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By Jeremy Schreiber, MSN, PMHNP-BC

Patients living with mental health conditions can be ambivalent about taking medication. So, when an event like COVID-19 disrupts their care, I worry.

Telehealth can help. I can continue to reach patients even when in-person contact is limited. Telepsychiatry, as it’s called, often helps to keep patients stable until we can follow up in person.  

I’ve also seen it boost my patients’ “show rate” – when they keep an appointment – during the pandemic. Many patients who require mental health care rely on a case worker, family member or public transportation to get to the clinic. Sometimes those methods are reliable; other times, not so much. Virtual appointments allow my patients to continue care regardless.

Now, some patients use a combination of virtual and face-to-face meetings, but the value of seeing someone in person can’t be overstated.

Mental health is complex, and telemedicine isn’t a solution for everyone. 

I think specifically of Jason, a new patient who came to me during the height of the pandemic. He was referred for extreme anxiety and paranoia. Jason was taking an antipsychotic, a mood stabilizer and an antidepressant, but he wasn’t improving.

While initial appointments are usually in person, the pandemic and our distance made it nearly impossible. So Jason and I met over the phone. Jason told me about his anxiety and about the paranoia he felt when walking down the street, like every stranger had their eyes glued to only him. We talked about it, but I had a hunch there was more to his issue. After a few months, I insisted on seeing Jason in person.

The morning he came to my office was life changing. After spending just five minutes with Jason, I saw clearly that he had tardive dyskinesia – jerking and involuntary facial expressions. I suggested these movements were the cause of his unwanted attention.

As we talked, Jason shared that no clinician ever offered to help address the movement disorder before. Had I not seen him in person, I fear his mental health would have continued to deteriorate – from a completely treatable condition.

As the pandemic wanes on, I am thankful that I can virtually connect with many of my patients. Yet Jason’s story is a reminder that in-person appointments are still a powerful and necessary component of personalized mental health care.  

We live in anxious times. Ensuring the best care possible – whether it be virtual, in-person or both – is the least we can do for patients.

Jeremy Schreiber, MSN, PMHNP-BC, is a psychiatric mental health nurse practitioner from West Virginia and a member of the Alliance for Patient Access.

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