I helped Uvalde (Texas) Community Hospital build and run a mental health clinic more than 20 years ago. In the wake of the tragic school shooting on May 24, the town’s residents desperately need help coping with the aftermath of trauma. People who have experienced trauma are at high risk for post-traumatic stress disorder, panic disorder, and other behavioral health conditions that can seriously affect their lives. However, rural communities two hours west of San Antonio also face a shortage of mental health professionals that affects rural areas across the country.
Texas is typical of states with large populations living in areas with too few mental health professionals.According to a 2021 report, more than 51% of the state’s population (about 15.5 million people) live in these areas Report From USAFacts, based on data from the Health Resources and Services Administration. There are 5 million more people in underserved areas than any other state.
When I helped create Crossroads Behavioral Health Services in 1998 as an outpatient clinic for depressed seniors, Uwald County didn’t have a single psychiatrist, let alone one who specialized in geriatric depression. We ended up finding a psychiatrist who was willing to travel from San Antonio to our clinic once a week to meet with patients.
It was a long time ago long before telemedicine was considered a solution to a shortage. In those days, Medicare did not reimburse telehealth. Equipment costs and lack of broadband internet also affect access. When Medicare changed regulations in 2002, we were able to hire a Spanish-speaking, culturally competent doctor to provide services in Uvalde via telemedicine from our Houston office, thereby avoiding wasting valuable weekly professional time travel.
But such virtual consultations can only do so much. The influx of pandemic-affected people seeking professional help, combined with a nationwide shortage of professionals, has created a massive backlog of care. Across the country, potential patients report having to wait a month or more to see a professional, a situation that has prompted California, Massachusetts and some other states to pass or consider requiring health plans to speed up mental health appointments. law.
The spiritual landscapes of thousands in Uwald and other rural cities are affected by the tragedy and they can’t wait. As a society, unfortunately, we only consider serious reforms after such tragedies have occurred. But just as the Uwald shooting prompted Congress and the Biden administration to join in passing bipartisan gun legislation, perhaps it will also prompt initiatives to expand access to mental health treatment, available to providers, and sustain the efforts to make telehealth a reality. Reform is more widely available to so many people.
Until then, until we manage to recruit thousands of new mental health professionals to alleviate the national shortage, one solution may be digital therapy. This category is often confused with the growing number of apps and online services that address health and wellness issues that are easily accessible to anyone with a smartphone or computer. But most of these health apps lack strong evidence that they work, and they require users to pay for themselves. Consumers are advised to exercise caution before choosing a health app that helps treat depression, eating disorders or countless other advertised serious illnesses.
In contrast, digital therapeutics have earned their designation based on strong supporting evidence and FDA approval to verify their effectiveness. Companies like Propeller, Lark Health, Pear Therapeutics, and my own Freespira, Provide evidence-based therapeutic interventions and behavioral therapies through techniques that replace or complement existing treatments for health conditions. Every day, more forward-looking health plans across the country begin to cover its use.
Unlike telehealth platforms that pair patients with online therapists, digital therapy can expand the mental health professionals who support them to thousands of patients, meaning a shortage of professionals won’t limit their use. Sadly, as tragedies like Uwald’s are increasingly common and cause widespread trauma, Americans deserve as much help as we can, whether in-person, virtual or digital.
Photo: Vacharapong, Getty Images
