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Columns

Telemental Health Care: A No-Brainer for Harvard

By Gemma J. Schneider, Crimson Opinion Writer
Gemma J. Schneider ’23, a Crimson Associate Editorial editor, is a Government concentrator in Pforzheimer House. Her column, “Wilted Wellbeing,” usually runs on alternating Tuesdays.

The nation’s harrowing mental health crisis has offered a ripe opportunity for bipartisan action, and the current administration has snatched it: Earlier this month, President Joe Biden touted his mental health care plans in his first-ever State of the Union address, including expanding access to telebehavioral health care coverage to every corner of the nation.

This is promising: Behavioral telehealth services — especially video therapy sessions — are demonstrably safe and effective, reduce administrative costs for providers, and ensure faster and more affordable access for those who are most struggling to enter and navigate the system. Dr. Risa L. Gold ’78, a New York psychiatrist who began offering video therapy at the height of the pandemic – and whose patients have swiftly embraced the benefits of the new modality – is highly hopeful that telehealth is “here to stay.”

Less promising, however, is the fact that the same opportunity for digital reformation hasn’t been grabbed at Harvard. The University’s Counseling and Mental Health Services has been pierced by daggers of excess capacity — leaving gaping holes in their provision of mental health care. But while a brief stint with the telemental health care provider iHope back in 2017 offered some hope, the prompt shut-down of the system suggests that, if anything, Harvard seems to be moving in the wrong direction.

The lackluster character of CAMHS’ virtual options becomes particularly pressing when brought into conversation with the importance of early mental health intervention at colleges. There exists an evidence-based need for colleges to build mental health support systems that are proactive, rather than reactive, according to Dr. Caitlin M. Nevins, instructor in Psychology in the Department of Psychiatry at Harvard Medical School. Yet from the student standpoint, Harvard’s approach embodies reactivity to a tee — those in need of urgent support are given priority to skip ahead on CAMHS’ months-long waiting lines, while those with less immediately dire concerns are left to wait.

Telehealth, according to Nevins, is “adding more resources, but it's doing it in a way that I think can happen a lot quicker for students.”

In the face of such strained choices, CAMHS’ prioritization of crisis intervention over prevention is the safest, most straightforward of moves. What remains problematic is the fact that such impossible trade-offs stand so firmly in the first place. That problem is, to be sure, largely attributable to CAMHS’ seemingly unchangeable funding strains. But on some level, these trade-offs are also self-imposed. Unwittingly, I suspect, CAMHS has spent years scrambling within a maze that has become outlined by boundaries of its own creation, too busy dealing with immediate, short-term crises to address surmountable long-term shortcomings.

The fact that CAMHS’ most creative digital explorations are all internally based serves as a testament to this point. As of today, CAMHS offers a series of digital group sessions led by their own clinicians, plus a tangled array of external links on their website. A new 24/7 hour hotline was also thrown into the mix this academic year, but it still fails to address the empirically-backed need for continuous, not sporadic, care. Worse still, students have been put on hold for what should be an on-demand 24/7 service — highlighting the limitations of working within CAMHS’ own strained internal ecosystem.

Let me be clear: CAMHS’ efforts are clearly well-intentioned. But that doesn’t change the difficult truth that their dedicated staff can’t fix this problem on their own. Ultimately, CAMHS continues to spend too much time working within the limited architecture of its own internal world – and nothing will change until it dives into the universe of opportunities that live beyond it.

Institutions like our own seem to have grown used to a very specific, short-term approach to behavioral care. “Do they have to rethink that, given what's going on in their student population? Rethink their role entirely, and their model?” Dr. Haiden Huskamp, Henry J. Kaiser Professor of Health Care Policy at Harvard Medical School, tellingly asked when we spoke on the phone in February.

Some colleges, in fact, are beginning to blaze such innovative external trails. Key among them, a chorus of community colleges across California, whose mental health teams managed to combat internal resource problems by partnering with TimelyMD, a telehealth company that specializes in higher education. Duke and the University of Virginia have also entered the video therapy domain, and other schools have made similarly innovative moves – including Penn State, which began this year by offering students three months of free access to telehealth behavioral coaching using an evidence-based messaging service.

The impact of these offerings speaks for itself: As Harvard’s students watch the clock tick away with wait times of six weeks, some of these schools have been able to bid farewell to ungodly wait times entirely. And as wait times themselves repeatedly deter prospective patients from seeking care, telehealth actively pulls students in: In one case study, 82 percent of student patients reported that, if digital services had not been available to them, they would have “done nothing.”

But doing nothing — or what feels like nothing, compared to the options offered by Harvard’s more innovative peers — is rarely enough. The precedents set elsewhere illustrate that Harvard has been entrapping itself within a prison of avoidable trade-offs — plagued by impossible choices that, with digital innovation and expansion, it wouldn’t be so pressed to make.

Ultimately, to achieve their desired ends, CAMHS needs to stop dipping its toes within familiar yet shallow waters; and to instead submerge itself within the expansive sea of online possibilities out there — head, neck, toes, and all.

Gemma J. Schneider ’23, a Crimson Associate Editorial editor, is a Government concentrator in Pforzheimer House. Her column, “Wilted Wellbeing,” usually runs on alternating Tuesdays.

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