The coronavirus pandemic posed a challenge for those living with mental health concerns prior to its onset: at a time of great need for the support they could no longer safely see their CJE Counseling Services social workers in person. Luckily, the Centers for Medicare and Medicaid Services (CMS) and other insurers quickly responded to advocacy from mental health service providers across the country and temporarily approved telehealth services to address this challenge.
WHAT IS TELEHEALTH?
Telehealth is a health service provided through either online video or audio-only phone sessions. CJE Counseling Services (CS) made a quick and successful pivot to telehealth as soon as CJE shifted to remote service in March. While initially providing these services to meet the need without any guarantee of insurance reimbursement, CMS retroactively approved these services on March 6, 2020. Now, more than 90% of CJE’s counseling clients have successfully converted to telehealth. “And, of course,” adds Manager of Counseling Services Rosann Corcoran, “We’re bringing in new clients all the time, because the demand is so great right now.”
Telehealth eliminates obstacles to obtaining mental health services that many older adults face. For those with physical disabilities, CJE social workers using telehealth can be even more accessible than traditional visits, since no commuting or navigating of walkways and parking lots is required. Also, telehealth can be better than in-person sessions for persons with hearing impairments, because they can often turn up the volume on their phone or computer to amplify the therapist’s voice. Th therapists can also wear headsets.
In addition to continuing to serve individuals through one-on-one mental health services, Counseling Services is also offering a growing list of support and therapy groups via telehealth. Support groups include grief support and Linkages groups for older adults with an adult child with a disability. Cognitive Behavioral Therapy groups are available to address depression and anxiety and a new group to address caregiver stress is being developed for the fall.
The monthly education program, Insights on Aging, and a weekly mindfulness group have been moved to a virtual platform as part of an exciting collaboration between Counseling Services and Community Engagement. Most groups are hybrid sessions available on both phone or online video.
MENTAL HEALTH AND THE PANDEMIC
What issues are CJE social workers seeing? “The impact of isolation on an older person’s mental health is the primary concern,” submits Corcoran. “We know that social and physical activities are dramatically intertwined with our mental health, and, when they are eliminated because of isolation, we see increased depression and anxiety.” Not only that, but isolation has pronounced negative effects on both the mind and body, with studies showing that isolation causes an increased decline in both cognitive and physical function. As Corcoran suggests, “Because of the pandemic, older adults can no longer go to the senior center or out to lunch with friends, and many are putting off services like physical therapy and routine health care. This also leads to greater isolation and can lead to physical deconditioning, which can happen quickly with older adults.” While it is possible to exercise at home, those who are already coping with depression may not have the motivation or energy to make sure to walk around the house or climb up and down the steps.
Significant anxiety and fear is caused by realizing that the situation is going to go on for a while. “For older adults, the prospect of being isolated (that some describe as feeling incarcerated or imprisoned in their own home) is hard to endure, particularly if no end is in sight,” explains Corcoran. She says that they can feel that they have no viable options. They can either stay cooped up all alone in their home for the foreseeable future, or they can go out and risk being exposed to a virus that has shown to be particularly dangerous to the elderly. Of course, neither one of these options is good for older adults, and they can begin to feel under siege, which in turn can seriously impact mental health.
In addition to the many remote socialization and exercise programs available, for many telehealth is a pillar in the structure needed to maintain good mental health. And, while Corcoran notes she and her team were initially unsure how telehealth would be received or how well it would work, they have been pleasantly surprised. Against the ageist stereotype, clients have been highly adaptive and resilient and are making the most of these new platforms.
Th is is the easiest way to connect. A phone call is made, and a therapy session (or group) ensues. With a connection made, therapy can proceed in much the same manner as it would in the office or at the client’s home. Ease of use has its drawbacks, though, because parties cannot see each other. When there is a silence on the other end, is that because there is a distraction?
Is this person feeling emotionally disconnected from their therapist or particularly depressed? Corcoran and her team must ask the right questions to assess the person’s well-being and safety.
TELEHEALTH BY VIDEO
Video therapy sessions and groups that are accessed on a computer, tablet, or smartphone via platforms like Zoom or FaceTime are a good method because of the ability to see clients—and for clients to see their therapist. Corcoran indicates that “Clients feel connected, albeit differently, but it can still feel good.” That’s because they can actually see the therapist’s expression on their face. The client sees and reacts to non-verbal cues, like when the therapist “leans in” toward the camera to get closer or as an expression of empathy.
Counseling Services acknowledges that telehealth does not work for everyone. Corcoran is afraid that they are missing people who don’t have access to equipment, can’t get on the internet, or, like some who have access but don’t know how to employ it and are lacking in digital literacy.
“So, there’s a big digital divide that we’re identifying,” says Corcoran. It might occur because someone can’t afford equipment or internet service, and perhaps they can’t afford or don’t otherwise need a caregiver who might be able to assist. They may not have a family to train and support them in accessing telehealth. Other difficulties include the burden therapists take on to help with technical issues, something that can distract from the therapeutic work at times and may not be something the therapist is particularly adept at doing remotely themselves. Also, trying to complete intake paperwork over the phone can be time-consuming and cumbersome.
This is a new platform with a steep learning curve for some, but all in all, the outcomes have been very favorable. While it is uncertain if Medicare and other insurers will continue to pay for telehealth once the pandemic is over if they elect to do so Counseling Services hopes to offer telehealth indefinitely to those for whom it is a better option than home or office visits.
You don’t have to deal with isolation or other issues alone. Talk to someone, either individually or in a group, without leaving your home! To get connected to Counseling Services through telehealth, call us at 773.508.1000 or email us at email@example.com. Plus, watch for information about our mental health community education series, Insights on Aging, through CJE’s Cyber Club at www.cje.net.