I am the consummate city mouse. Other than my time in college, I have lived exclusively in large cities. In fact, I have lived in the 3 most populous cities in the US (I grew up in #3 Chicago, spent most of my adult life in #2 Los Angeles, and now live in #1 New York City). Even within NYC I live in Brooklyn, the most populous borough in the most densely populated urban area in the US. It is the kind of urban neighborhood where most things that my family or I might need are within walking distance or at least within a subway ride. Countless bodegas (NYC’s iconic convenience stores), restaurants, and other small businesses keep my neighbors and me stocked, fed and entertained.
In stark contrast to the ease with which we can get most of our needs met, what is still extremely challenging to find even in our denseness, incredible demographic diversity, ubiquity of stuff, and just sheer numbers of bodies is culturally intelligent and adapted care that is accessible to those who most need, and deserve, it. While it may be relatively easier to find in a place like New York than many other places that people from marginalized communities and minority identities might live, the fact that such care is still inaccessible and that significant barriers still exist speaks to how deeply embedded these inequities are in our healthcare system.
Which brings us to COVID-19. At the risk of stating the glaringly obvious, the COVID-19 pandemic resulted in numerous changes, essentially overnight, in many of the ways in which we live our daily lives, and especially how we interact with the (literal) outside world. While some of these changes will likely revert back to our pre-pandemic ways, for better or for worse, many are irrevocably changed for the foreseeable future.
In many ways the pandemic served as a massive experiment of nature, which is a type of observational study defined by the collective exposure of a defined group of people (in this case, the group is ALL of us) to a specific event. When such events occur, it gives scientists unique opportunities to look at various outcomes which might be difficult or sometimes impossible to examine otherwise.
This sudden, and collectively traumatic, event resulted in entire cohorts of people staying home, and the isolation that came along with that is something of which most of us are still suffering the often-painful consequences. Prolonged social isolation is associated with a host of serious consequences: increased anxiety and depression, sleep disturbances, negative impacts on our immune and neuro cognitive systems, among other psychological and physiologic consequences. All of these consequences are potent factors that have resulted in significant, negative impacts on our mental health. For those who were already at risk or already vulnerable, these consequences showed up in the form of relapses, worsening of existing symptoms, an increased sense of hopelessness and helplessness, grief, and, for many, immeasurable loss.
But as often happens with tragedies, necessity birthed innovation and invention, and at a pace that was incredible to witness. In healthcare, we pivoted to using telehealth and other virtual tools to address the needs of patients and clients. While not perfect, we have seen many advantages and benefits from virtual care that will hopefully continue to be improved upon.
Early approaches in telemedicine were developed for use by NASA astronauts. As we were preparing to send the first people into space, the potential consequences on the human body were largely unknown. Doctors needed to monitor the physiological condition of the astronauts while they were in space so both NASA and her Soviet counterparts developed ways to monitor the medical status of astronauts, which would be transmitted back to Earth to be examined. These innovations were then brought to rural and remote areas where the challenges of distance were similar. The internet, as it does, then changed telehealth even more in terms of speed of communication, addition of video and other data intensive tools, and allowed for relatively instant communication across very long distances.
Prior to COVID-19 attitudinal barriers and beliefs about the potential problems of virtual care kept it largely relegated to the fringes or for very specific applications. Since the pandemic, however, we’ve all become more comfortable using virtual communication more routinely, and telehealth and other virtual health tools more specifically, and we’ve subsequently seen many of the significant benefits of telehealth and virtual care.
People from remote areas or living outside of major metropolitan areas often had limited access to providers in their geographic area. This was especially true for people seeking mental health treatments and for people from marginalized communities who often had very limited access to culturally competent providers. People with physical limitations or disabilities, or who did not have access to transportation, also experienced barriers when trying to access care. In addition, having to take time away from work or family obligations to get to appointments and back was an additional burden for many. All of these factors also meant that the cost of seeking care was not simply the cost of a session or appointment. People often had to pay for childcare, take time away from work, pay for transportation, etc. These additional costs all added to the burden of trying to access care and are also factors that are particularly salient ones for people from marginalized communities.
Telehealth addressed many of these barriers and made it possible for seeking help to be less burdensome and more accessible. You could be seen more at your convenience, the cost in terms of time and associated financial costs was mitigated, and you had greater options of providers because proximity was no longer as defining of a factor.
For many people seeking help for mental health issues is also very stigmatized. Our society continues to stigmatize mental illness and misunderstandings and prejudices about mental illness and mental health continue to be prevalent. People from many marginalized communities come from cultural backgrounds where this stigma is even more magnified by cultural beliefs around shame and discussing one’s “problems” with people outside of one’s own community. For many people telehealth made is somewhat easier to overcome the stigma of help seeking and was a safer entre into treatment. In addition, there’s been a general cultural shift, led largely by young people and young adults who have grown up with the internet and devices as constant presences in their lives, and who are more comfortable discussing mental health struggles and understand that seeking help is an act of courage rather than something of which to be ashamed. These attitudinal changes are long overdue and necessary for us to continue to have more vulnerable and honest conversations about our collective mental health and wellness.
These benefits of virtual care are important for us to continue with as we re-conceptualize what mental health and mental wellness means, and therefore what mental health treatment looks like in a post-pandemic world.
To that end, I’m proud and honored to partner with Lightfully Behavioral Health, a primary mental healthcare company that has been built from the ground up to center the experiences of those who struggle with their mental health. Particularly for those folx from marginalized communities, it is crucial to find a place that offers safety by ensuring that everyone is seen, heard and valued as their authentic selves. Core to Lightfully’s mission is the expansion of access to quality mental healthcare services, and their virtual program is a terrific example of how to utilize technology to consider, reach, and improve mental health conditions affecting people from marginalized communities.
The benefits of virtual care are crucial to continue to improve upon in and of themselves, but they also beg an important core question that we face as a society: when the pandemic subsides and we can start to resume our lives, will we just go back to business as usual or will we take away any lessons about the fragility of our systems and start to work together to make some much needed changes? People from marginalized communities and all those who have been left out of the mainstream of mental health treatment are particularly vulnerable to the negative impacts of returning to business as usual. It is therefore imperative that we learn from these important lessons about equity and access that the pandemic has writ large and continue to progress our healthcare system to allow for better access and better care for all by using any and all tools available to us.