Estimated read time: 5 minutes

The rapid spread of COVID-19 led many medical providers and health centers to quickly switch over from in-person to virtual care using a variety of platforms. Social distancing measures and quarantine orders prompted the resurgence of telemedicine, a method embraced to different degrees across North and South America. This alternative has also gained popularity among mental health professionals, many of whom are able to offer care from a distance.

A study measuring the growth of telemedicine in the United States found that virtual visits for mental health and substance abuse disorders increased dramatically during the pandemic. Previously, fewer than 1% of visits were conducted virtually. In contrast, by early October 2020, a whopping 41% took place via telemedicine.

Dialogue at a Distance

As with all forms of care, telemedicine has its proponents and its critics. The former believe that telemedicine is an invaluable option, especially for psychotherapy (also known as talk therapy), which depends largely on dialogue and exchange, and not on a physical examination.

The American Psychiatric Association lists its many benefits as follows:

1. Brings care to the patient’s location, where they may feel more comfortable having deep conversations and discussing personal topics.
2. Helps integrate behavioral health care and primary care (doctors are known to interact more frequently when they share a platform)
3. Reduces delays in care, since there is usually more appointment availability for online sessions
4. Improves continuity of care and follow-up (studies show patients adhere to treatment)
5. Reduces potential barriers to care, such as lack of transportation or the need for time off work, childcare services, etc. in order to attend sessions in person
6. Reduces the barrier of stigma (many people don’t like spending time in waiting rooms for therapy sessions or help with substance abuse issues, or even for others to know that they receive such services.)

While there are health conditions that don’t require being physically close to a doctor or medical provider for effective diagnosis and treatment, some experts consider that in the case of mental health disorders, a lack of proximity is a major drawback of remote care. Those who criticize the use of telemedicine in therapy tend to cite the following issues:

• It could sacrifice some aspects of the doctor-patient relationship in psychological or psychiatric therapy, since a patient’s facial cues and body language are important parts of each session and mental health professionals analyze these factors along with what they are saying.

• A weak Internet connection can make the screen freeze or pixelate, or it can cause the call to drop altogether. These technical difficulties make it harder to understand the patient’s narrative and may even require them to repeat themselves.
• It may be impossible to replicate the calm environment of a therapist’s office, if the patient does not have a dedicated space in their home where they can have a virtual session. The problem is compounded for older adults, minors, and patients with disabilities.
• Telemedicine cannot help individuals in the midst of experiencing a crisis during a therapy session, who may need different services or services that must be delivered in person.

To this, critics add some people’s difficulties using Zoom or other videoconferencing platforms, which can disrupt interactions during a remote session, with therapists seeing only their patient’s foreheads or the tops of their heads. Some experts suggest explaining the platform to their patients or even offering a mini training, so that their virtual exchange replicates an in-person environment as closely as possible and their therapeutic goals can be met.

Who Has Access to Online Care?

The use of telemedicine for general medical care, and for mental health care in particular, may have its pros and cons, but according to experts, its success may depend on one key factor: Internet access. The Internet is a fundamental component of modern life, and its importance has never been more evident than during the COVID-19 pandemic, when online connectivity proved essential for remote work, education, telehealth, and staying in touch with family and friends.

In the early months of 2020, when the pandemic began its onslaught in America, 32% of the Latin American and Caribbean population (244 million people) did not have Internet access. Connectivity is strongest in urban areas, where 71% of the population have Internet access options, but rural and remote communities often have no connectivity at all.

Digital access -- an individual’s ability to use tools and technologies such as computers, smartphones, and an Internet connection -- is also far from perfect in the United States, where the digital divide disproportionately affects Hispanic and immigrant communities. Language barriers are another obstacle to accessing virtual care through telemedicine.

The World Health Organization (WHO)’s definition of telemedicine sums up many of these challenges: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”

In the US, the use of telemedicine for mental health care as a result of the COVID-19 pandemic gained legislative support at the federal and state levels, expanding the practice in regions where it was previously limited.

Aside from increasing access to connectivity so that telemedicine can be a viable option for the greatest number of people, experts continue to debate several questions related to remote care. These include whether mental health professionals are properly trained and prepared to offer therapy from a distance and deal with its specific challenges, as well as issues related to patient confidentiality and safety in the virtual sphere.

Joint efforts by governments and public health systems are desperately needed in Latin America and the Caribbean, where mental health services and facilities are sorely lacking. Depression continues to be the leading mental health disorder in these regions. Severe depression affects 12.5% of the population, closely followed by alcohol abuse or addiction at 11.7%.

But mental health services, trained professionals, and other resources remain scarce. In 2019, the total health budget for psychiatric hospitals in Mexico, Central América, and the Caribbean was only 0.9%, and 2.1% for South America, according to the Pan American Health Organization. Supporting efforts to advance telemedicine services could pave the way for bridging the gap in access to mental health care in the region.

Remote therapy can be a powerful tool for treating mental health, especially at a time of increased stress and isolation. People should not be afraid of trying out this new and promising alternative to in-person care.