“Can you hear me?”, is coming to be the anthem of 2020. It’s been almost a year since this COVID-19 pandemic started and everyone has had to change in order to survive. Collectively, we strained to bear the weight of this pandemic. This meant that many had to be isolated at home for months on end and access to care was more limited than ever before. To address this gap, Employee Assistance Programmes have started using telehealth to ensure reasonable access to care. And as the evidence suggests - no one is looking back.
The Telehealth Boom
Telehealth refers to provision of health-related services using telecommunication. This includes video conferencing, remote monitoring, e-mail, text messaging, remote data capture, and even surgical training.1 Various modifications to the term have been used to signal the provision of specific services such as teletherapy, telemedicine, telepsych amongst others.2 Despite being used since the 1960s, cost and access to telecommunication services were huge inhibitors to adoption. Now, with technological advancements and the current pandemic, telehealth has gained traction and disrupted the healthcare industry.3
Teletherapy or telepsych, the provision of mental health services remotely, deserves particular attention during the pandemic. The mental health impacts of pandemics, and COVID-19 in particular, are striking. Increases in psychological distress as well as symptoms of anxiety, depression and trauma are good examples of this. In tandem with this demand, teletherapy adoption has surged. The American Psychiatric Association (APA) recently surveyed its members on their use of telepsych and found that 63.3% of respondents had not used teletherapy to see any patients prior to the pandemic. However, two months into the pandemic, 84.7% of APA members saw three quarters of their patients using telepsych. APA members are not alone.4 In a global study of 130 countries, 70% of those surveyed indicated that they have used telemedicine/teletherapy to replace in-person consultations.5 Taken together, it appears that teletherapy will be a force to be reckoned with in the coming years.6
Understandably, the hype generated for teletherapy did not go unquestioned. At the most intuitive level, people have voiced concerns about ethical considerations such as regulating provider credentials, client confidentiality, and standardised guidelines.7 In this manner, teletherapy follows the same pattern as many other industries when they are initially digitised - the enthusiasm for industry-disrupting digital platforms outrun regulatory provisions in initial years. Relevant as they may be, these concerns can be addressed within the near future. Further, a look into the driving factors for teletherapy suggests that the demand for such services is likely to continue being high and thus will encourage regulatory bodies to take action sooner rather than later.
Comparison to traditional therapy
Treatment efficacy is an important driving factor for teletherapy. Some have voiced concerns that treatment efficacy might decrease as going online limits the number of social cues available to both therapist and client. Afterall, studies have shown that therapeutic alliance and positive treatment outcomes are correlated. This is particularly important as the perception of support from therapists8,9 and the development of a personal bond10 are key building blocks of a good therapeutic alliance.
However, research suggests that these cautions on therapeutic effectiveness might be unfounded. Meta-analyses, exploring treatment outcomes for teletherapy, indicate that teletherapy was not found to be less effective than face-to-face treatment for common disorders like depression.11,12 In fact, some studies have found that teletherapy can be as effective as conventional treatment for more complex disorders as well (e.g., eating disorders).13
Telehealth support for employee wellbeing
Perhaps the most potent driving factor for teletherapy in workplaces is its ability to increase access to care. It is an affordable option that eliminates the trouble of transport, making it accessible to remote workers and vulnerable populations (e.g., those with physical disabilities that make travel difficult or serious health problems).
Cost is also a huge factor in the rise of teletherapy in organisations. In countries like the United States, teletherapy can cost less than $100/session which is up to a third less than traditional therapy.15 Reports have shown that telehealth uptake has surged during the recent pandemic14 and thus suggests that it is a worthy option regardless of scale.
Pragmatics aside, the comfort of seeking help from the security of our homes is an important psychological driving factor for teletherapy. Mental health is an area that is rife with treatment gaps and underreporting16, due to stigma and lacking psychoeducation amongst the public. During this period of uncertainty, ensuring adequate employee wellbeing care has become more important than ever.
For years, teletherapy remained unheard of to the wider public. This happened due to a confluence of factors ranging from cost, ignorance, to doubts about its efficacy. But times have changed. Technological advancements have made the provision of teletherapy accessible and affordable. Research collated further suggests promising treatment efficacies, that are comparable with conventional treatment methods. While ethical issues have yet to be resolved, the mandate conferred by the surge in demand for teletherapy is likely to propel prompt action from regulatory bodies. The interaction of these factors are likely to account for the surge in teletherapy demand and chatter globally. And in response to that, the world is saying: Yes, we hear you.