Doctors without (virtual) borders for mental and behavioral health in Maryland
Now that we’re beyond most declared states of emergency issued at the onset of the pandemic, most emergency orders allowing expanded telehealth access have also expired. While many people were familiar with using telehealth to consult a doctor about a sore throat or sinus infection, emergency orders suddenly expanded telehealth modalities in a variety of healthcare settings. Dentists, for example, could consult patients via phone or video to assess whether a toothache was cause for immediate concern. Mental health professionals like psychologists and counselors were also able to “see” patients via telephone to better accommodate mental health needs. In fact, mental health services topped the charts when it came to telehealth use during the pandemic: at the onset of 2021, psychotherapy visits were the most popular telehealth service in the United States. This makes sense; the pandemic challenged the mental and behavioral health of many Americans, and fortunately telehealth could be used as a lifeline during lockdowns.
Patients and providers were happy with virtual treatment options, and many said they planned to continue using telehealth. Luckily, some states that have let temporary allowances expire aren’t forgetting what the increase in telehealth access did for citizens. Most recently, Maryland policymakers introduced a bill that would allow out-of-state providers to treat Maryland residents virtually, so long as they are in good standing and follow some basic registration requirements. The rationale for this move is largely due to the effects the pandemic had on mental and behavioral health needs. Maryland Lt. Gov. Boyd Rutherford, who is a proponent of increased telehealth access, explained how the pandemic exacerbated the need for mental and behavioral telehealth services. “Just before the pandemic,” Rutherford told R Street, “the Behavioral Health Administration conducted a survey of mental health and substance abuse disorder treatment providers. That survey found that these providers reported that they did not believe they had adequate staff to provide quality care.”
Adequate staffing is a major problem in many areas of healthcare in the United States, and telehealth is an avenue for alleviating this issue. In the appropriate applications, telehealth can save both patients and providers time, help them connect more often, and even help mitigate the spread of illness. It’s also helped keep people connected, which is a crucial component of addiction treatment services. As Rutherford described, “Early on, people, including those struggling with mental and behavioral health disorders, were not able to connect physically with their social and emotional support systems or access treatment and services in-person. We saw the impact of this disconnection when the Centers for Disease Control [and Prevention] reported a nationwide spike in overdoses and deaths with 93 thousand people dying from drug overdoses in 2020.”
Maryland is not the only state considering permanent changes to telehealth policies, particularly as they relate to mental and behavioral health. But allowing out-of-state providers to treat patients virtually has not been as uniform a change across the country. An R Street study examined the temporary telehealth changes that states made, and found that even the temporary cross-state licensing directives for telehealth differed across states. Cross-state licensing allows individuals licensed in good standing to treat patients across state lines with fewer regulatory hurdles. Allowing mental health professionals to treat Marylanders regardless of where they are increases convenience and access. Maryland policymakers are considering a change that many other states have lagged to adopt. “It is important to eliminate outdated and superficial barriers to getting people the help that they need to not only survive mental and behavioral health challenges, but thrive here in Maryland,” Lt. Gov. Rutherford told me. “If an individual from North Carolina decides to go to school or work in Maryland, why should they have to disrupt their continuity of care?”
Continuity of care is exactly why cross-state licensing is beneficial in the telehealth space. It allows patients to keep seeing their preferred mental or behavioral health provider, without interruption, regardless of physical location. This proposal out of Maryland is a major step forward for telehealth access, and other states should follow suit.
Image credit: thodonal
