Virtual mental health care visits: Making them work for you
Before the pandemic, talking to a therapist or psychiatrist on a video call was novel. Now it’s fairly common. One recent analysis, for example, found that video appointments within the massive Veterans Affairs Health Care System jumped from about 2% of all mental health care encounters in January 2019 to 35% of these encounters in August 2023.
What are some advantages and disadvantages of virtual mental health care visits? Does seeing a therapist or psychiatrist by video instead of in person affect your response to treatment? If you haven’t yet used virtual mental health counseling, what do you need to know? Below, Stephanie Collier, MD, MPH, a psychiatrist at Harvard-affiliated McLean Hospital, shares her expertise and insights.
What are some advantages of virtual mental health visits?
Virtual visits are convenient for many people, including those who might have trouble getting to an office or who live in areas where it’s not easy to find mental health care providers.
“You can chat with your mental health care clinician in the setting of your choice, which might make you feel more comfortable,” says Dr. Collier. “You don’t have to worry about getting to and from an appointment. And you can be confident that your outcome will be similar to receiving in-person treatment. For example, in a 2022 study of about 1,500 people, participants being treated for anxiety or depression reported the same level of symptom improvement on standardized scales, whether they received virtual or in-person treatment.”
How do virtual visits work?
A virtual visit with a mental health care clinician works in much the same way as a virtual visit with your doctor.
You make an appointment to speak with an expert, typically a licensed therapist, psychologist, or psychiatrist. They may be in a private practice or work with your insurance plan or a hospital system. Or they might be affiliated with an online mental health care platform. Often, you can read a bit about their professional background, expertise, and other information to help you decide if they are a good fit for your needs.
Shortly before your appointment, you’ll log on to a specified video platform, and then find yourself in a virtual waiting room. When it’s time for your session, the expert will appear on the screen and conduct a 30- to 50-minute session, depending on what you’ve agreed on, just as they would during an office visit.
Will your insurance pay for virtual visits?
Not necessarily. Make sure your sessions will be covered. Medicare and Medicaid cover virtual mental health care visits, but not all private insurers cover the service. Even if you think you’re covered, double-check in advance.
What should you check on ahead of time?
Getting ready for a virtual visit involves prepping for both a mental health appointment and a video meeting.
- Go over the instructions. The mental health care clinician should give you instructions for accessing the platform where the virtual visit will take place. If you don’t have instructions, contact the clinician’s office or the online service to get them.
- Look for compliance. The platform your clinician specifies for your session should clearly state if it’s HIPAA-compliant, ensuring the privacy and security of your information. If you don’t see any evidence of HIPAA compliance, ask your clinician about it or consider choosing another mental health provider.
- Do an equipment inventory. You’ll need a smartphone, tablet, desktop computer, or laptop to take part in a virtual mental health care visit.The device needs a camera, a microphone, and an internet connection.You’ll also need a quiet space (so you and the expert can hear each other) and decent lighting (so the expert will be able to see you).
- Do a practice run. Well before your appointment, log on to the platform your clinician has specified. Check to see if you need to upgrade your software in order to use the platform. You don’t want any surprises just before appointment time. Try out the volume and your camera angle.
How can you help make video sessions work well for you?
When you have an in-person visit, it may be easier to see body language and express yourself. But many people –– especially younger people –– feel very comfortable online. And others might find the technology and apps easier to navigate with a little guidance.
Here are some tips to ensure that you’re seen and heard.
- Set a reminder to charge your equipment. The device you use should be well charged or plugged in to an electrical outlet for the appointment.
- Gather some supplies. You might want to have a drink of water, a box of tissues, and a pad and pen handy for taking notes.
- Make a list of questions or topics on your mind. “Think of a few topics you want to discuss in advance, so you can get through them during your session,” Dr. Collier says. “If you keep a journal or sleep log, and the information will be important, have it with you at appointment time.”
- Be willing to share your thoughts and emotions. You won’t have to carry the whole conversation. Your therapist will ask you questions and prompts to guide the session and help you open up about your feelings and experiences. For instance, they might ask, “How has your mood been since our last session?” or “What are some challenges you faced this week?”
- If you like, ask a friend to join you. If you’ll feel more comfortable with a friend in the room to support you or help you with the technology, arrange it in advance. During your appointment, tell the expert that someone else is there with you.
- Be patient. Sometimes experts run late. That means you might be stuck in an online waiting room, wondering if the appointment is still on. Dr. Collier advises waiting for about 10 minutes, and then leaving a voice message (if possible) or an email for your expert, explaining the situation.
Should you make another appointment?
If you feel your appointment was productive, consider scheduling another one. Again, make sure your insurance will cover it.
What if you didn’t “click” with the expert? “It’s an important consideration, since your relationship with your therapist is the best predictor of how you’ll do in therapy. So give it a few sessions. If you still don’t think your therapist is a good fit, it’s ok to change clinicians. Many telehealth platforms allow you to do that pretty easily.”
About the Author
Heidi Godman, Executive Editor, Harvard Health Letter
Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing
Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD
New urine test may help some men with elevated PSA avoid biopsy
When a prostate-specific antigen (PSA) blood test produces an abnormal result, the next step is usually a prostate biopsy. A biopsy can confirm or rule out a cancer diagnosis, but it also has certain drawbacks. Prostate biopsies are invasive procedures with potential side effects, and they often detect low-grade, slow-growing tumors that may not need immediate treatment — or any treatment at all.
Researchers are exploring various strategies for avoiding unnecessary biopsies. Specialized magnetic resonance imaging (MRI) scans, for instance, can be useful for predicting if a man’s tumor is likely to spread. A blood test called the Prostate Health Index (PHI) measures various forms of PSA, and can help doctors determine if a biopsy is needed.
In April, researchers at the University of Michigan published results with a test that screens for prostate cancer in urine samples. Called the MyProstateScore 2.0 (MPS2) test, it looks for 18 different genes associated with high-grade tumors. “If you’re negative on this test, it’s almost certain that you don’t have aggressive prostate cancer,” said Dr. Arul Chinnaiyan, a professor of pathology and urology at the University, in a press release.
Gathering data and further testing
To create the test, Dr. Chinnaiyan and his colleagues first turned to publicly-available databases containing over 58,000 prostate cancer-associated genes. From that initial pool, they narrowed down to 54 genes that are uniquely overexpressed in cancers classified as Grade Group 2 (GG2) or higher. The Grade Group system ranks prostate cancers from GG1 (the least dangerous) to GG5 (the most dangerous).
The team tested those 54 genes against archived urine samples from 761 men with elevated PSA who were scheduled for biopsy. This effort yielded 18 genes that consistently correlated with high-grade cancer in the biopsy specimens. These genes now make up MPS2.
Then the team validated the test by performing MPS2 testing on over 800 archived urine samples collected by a national prostate cancer research consortium. Other researchers affiliated with that consortium assessed the new urine test’s results against patient records.
Interpreting the results
Study findings showed that MPS2 correctly identified 95% of the GG2 prostate cancers and 99% of cancers that were GG3 or higher. Test accuracy was further improved by incorporating estimates of the prostate’s size (or volume, as it’s also called).
According to the team’s calculations, use of the MPS2 would have reduced unnecessary biopsies by 37%. If volume was included in the measure, then 41% of biopsies would have been avoided. By comparison, just 26% of biopsies would have been avoided with the PHI.
Dr. Chinnaiyan and his co-authors emphasize that ruling out high-grade cancer with a urine test offers some advantages over MRI. The specialized multi-parametric MRI scans needed to assess high-grade cancer in men with elevated PSA aren’t always available in community settings, for instance. Moreover, the interpretation of mpMRI results can vary from one radiologist to another. Importantly, the MPS2 can be updated over time as new prostate-cancer genes are identified.
Commentary
Dr. Boris Gershman, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, and a member of the advisory and editorial board for the Harvard Medical School Guide to Prostate Diseases, described the new study results as promising. “It does appear that the performance of the 18-gene urine test is better than PSA alone,” he says.
But Dr. Gershman adds that it will be important to consider how such a test will fit into the current two-stage approach for PSA screening, which entails prostate MRI when the PSA is abnormal. Where MRI delivers a yes/no result (meaning lesions that look suspicious for cancer are either present or not), the MPS2 provides numerical risk estimates ranging between 0% and 100%. “The challenge with clinical implementation of a continuous risk score is where to draw the line for biopsy,” Dr. Gershman says.
“This research is very encouraging, since many men in rural areas may not have access to prostate MRI machines or the added sophistication that is needed in interpreting these MRI scans,” says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “A widely available urine test may eventually help provide more precision in determining who should undergo a prostate biopsy, and may also help to assess the probability that a cancer is clinically significant and in need of treatment.”
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt
About the Reviewer
Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing
Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD