To ensure that students have access to mental health care regardless of location and socioeconomic status, are not stigmatized for seeking mental health treatment, and feel comfortable engaging with mental health professionals, some states are expanding access to telehealth services.
Health officials and professionals in Texas and New York have taken unique and intentional approaches to using this technology to break accessibility barriers to mental health care for students in need.
TEXAS
According to the Texas Department of State Health Services Health Professional Shortage Areas dashboard, 248 of Texas’ 254 counties have been identified as Mental Health Professional Shortage Areas (HPSA), and an additional three counties have a partial HPSA designation.
Obtaining mental health services for children within these areas, especially those without resources, is difficult.
“The wait time for a first-available in-person appointment with a mental health professional may be six months or more, and these services tend to be located in urban areas, which means that some youth and families must travel significant distances for these appointments and take time off from work and school,” Dr. David Lakey, presiding officer of the Texas Child Mental Health Care Consortium (TCMHCC), told Government Technology.
After reviewing stunning youth mental health statistics from a yearly data study — ranking Texas last among the 50 states for youth access to mental health care in 2019 — officials there galvanized resources and collaboration opportunities to bridge the gap by tackling mental health policies at the state level. A key aspect was at the forefront of these efforts was telehealth.
TCMHCC, funded by the state of Texas, was created through Texas Senate Bill 11 to fix the foundational schisms within the youth mental health system in 2019. The consortium is a collaboration between the state’s medical schools, state agencies involved in mental health services and Texas-based, mental health-focused philanthropic organizations.
One of the specific programs the TCMHCC is responsible for is Texas Child Health Access Through Telemedicine (TCHATT), which currently allows access to no-cost mental health care for over 3 million children and almost 600 school districts.
The Texas telehealth initiative has played a significant role in addressing health disparities for youth, as well as their families living in remote or rural areas.
“Our telemedicine services essentially aim to remove historical barriers to accessing care,” Lakey said.
Using a school-based model, students are referred to the TCHATT program by a parent, teacher, counselor or similar party. Once referred, the child will complete an intake and assessment with a TCHATT health-care professional and begin an appropriate short-term, therapeutic mental health intervention. Most visits do not require the involvement of a psychiatrist, but psychiatric support and medication management are available when needed.
“For many students and families without transportation or who live in health-care ‘deserts,’ it can seem physically or financially impossible to take off work to attend to healthcare needs,” Lakey added. “Telemedicine allows more opportunities for individuals to get the care and attention they deserve by meeting the clients where they are — whether it be at home or school. In addition, individuals receiving services can access licensed mental health clinicians with minimal wait times.”
All services are free for children for the approximately 3 million who attend participating public schools, as the state of Texas fully funds the program. TCHATT also works to secure a referral to long-term care for children in need of ongoing mental health services.
As beneficial as telehealth is for lessening health disparities, there are challenges to overcome. One critical hurdle to health-care accessibility is identifying and tracking which areas require telehealth services and how to make students and families aware of the resources available.
“The organization first identifies the need for improved access to children’s mental health services based on data and information, then works to develop partnerships with funders, providers and recipients of services to recommend needs-based services and implement a plan to address challenges,” Lakey said. “We then engage in conversations with families to determine what services they believe are needed and where access to care may be a hindrance.”
To ensure the screening and identification process is equitable, TCHATT uses a variance of data sets to analyze socioeconomic factors and decipher barriers to care for children and families.
“We are currently collecting data on the youth and families served and comparing that data to state information such as zip code, race/ethnicity, age and gender,” Lakey specified. “As we examine the results, we can utilize this information to collaborate with local schools, districts, community and state partners to address issues related to mental health stigma and access to care, as well as provide information that is relevant to the various constituencies in our diverse state.”
To protect student privacy, there is one stipulation for receiving services: informed consent.
“We take parental concerns and barriers to care seriously and are available for any opportunity to provide education and awareness, especially if a family does not have previous experience with mental health care or telemedicine,” Lakey stated.
TCHATT is currently enrolling more schools in its telehealth program, with the goal of eventually reaching every school within the state.
NEW YORK
New York is also leveraging telehealth services to intersect the mental health challenges students face with regard to addiction.
According to the Substance Abuse and Mental Health Services Administration, children growing up with parents struggling with addiction are at a higher risk of experiencing depression and other mental health concerns, which can have lasting effects on their development. When a child is emotionally underdeveloped, they can experience a lack of remorse or empathy, causing them to potentially make detrimental decisions. This can lead to depression, anxiety and other mental illnesses.
As such, the NYS Office of Addiction Services and Supports (OASAS) is using telehealth to get to the core of many students’ mental health issues.
“Telehealth has proven to be an effective way for us to reach people with addiction services, in particular those in underserved communities,” Evan Frost, assistant director of communications and public information at OASAS, told Government Technology.
New York State’s telehealth program for addiction is open to certified OASAS providers and allows them to deliver most services through telemedicine, without the need for an in-person visit. This can include medical assessments, counseling, peer support and initiation of medication for addiction treatment.
“The main benefit of the program is to allow access to addiction services without the need to travel to an in-person location,” said Frost. “This program supports the OASAS mission to reach people wherever they are on the continuum of care and provide individualized services to meet their needs.”
In January of this year, Acting Commissioner of the New York State Departmet of Health James McDonald issued a Commissioner Determination for the use of telemedicine to ensure continued access to life-saving medication for New Yorkers struggling with mental health and opioid use disorder and the department has taken an active role in supporting telehealth services throughout the state.
“Our department has been a staunch supporter of the NY MATTERS and REACH Medical programs that have extensive telehealth-tele-addiction services throughout New York State,” Cadence Acquaviva, public information officer for the New York State Department of Health, told Government Technology.
Acquaviva noted that health officials across the state have witnessed a need regarding telemedicine and are constantly working to fill it.
According to New York City Mayor Eric Adams’ city health department data, rates of youth suicidal ideation jumped to nearly 16 percent from about 12 percent over the past decade, with more than 9 percent of the city’s high school students reporting that they attempted suicide over the course of 2021.
The mayor’s “Care, Community, Action: A Mental Health” plan, unveiled in early March, reinforced the need for telehealth technology to help combat these issues.
“Telehealth can improve access to care for young people and their families who cannot easily get around or meet the strict time or expenses of traveling to in-person appointments, especially when mental health provider locations might be far away from the child’s home,” Mayor Adams stated in the plan. “In addition, many youths feel more comfortable using technology to connect, and technology offers new ways to stay connected outside of traditional therapy sessions.”
Adams is spearheading a comprehensive telehealth program for high schoolers that was announced in January. The city will also launch suicide prevention pilots aimed at youth in crisis as part of the program, which is currently in the planning phase.
