As a mental health nurse practitioner who sees patients both in person and via telehealth, I’m often struck by just how many of my patients would not have received any mental health treatment before the covid-19 pandemic: the stay-at-home mother without any child care; the college student on a rural campus, many miles from home or a clinic; the middle-aged man who is finally ready for help — but not ready to be seen by a neighbor in the waiting room.
During the pandemic, access to remote mental health care sprouted up almost overnight. In 2020, Medicare, a federal health insurance program for seniors and people with disabilities, began covering online telemental health, and most state Medicaid programs and private insurers soon followed.
Fewer than 2 percent of people getting mental health treatment received such care online in 2019, but now about half receive at least some of their mental health care this way.
Undoubtedly, this shift has brought many benefits. Online mental health visits literally meet you where you are — whether in the comfort of your home, a parked car or a quiet space on your break at work. Virtual care offers convenience, ease and privacy.
But with so many choices, it can be hard to decide how to start accessing mental health care online. Many patients get stuck trying to find clinicians who can treat their concerns, and fit their schedule and budget. But finding an online clinician who fits your needs doesn’t have to be overwhelming.
Understand your goals
Whether you are seeking care online or in person, it helps to define what’s troubling you and what you would like to change. One approach is to write down the symptoms, such as emotions or behaviors, you are experiencing. For example, many people seek treatment for anxiety or mood changes, especially if these feelings are interfering with their daily lives.
You should be able to find online practices for any type of clinician you would see in person, such as psychologists, psychiatric nurse practitioners or clinical nurse specialists, psychiatrists, social workers or other licensed counselors.
Consider whether you would prefer engaging in talk therapy, such as cognitive behavioral therapy, exploring the use of medication or both. This will help point you to the type of clinician who could best help you.
But don’t worry too much if you’re not sure. Any clinician you see will be able to evaluate your concerns and help direct you to the best treatment plan. For example, a therapist who does not prescribe medication still will be able to let you know whether you should consider medication, and point you to an advanced-practice nurse or psychiatrist who can prescribe it.
Finding a good fit
Clinicians typically list the types of problems they treat and whether they offer therapy, medication or both. They may also have a profile — either through their practice or on a site such as Psychology Today’s provider listing — outlining their background, treatment style, as well as their license and qualifications.
Services such as life coaching are different from therapy but also are often found online. Life coaches are not licensed or regulated in the same way as mental health clinicians. If you are seeking formal mental health treatment, you should ensure you are seeing a licensed clinician.
If you plan to use insurance, confirm that the clinician you chose accepts your specific insurance plan. Before your first appointment, make sure to clarify any policies related to co-pays, missed visits and communication between visits, including what to do if you have an urgent or after-hours concern.
If the clinician doesn’t seem to have clear policies, you may find yourself with surprise bills or a lapse in treatment when you need it most.
Your first online session
Talking to a clinician through a screen about things that are often kept highly private can take a little getting used to. Don’t worry if it takes a few meetings to get comfortable with it.
Ensuring that you have a private and comfortable space for your visit can help. These health appointments should be as secure and private as in-person visits. You and the clinician should both be in quiet and private areas, away from other people.
Your appointment is your time to focus on you — a good mental health clinician will not appear distracted or have a lot of outside interruptions. You should be able to see and hear each other clearly. If they seem disorganized, or you do not feel they understand and are attentive to your concerns, that is a red flag.
The clinician will ask a lot of questions about you, the history of your symptoms and your current concerns. After the first meeting or two, they should share their diagnosis and treatment plan. They should be able to explain how those recommended treatments work, any potential risks and how you both will decide whether things are improving.
As online mental health care has become more available, more people are seeking care. That is a good thing, but it’s important to remember that mental health care should provide a specific treatment for a specific problem. You and the practitioner you work with can’t know whether you have addressed it if you haven’t first defined it.
If you have any concerns, ask questions and don’t be afraid to speak up. Questions about privacy, a clear diagnosis, understanding your treatment options — whatever it is, if the clinician cannot address your concerns, they are probably not a great fit for you.
Future-proof your treatment plan
Regulations for online mental health services have changed a lot in the past several years, and they are still in flux. Many Medicare plans have committed to covering remote mental health care through December 2027, but what happens after that is an open question.
The same pandemic-era regulations that expanded access to telehealth in 2020 also permitted mental health practitioners to prescribe controlled substances — medicines with higher potential for abuse or misuse, including benzodiazepines or stimulants — via online care, without an in-person exam. These rules are set to expire in December, though some states already have additional laws, such as requiring an in-person visit before or during treatment.
If you take controlled substances prescribed by a clinician you see remotely, ask how they will manage potential changes in laws or regulations that affect your access to them. This might involve switching to in-person visits, transitioning to a clinician who can continue prescribing them or changing your treatment plan.
A team-based approach
No matter what kind of mental health treatment you receive, it is essential to work as a team with your primary care team and other clinicians. As a start, inform your primary care and your online mental health care clinicians about everyone who is treating you and their contact information. You may have to sign a release so that they can share information to coordinate your care.
This coordination is important because many mental and physical health conditions have overlapping symptoms. Additionally, if you take any medications to treat mental health conditions, your primary care clinician or other clinicians may be best positioned to manage any possible side effects. You may need certain lab tests or other assessments, such as vital signs or a physical exam, to safely use those medications.
Online mental health treatment can be just as effective as traditional in-person visits. In my experience, communication and teamwork are the keys to making it work.
Shari Harding is a psychiatric-mental health nurse practitioner (PMHNP) and associate professor of nursing at UMass Chan Medical School.
This article was produced in collaboration with the Conversation, a nonprofit news organization.
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