Virtual Mental Health Care Presents Opportunities—and Potential Risks

A sharp rise in the availability of telehealth benefits has opened up new opportunities for mental and behavioral health counseling, as well as challenges for health care providers, employers and employees.

Addressing a 'Mental Health Crisis'

"The COVID-19 pandemic has created an unprecedented mental health crisis" with increased cases of depression, substance use disorders and suicide, said Dennis Urbaniak, executive vice president of digital therapeutics at global pharmaceutical company Orexo. "The ability to receive care regardless of a person's geographic location or proximity is obviously appealing, particularly when it comes to mental health care, which unfortunately continues to be surrounded by stigma, especially in the workplace," he pointed out.

Employees in areas without access to, or sufficient choice among, individual therapists—or enough local demand for certain types of group therapy—can still get the support and resources they need by connecting with others, who could be located literally around the globe, Urbaniak noted. So it's no surprise that virtual mental health care options have been on the rise.

At Voya Financial, chief HR officer Kevin Silva said that while telehealth options for acute physical care were already available to employees pre-pandemic, these options have been expanded to include primary care and mental health care. "Telehealth visits spiked for Voya in 2020 and have yet to return to pre-pandemic levels," Silva shared. "Many employees prefer the convenience of telehealth [for physical and behavioral health visits], and it's beneficial to employers because appointments are quicker with less impact to productivity."

Virtual care is also being further automated through artificial intelligence, so that sometimes the "doctor" an employee may be interacting with isn't a doctor at all. Wysa, an AI- and human-driven digital mental health app, provides counseling and support delivered by both credentialed mental health counselors and an AI chatbot available to employees and other users 24/7, for example. The AI chatbot uses AI-CBT (cognitive behavioral therapy) to help people through their challenges and adapts to their unique situations based on their responses.

Zoom for Group Therapy

Many employees continue to feel isolated and anxious as remote and hybrid work continue. The opportunity to get together virtually to share concerns or participate in group treatment options can help.

Zoom, the popular app for holding online business meetings, is now being used by some mental health services providers as a virtual venue for behavioral group therapy or disease management support. For example, BrightView, an addiction services treatment provider in Cincinnati, facilitates virtual group therapy via Zoom to "help provide a safe environment [for patients] to heal emotionally, connect to others who understand your background, express your ideas, reflect on your experiences and engage in support," according to the organization's website.

Writing in Psychology Today, psychotherapist Sean Grover described how during the pandemic he began using Zoom for therapy groups he had formerly held in his New York City office. "I didn't have high hopes," he wrote. "I decided not to charge for the first Zoom sessions because I was confident that online therapy groups would be a snoozefest. … I was wrong. From the first session, I could see that group members [were] starved for contact. They were thrilled to see each other."

Zoom groups provide more flexibility for busy patients, Grover noted. Due to schedule conflicts, illness, child care and other priorities, group members often "would have to miss the session or even drop out of group. Now they call in from home, the office or other locations."

As the pandemic wanes, Grover continues to offer Zoom sessions for individual and group therapy, as do other therapists, although some have raised concerns over hacking risks (see the discussion of privacy issues later in this article).

Effective Care

The early evidence suggests that virtual care for mental and behavioral health issues is effective. Virtual care provider Teladoc's 2021 Mental Health Survey of 2,253 U.S. adults found that:

• Mental health support seekers give nearly identical high ratings to their virtual and in-person mental health care experience.
  

• 92 percent of virtual mental health support seekers report at least some improvement during the pandemic, with over one-third reporting a "breakthrough."
  

• 75 percent of those with anxiety reported improvement after the fourth visit, and 76 percent of those with depression reported improvement after the third visit.

Despite the promise of this technology to serve a wide range of needs while improving access and even reducing costs, there are some caveats to be aware of. For instance, the Teladoc survey showed that:

• Almost 70 percent of respondents believe it is too difficult and overwhelming to use multiple websites, mobile apps and virtual care platforms to address their mental health.
  

• 78 percent said they preferred a single, unified experience for mental and physical health virtual care.

Privacy Issues

Using Zoom for group therapy could pose privacy risks, said Inga Shugalo, a health care industry analyst at itransition, a Denver-based software development company.

"It's better to hold such meetings in a specific telemedicine tool, since health tech vendors typically take extra steps to ensure end-to-end security of their customers' health data in such apps," she advised.

Concerns over data privacy were also raised by Dr. Mark Kestner, chief innovation officer with MediGuru, a telehealth services provider.

"The data generated by the virtual visit must be compliant with privacy standards and integrated into the clinical plan to measure the quality and outcome of care," he said. 

In addition, Kestner noted, "while the thought of 'care anywhere' is intriguing, there are limitations on the clinical force, such as state licensure and credentialing for the service."

Employers need to practice due diligence as well.

For both mental and physical telehealth care, "just as we do with regular in-network providers, we need to continue to monitor quality and cost for telehealth services, holding health plans to the same standards that they have for in-person visits and in-person providers," Silva said.

Lin Grensing-Pophal, SHRM-SCP, is a Wisconsin-based business journalist with HR consulting experience.

Related SHRM Articles:

Navigating the Next Generation of Telehealth, SHRM Online, February 2022

Employers Identify Workforce Mental Health Priorities for 2022, SHRM Online, January 2022

Mental Health Apps Offer New Ways to Support Employees, SHRM Online, May 2020