pain patterns. It was personal family issues of addiction and mental illness and a 12 year journey working in the New York City public healthcare system that steeped Carville in the problems in U.S. behavioral care delivery.

Dr. Anica Camela Mulzac is executive clinical director and Institute director, Resilience Lab. Dr. Anica leads the clinical director/supervisor team at Resilience Lab and spearheads the development of the Resilience Lab Institute for professional staff. A licensed clinical psychologist and entrepreneur, Dr. Anica combines a keen eye for detail and production with years of experience and expertise in clinical, group, and curricula development to foster high quality supervision and robust training for all.

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