Policies that increase access to telemental health services are key to ensuring mental healthcare is equitable and inclusive.
As a practicing social worker, I believe that mental healthcare is a right, not a privilege. LGBTQ+ and persons of color face numerous barriers to finding affirming mental healthcare and often experience racism and/or discrimination while accessing those services. Through support of the Robert Wood Johnson Foundation’s Health Policy Research program and in collaboration with my research partner Liana Petruzzi, I’m working to help shape a health and mental healthcare system where racism, homophobia, and transphobia are not tolerated or perpetuated.
The COVID-19 pandemic forced us to look at how trauma, stress, and a public health crisis combine to influence our mental health and wellness. This new reality drove the nation to significantly increase its investment in telehealth services. Now in our third year of the pandemic, we must reflect and ask ourselves if that investment is working, and more importantly, if it is equitable. We have a serious opportunity to better meet the needs of Black, Indigenous and People of Color (BIPOC) individuals and communities—needs that must not be ignored.
Barriers in Delivering Mental Healthcare During COVID-19
In March 2020, the Centers for Medicare & Medicaid Services issued temporary waivers for telehealth services to expand access to healthcare during the pandemic. Telehealth services use remote communication technologies, such as FaceTime, Google Hangouts, or Zoom. This made it easier for people enrolled in Medicare, Medicaid, and the Children's Health Insurance Program to receive care through telehealth services while remaining safely at home.
Three weeks after the expansion, the demand was clear. Telehealth services increased by 154 percent, along with a 120 percent increase in tele-behavioral health claims in the spring. But with high demand comes the challenge of accessibility. Recent surveys suggest at least 36 percent of people in America have delayed medical or mental health treatment during the pandemic, and estimates are even higher for BIPOC individuals.
Prior to the pandemic, communities of color were already at increased risk for conditions like depression and anxiety due to structural and interpersonal racism. The pandemic, the police killings of George Floyd, Breonna Taylor, and others, as well as increased Anti-Asian and anti-immigrant hate, have all contributed to a spike in mental health conditions among Black, Asian, Latino and multi-racial adults; this spike continues to serve as reminders that structural racism persists.
We Can and Must Do Better
The mental health system was already stacked against LGBTQ+ and BIPOC communities, and those at the intersection. My clients have talked about the interpersonal racism they’ve experienced from their predominantly White therapists and how hard it was for them to find a Queer therapist of color. These stories are not unique, and for so many others seeking services, waiting months to find someone who is affirming of your identity is the final deterrent to seeking care.
While we should celebrate expanding access to telehealth services, we must be honest that simply expanding services does not address the root problem. In order to meet the need, we should reflect the current mental health infrastructure to find avenues of improvement.
One major improvement would be ensuring that future legislation intentionally ensures telehealth is equitable and accessible. Congress and the current administration should make a significant investment in technology in community health centers, training programs for BIPOC communities, and distribution of technology such as smartphones or tablets within these communities, to ensure that vulnerable communities can access telehealth services.
While some providers have returned to in-person care, the pandemic has created geographic barriers for those who seek telemental health services. COVID-19 forced people to relocate for a variety of reasons such as unemployment, gaps in childcare, or caretaking for elderly relatives, which may require moving across state lines. Mental health licensure reciprocity across state lines is needed to allow mental health providers to treat their patients even if they move. This is critical for BIPOC patients who already face challenges when finding a therapist of color; it will mean they do not have to wait even longer to find a new therapist in their new state and will be able to maintain continuity of care.
In August 2021, the Biden administration announced investments—totaling over $19 million—to be distributed to 36 award recipients through the Health Resources and Services Administration. While this is a significant investment, it will surely not meet the demand that continues as we navigate our third year in the pandemic. We need federal policies to standardize telehealth practices across insurance plans and federal funding to expand broadband internet to poor and rural areas across the country.
To further the reach, we should also look for examples at the local, state, and federal level to see where telemental health services and policies are working, and how they may be replicated. For example, New York announced a wide-ranging telehealth bill in January 2022 that would pave the way for multi-state telehealth programs, support specialist consults, and improve telehealth training. The bill included many components, including eliminating geographical restrictions in Medicaid coverage, creating an open-access continuing professional education telehealth training program, and expanding telehealth services for mental health and substance abuse treatment. New Jersey also signed legislation (S-2559) that extends the requirement that health benefits plans reimburse healthcare providers for telehealth and telemedicine services at the same rate as in-person services. Massachusetts passed legislation to permanently do the same.
Also needed is increased mental health services across healthcare and community settings, such as federally-qualified healthcare centers, schools, or community centers. This is particularly important for communities of color, non-English speaking individuals, low-income individuals and households, people with disabilities, and rural communities that may be more inclined to receive mental health services from a trusted clinic or community center. We must invest in more therapists who are from these communities, who may help patients of color to feel safer sharing mental health needs and racialized trauma experiences.
Expanding telemental health services made the impossible possible. But to truly build a Culture of Health that is equitable for all, we must fight for more equitable and culturally responsive mental health services.
Working Together to Advance Health Equity
As a current RWJF Health Policy Research Scholar, I am inspired and motivated by the work of my cohort members and other cohorts working to advance health equity. They give me hope by working together and remembering that a different reality is not only possible, but probable, if we work in an intentional community.
Daniel Do is a current Health Policy Research Scholar. His hope is to be a part of the change that creates a health and mental health care system where racism, homophobia, and transphobia are not tolerated or perpetuated.