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(855) 940-4867
Knowing Your Options for Telehealth Mental Health Care
Mary El Grammer
Telehealth for mental health care has become normalized and widespread recently due to the COVID-19 pandemic. But before leaping into telehealth mental health care as a default option, it's important for us to consider the quality of care offered and the pros and cons of telehealth.
In a rush to accommodate providers and their patients, the Centers for Medicare and Medicaid Services, a federal agency under the Department of Health and Human Services,
issued nationwide waivers to ease requirements that would have made telehealth problematic. Two months into the new normal, the American Psychiatric Association called for some of those
changes to be made permanent to "ensure continuity of care and continued improved access to mental health and substance use care."
That is an alluring prospect to many providers, as telehealth reduces overhead expenses and is generally more convenient. However, psychiatry is a medical specialty that, at times, requires face-to-face assessments. Telehealth has provided a necessary service during the COVID-19 pandemic; however, providers should still weigh its convenience against what is best for the patient.
Pros and Cons of Telehealth
Telehealth was originally designed for
patients who live in remote locations and have to travel long distances to meet with their provider. Because of the
shortage of behavioral health specialists in rural areas, mental health care often falls on primary care physicians. Although they can certainly handle first-line interventions, their skill set reaches its limit in treatment-resistant diseases or complex cases.
That's where sub-specialty expertise should be employed, and that's where the real value of telehealth mental health care is manifested. It brings sub-specialty expertise to people in areas where that otherwise may not be available. If a patient needs to drive two hours for a visit, they are not likely to give the doctor a good interview—and it's especially impractical if the patient is stabilized on a medication and just needs a check-in for a refill. Similarly, if a patient has weekly talk therapy appointments but has to drive hours to get there, their attendance may drop off. In this case and others, telehealth is just as good as an in-person visit.
However, there are also some challenges to telehealth. As many people have experienced during the pandemic, the availability of video telehealth services is predicated upon internet bandwidth, as well as in-home computer equipment. At worst, many people do not have reliable broadband internet access or suitable equipment to have a satisfactory appointment. For those who do have a workable setup, technology issues can still arise, with sound delays, lighting issues, and audio glitches.
What's more, patients often seek mental health care for what they believe is depression, but upon a medical examination, the physician may determine the patient is suffering from a neurological condition that can have a secondary symptom of depression. Without an in-person assessment, the root problem would be missed and the patient would be misdiagnosed.
Telehealth Options at Greenbrook TMS
Another concern about the push for telehealth is that providers may prefer the convenience of remote visits without accounting for patient preference. Telehealth should not be used as a service to the provider, but rather to the patient. At Greenbrook TMS, we offer telehealth mental health care appointments based on clinical suitability and patient preference. If you want to take advantage of telehealth and it is clinically appropriate, we will offer it to better accommodate your needs. If it's not clinically appropriate or if you don't have the resources or preference for that mode of therapy, you have the option of an in-person examination.
Greenbrook TMS has always promoted patient convenience and choice. So although the regulations for telehealth are relaxed, we've retained the option for face-to-face visits using various
hygiene and social distancing measures to maintain safety. Because
TMS is a hands-on procedure , you will come in for a visit eventually, but we want you to feel reassured with the knowledge that Greenbrook TMS offers the types of appointments that best serve you. If you are considering TMS therapy, you can
reach out to us for a consultation , and we will help you determine whether a telehealth appointment is right for you.
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You may feel isolated and alone when you have clinical depression, and depression also affects your relationships with family and friends. While the primary focus of your treatment is to improve your mental health, it’s also essential to understand your loved ones may experience their own issues as they try to support you. An understanding of how depression affects relationships can help everyone maintain healthy connections and navigate problems. Here are some of the ways depression may affect the people in your support network.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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