Accessing Therapy – Why you might want to Consider Virtual Options

Therapy Referrals are in High Demand 

Looking for a mental health referral? If so, you are not alone. The Mass General Brigham Employee Assistance Program (EAP) is receiving many requests for therapy and is here to help employees and their immediate household family members. It’s a good sign that those who need help are willing to reach out for assistance. Some hospital workers have reported increased stress, depression, and anxiety.

Many people welcome and even prefer virtual visits, and others lean more towards traditional care settings. It is understandable that many want a return to “normal” with things such as in-person therapy visits, but in the current healthcare landscape, these requests are hard to fulfill and not always possible. A 2021 APA Survey indicates that 96% of psychologists continue to provide some services remotely. Finding a therapist before the Pandemic was sometimes challenging, especially for certain populations, such as children. In the last few years, it has become even more difficult.

The discussion below covers the pros and cons of virtual therapy and  provides an explanation of the EAP referral process. Many people also choose to get assistance for mental health issues through their primary care physician. PCPs often have a pulse on providers in their systems or communities.

If you Request a Referral through the EAP, you can Expect the Following:

•  One or more sessions with an EAP counselor to provide an assessment of the problem and to identify options for assistance and/or a referral.
•  The EAP counselor will work within your insurance coverage and preferences (location, time, clinician characteristics) to identify a suitable therapist.
•  Finding therapists for weekday and virtual appointments typically takes up to 3 weeks (or longer in some cases).
•  Please note that requests for evening or weekend appointments and in-person therapy tend to represent longer wait times (sometimes up to one to two months).
•  An in-person referral may be changed to virtual care by a provider due to Pandemic-related factors.
•  The EAP is a free service but referrals outside the EAP typically have costs (some covered by insurance and some not, for example, co-pays).

Before seeking Therapy, Consider what your Needs are related to the Referral

Whether you seek a mental health provider through the EAP or another source, you will want to identify how to best meet your needs. You may not get to “tick every box” if you want a referral more quickly. Like many relationships, the therapeutic one should be a good fit for you. Try to be open-minded and avoid immediate judgment. It may take a few sessions to know if you have a reasonable match. Some factors to consider:

•  Therapist characteristics – specialty, gender
•  Type of intervention needed
•  Visit frequency
•  Office/clinic type – hospital-based, agency, private practice
•  Timing – do you need help immediately, what accommodates your schedule?
•  Setting/Platform – in-person, virtual (video, online program, phone)

Is telemedicine right for you?

The Pandemic triggered a massive increase in virtual visits for all of healthcare, including mental health. An industry that was slow to evolve moved several steps ahead very quickly. A combination of health insurance company flexibility about coverage, and having no other option due to COVID, resulted in a situation where most providers were delivering care virtually.

Is virtual care effective?

In general, evolving research (highlighted below) indicates positive findings for virtual care. As is the case, with all treatment, you and your provider are in the best position to decide what is best for you.

•  Psychological Services – Efficacy of Telepsychology for Anxiety, Depression, PTSD

•  According to the APA, most psychologists agree/strongly agree that telehealth has proven its worth as a therapeutic tool.

•  A study from the State of Michigan showed increased client satisfaction, engagement, and retention and missed appointments with telehealth.

•  Much of the research surrounds iCBT – the online version of cognitive behavioral therapy:

– JAMA Psychiatry – Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety

– BMC Psychiatry – iCBT with Depression in Nurses

– Cureus – The Effectiveness of Internet-Based Cognitive Behavioral Therapy in Treatment of Psychiatric Disorders

The SilverCloud iCBT Program is an option for MGB Employees

For some, online CBT (iCBT) can be helpful and convenient. SilverCloud is a free online, self-directed course CBT course, which includes some added well-being activities, for individuals with low to moderate levels of depression or anxiety. SilverCloud can help clients to manage their symptoms using these modules in:

• Depression
• Anxiety
• Stress
• Insomnia
• Resilience

COVID-19.Employees, IHP students and household members (over the age of 18) can access this program via a mobile device or desktop computer. Referrals can be done via your PCP, the EAP or self-referral.

Pros and Cons of Telehealth (some factors cut both ways)

Pros
•  Convenience
•  Typically requires less time (no travel or parking required)
•  Access – more appointment availability
•  Some evidence indicates no-shows went down with telehealth
•  Cost
– Some insurance providers waive co-pays for virtual visits
•  Privacy
•  COVID safety
•  No mask requirement
•  Less stigma
•  More comfortable for some patient groups (those with autism or social anxiety)

Cons
•  Access –  limitations due to technology or user skill set
•  Privacy (dependent on work/living situation)
•  Small screens may limit perceptions of connection
•  Possible relationship limitations
•  Focus level of participants may be impacted
•  Not appropriate for all populations, such as those with safety risks (suicidality)

Some Other Common Therapy Referral Pathways

•  Insurance providers
– Aetna
– Mass General Brigham Health Plan/Optum 
– Blue Cross Blue Shield
– Cigna
– Harvard Pilgrim
– MassHealth
– Tufts
•  Psychology Today
•  William James Interface Referral Service
•  A variety of new online platforms which are still being vetted
–  Mass General Brigham Health Plan members have free access to Talkspace via Optum

Resources

• EAP Mental Health Resources
• EAP Wellness Resources
• Samaritans – Suicide Prevention
  Helpline: 877-870-4673
• Preventing and Destigmatizing Suicide: A Message from Newton-Wellesley Hospital and Salem Hospital – YouTube
• If you are concerned about a co-worker or friend, don’t hesitate to let them know you care. The “RU OK?” Program has some guidance about how to approach and engage a friend in need.

Help from the EAP
The Mass General Brigham EAP is available to help with concerns about yourself or someone you care about. The EAP provides assessment, consultation and referrals for mental health issues and has Mental Health Resources available on the website. The program offers free and confidential services for Mass General Brigham employees and immediate household family members. EAP records are separate from medical and HR records. Contact the EAP at 866-724-4327 or request an appointment via our online form for confidential assistance.