The trouble with New York using teletherapy to help teens with mental health issues: Shots

Teenage mental health has suffered in recent years, fueled in part by pandemic-related disruptions. New York City is working to expand mental health support to all high school students via telehealth.

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Pollyana Ventura/Getty Images

Teenage mental health has suffered in recent years, fueled in part by pandemic-related disruptions. New York City is working to expand mental health support to all high school students via telehealth.

Pollyana Ventura/Getty Images

The COVID pandemic has taken a toll on the mental health of virtually everyone, but the past few years have been particularly difficult for teenagers. Social distancing and distance learning have led to higher rates of anxiety and suicidal ideation among young people. Often the only way for them to access mental health care was through a Zoom chat or a phone call.

Two years ago, I wrote about my own struggles with remote learning after the high school I attended on Manhattan’s Upper East Side halted in-person learning during the pandemic. So I had mixed feelings in January when New York City Mayor Eric Adams announced a plan to establish what he said was “the largest student mental health program in the country.” . All New York City high school students would have access to mental health support through telehealth programs, Adams said.

On the one hand, I think that the expansion of telehealth and the access of more young people to therapeutic spaces is a net benefit. Even though many health care providers have reopened their doors to in-person visits, it seems clear that telehealth will remain a staple of mental health care for some time to come.

Adams’ new budget allocates $9 million for a telehealth program exclusively for New York City school-aged teenagers, plus additional funds to expand telehealth service to residents with serious mental illnesses and to children in family shelters. I am encouraged that the city views mental health as an essential service.

But I’m also concerned that the city is rushing to develop telemental health without clear evidence that it will actually meet the needs of the city’s young people — and without a clear plan to implement it equitably. When Adams Commissioner for the Department of Health and Mental Hygiene, Ashwin Vasan, was asked at a press conference in March if there was any evidence supporting the therapy’s effectiveness via telehealth, he replied, “There is no in-depth evidence base, except that we know that children are engaging online more than ever and want to receive care in this way. »

In a paper released that month outlining the plan, the Adams administration wrote that “the evidence for many telehealth approaches is still evolving.”

It seems to me that the Adams administration is trying to answer the question of what young people need before asking them what they want. It is certainly true that young people interact with each other online, but that does not necessarily mean that we also want or need to go to therapy there.

In fact, some experts worry that therapy delivered exclusively through video telehealth may exacerbate “zoom fatigue,” which, ironically, can worsen the very depressive symptoms the therapy is meant to treat.

Additionally, home and school environments are not always ideal places to seek therapy; they may even be triggers for the stress and anxiety that caused a person to seek care in the first place. According to the National Institute of Mental Health, fear of being heard by others is a potential downside of using telehealth therapy services. Many teens simply don’t have the privacy they need at home.

The Adams administration is committed to centering equity in its mental health agenda. But it’s not hard to imagine how massive investment in telemental health could leave many New Yorkers on the hook. According to the New York City Council, between 11% and 13% of public school students in the city “did not have adequate Internet access at home during remote learning.”

In some districts, more than 40% of households lacked broadband service.

I fear that a program to expand telehealth services for adolescents will be for naught if it does not first address these and other barriers to accessing care. And while the Adams administration has acknowledged some obstacles, the strategies for overcoming them remain vague.

It’s particularly discouraging that Adams proposed cutting $36.2 million from New York City public libraries, which would have reduced opening hours at branches that many New Yorkers depend on for internet access. and private spaces. (That funding was reportedly reinstated as part of a last-minute deal with the city council.)

Telemedicine, in general, is potentially an important tool for making health care more widely accessible to young people. There is some evidence to suggest that such care may even provide greater patient satisfaction than in-person care. But sadly, the Adams administration has provided few details to reassure the public that its telemental health plan will adequately meet residents’ needs.

For example, it remains unclear who will be eligible for the program, and how and where they will receive care. (Since the initial January announcement, the administration has begun using the term “high school-aged teens” — rather than “high schoolers” — to describe the program’s target participants, suggesting that teens aren’t don’t need to be enrolled in school to be eligible. .)

And it’s unclear what steps the city will take to ensure telemental health providers aren’t overwhelmed by a surge in demand, putting unsustainable pressure on practitioners.

Hopefully, firm answers to these and other questions will emerge soon, now that Adams and the New York City Council have finalized the budget and program implementation begins. For the sake of the hundreds of thousands of teenagers who call New York home — and their families — I hope the administration gets it right.

Rainier Harris is a student at Columbia University. He does health reporting for his school newspaper, the Columbia Daily Spectator.

This article was originally published on In darkness. Read it original article.