The Great Recovery is a series examining how a surge in innovation, outreach, access and attention to equity is improving our mental health system. It is supported by a grant from Wellcome Trust.
This is part two of a two-part story about how telehealth is bringing therapy to places where it is often difficult to access.
Suffering from dementia, 94-year-old George (not his real name) was admitted to a nursing home in a rural town in California in 2019. Since he lacked family nearby, he received few visitors. George soon became lonely and depressed — and these feelings were exacerbated by the sense that there were few people he could connect with at the home. His failing memory led to confusion and frustration, culminating in George putting a bag over his head in an attempt to end his own life last year.
Despite the nursing home’s social services director identifying him as a candidate for psychotherapy, no psychologists were available to visit George in-person due to the home’s rural location. Instead, George was set up with a clinical psychologist who could work with him remotely in weekly telehealth psychotherapy sessions.
After his initial psychologist left the company, George began seeing Dr. Jennefer Ho, senior clinical manager at Executive Mental Health. George’s sessions have helped him process his feelings and embrace life in the facility, while also accepting his difficult relationship with his daughter, with whom he previously lived.
“Telehealth has made a huge impact on George’s life,” says Dr. Ho.
George is one of the estimated 122 million Americans, or 37 percent of the population, who live in the 5,833 federally designated “mental health professional shortage areas.” That number rises to 80 percent of the population in some states, with two-thirds of the shortage areas located in rural parts of the country.
About a fifth of Americans living in rural areas are reported to have a mental illness, according to a study published by the Journal of Clinical and Translational Science. The study also notes that, while the prevalence of mental illness is similar across rural and urban areas, there has been a significant disparity in treatment levels. In other words, rural residents like George simply don’t have access to specialist medical professionals like psychologists that are available to their urbanite counterparts.
Telehealth services have shown promise in meeting this need. In a 2021 study, rural residents reported growing acceptance of, and satisfaction with, telehealth services for a range of medical needs. Telehealth services bring overall benefits like better access to care, reduced costs to the patient and health care provider, and increased training for health care professionals — which in turn leads to better recruitment and retention.
Still, challenges remain: A 2023 study found telehealth uptake to be low in rural populations because many residents lack the required technology, such as digital devices and high-speed internet. Issues like language barriers, and visual and hearing impairments are also more likely to hinder rural residents’ use of telehealth services in general, according to a 2021 national survey conducted by the Bipartisan Policy Center and Social Sciences Research Solutions.