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Maintaining mental health amid a global pandemic

Compass Health launched a telehealth service a year ago. Six months in, the virtual platform was logging a respectable 500 appointments a month.

Then the coronavirus pandemic struck full-force in March, making in-person visits risky. Within weeks, the number of virtual health care appointments shot up more than tenfold — to 6,000 appointments a month.

“We trained 500 of our staff on the platform in a matter of weeks,” Compass Health CEO Tom Sebastian said.

The nonprofit behavioral health care provider serves patients in San Juan, Skagit, Island, Snohomish and Whatcom counties.

These days, about half of Compass’ services are delivered via its video conference platform, Sebastian said.

Healthcare providers have added another tool to the doctor’s bag — virtual visits. By the end of the year, up to 20 percent of all health care visits in the United States will have been virtual compared to less than 10 percent in 2019, according to the 2020 State of Telemedicine Report.

Julie Delaney, an Arlington first-grade teacher, prefers in-person visits, a more whole-body approach She meets twice a week with a therapist for help with anxiety.

The first face-to-face virtual talk therapy sessions with her therapist were awkward, she said, they didn’t allow her or her therapist to pick up on body language.

“Anytime we had a misinterpretation, it was usually during on-screen visits,” Delaney said.

Now, with restrictions on in-person visits eased, Delaney alternates between in-person and virtual visits.

“My best sessions are in-person,” she said.

Telemedicine got a boost this spring from the Trump Administration when it expanded access to telehealth services through Medicare and Medicaid. Before, they could only pay for telehealth on a limited basis — when the patient was in a designated rural area and had to leave home and visit a medical facility for service.

The quick ramp-up earlier this year caused some healthcare providers to puzzle over how to charge for virtual services. Telehealth visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits, the Centers advised this year. Medical associations advocated along similar lines.

“You can bill audio-video or audio-only telehealth visits as if they were provided in-person, the American College of Obstetricians and Gynecologists told members this fall. As a result, patients shouldn’t expect a discount when it’s a virtual visit but should expect to be charged the same amount as an in-person visit.

The convenience factor has helped reduce the number of patient appointments, according to Compass. Virtual appointments aren’t expected to disappear when COVID-19 subsides. Telehealth technology and mobile phones are helping health care providers reach communities that have traditionally lacked adequate healthcare. More than 40 percent of patients who have participated in virtual visits used their mobile phone to connect, the report said. More than 80 percent of patients who have had a virtual visit say they can envision incorporating them into their regular health care regimen, according to a recent doctor.com telehealth study.

Dr. Cami Milam, a psychiatrist at Compass Health, views telemedicine as an important tool in addressing mental health problems, especially as the pandemic rages.

As the pandemic extends into the winter holidays, suicide, depression, drug overdose and self-harm rates are expected to climb, according to a September report by the Washington State Department of Public Health.

“People who’ve never experienced depression or anxiety are suddenly battling isolation and uncertainty on a daily basis,” Dr. Milam said. “Everyone is tired, emotionally spent. This is a dangerous time. … We’re seeing a lot more anxiety. We’re seeing a lot of new folks who don’t necessarily have a mental illness that are being pushed to the brink.”

Compass caregivers are also using the telehealth platform to monitor children. When schools closed, the lives of special needs children, in particular, “were really disrupted,” said Sebastian said.

“It’s working effectively for them,” Sebastian said. “Kids have a much higher comfort level with technology.”

Another hurdle that Delaney, the Arlington teacher, said she faced was privacy.

With her husband and children working or attending schooling from home, locating a place in the house where she could talk freely was a challenge.

“I tried the closet a few times. I tried the garage,” said Delaney. “I went in the backyard. I sat in the car once. Now my husband knows on Wednesdays at a certain time he needs to leave.”

One benefit going forward is the ability to keep the same therapist should she move out of the area, Delaney said.

There’s comfort in that, she said.

“No matter where we are, I can get on the computer and talk to him,” Delaney said.

Compass Health has locations on Lopez, Orcas and San Juan. For more information, visit https://www.compasshealth.org/.

The Everett Daily Herald is a sister publication to the Journal of the San Juans.