More than 20 years ago, I helped Uvalde (Texas) Community Hospital establish and operate an outpatient mental health clinic. After the tragic school shooting on May 24, residents of the city are in desperate need of help to deal with the effects of the trauma. People exposed to trauma are at high risk of developing PTSD, panic disorder, and other behavioral health conditions that can seriously affect their lives. Yet the rural community two hours west of San Antonio suffers from the same shortage of mental health professionals that affects rural areas across the country.
Texas is an example of states with large numbers of people living in areas with too few mental health professionals. Over 51% of the state’s population, about 15.5 million people, live in such areas as of 2021. report by USAFacts, based on data from the Health Resources and Services Administration. That’s over 5 million more people in underserved areas than in any other state.
When I helped start Crossroads Behavioral Health Services in 1998 as an outpatient clinic for depressed seniors, not a single psychiatrist lived in Uvalde County, let alone a specialist in geriatric depression. We eventually found a psychiatrist willing to travel from San Antonio to see patients at our clinic once a week.
This was long before telemedicine could be considered a solution to shortages. In those days, Medicare did not reimburse for telemedicine. The cost of equipment and the lack of broadband internet also hinder access. When Medicare changed regulations in 2002, we were able to engage a Spanish-speaking, culturally competent physician to provide services in Uvalde via telemedicine from his Houston office, avoiding wasted hours of scarce professional time traveling each week.
But such virtual consultations can only do so much. The flood of people affected by the pandemic seeking professional help, combined with a national shortage of professionals, has created a huge backlog of care. Across the country, potential patients report having to wait a month or more to see a specialist, a situation that has prompted California, Massachusetts and a number of other states to pass or consider laws requiring health plans to expedite mental health appointments.
The thousands of people in Uvalde and other rural towns whose mental landscapes have been affected by the tragedy are impatient. As a society, it is unfortunate that we only consider serious reforms after such tragedies. But just as the Uvalde shooting spurred Congress and the Biden administration to join hands on bipartisan gun legislation, so too, perhaps, it will spur initiatives that will expand access to mental health treatment, providers, and sustain reforms that have made telemedicine more widely available to so many.
Until then, and until we somehow manage to hire thousands of new mental health professionals to alleviate the national shortage, one solution may be digital therapy. The category is often confused with the growing number of health and wellness-focused apps and online services that are readily available to anyone with a smartphone or computer. But most of these wellness apps don’t have strong evidence that they work and require users to pay themselves. Users are advised to exercise caution before choosing a wellness app to help with depression, eating disorders or a myriad of other advertised serious conditions.
In contrast, digital therapeutics earn the title based on strong supporting evidence and FDA approval confirming their effectiveness. Companies like Propeller, Lark Health, Pear Therapeutics and my Freespira, deliver evidence-based therapeutic interventions and behavioral therapies through technologies that replace or complement existing treatments for health conditions. Every day, more prospective health plans across the country are starting to include coverage for their use.
And unlike telehealth platforms that pair patients with online therapists, digital therapists can scale the mental health professionals who support them to thousands of patients, meaning a shortage of professionals doesn’t limit their use. At a time when tragedies like Uvalde are unfortunately becoming more common, resulting in widespread trauma, Americans deserve as much access to help as we can provide, whether in person, virtually or digitally.
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