Filling Telehealth Gaps in College Mental Health

COMMENTARY

I have been a campus psychiatrist for 14 years. In the pre-COVID-19 era, when a student left campus during breaks or graduated and moved to a different state, I always had time to find local psychiatric resources for the student or connect the student with his or her primary care physician. There was rarely a need to choose between patient safety and my own medical licensure.

In the wake of the COVID-19 pandemic, however, the luxury of time and planning went out the door. Within days, students had scattered from campus to locations around the country, and their psychiatric and mental health care was interrupted at a time when they needed support more than ever.

Our counseling center immediately converted all services to telehealth, so that students could continue to receive treatment remotely. However, since physicians need to hold medical licenses in states where their patients are located, out-of-state students could not and cannot take advantage of telehealth services. Many in my profession must now choose between abandoning patients or practicing illegally across state lines.

Many state medical boards have loosened restrictions so that physicians can practice across state lines in a limited capacity during the COVID-19 health emergency. As of April 15, 2020, 44 states had waived telehealth licensure requirements, and the list grows every day (www.fsmb.org).

However, such decisions are not universal or standardized, making it time-consuming and difficult for physicians to decipher the executive orders and latest regulations of each state. Furthermore, it is not clear if these exceptions apply to routine psychiatric care of college students.

Federal law allows Veterans Administration psychiatrists to work with veterans nationwide without concern about crossing state lines. There should be similar federal and state laws and malpractice insurance to protect campus psychiatrists who provide telehealth services to out-of-state students.

One proposal is to create a special telepsychiatry license allowing campus psychiatrists to work with students enrolled in their universities, regardless of where the students are located. This proposal is worth considering for the following reasons:

• A survey by Healthy Minds Network of college students in the 2018-2019 academic year reported that 36% of students experienced depression, 31% experienced anxiety, 24% reported engaging in self-injury behavior, and 14% had suicidal thoughts. This translates to nearly 7 million students nationwide that have significant mental health treatment needs.

• Many students have limited access to psychiatric services in their hometowns. The wait for an appointment at the local mental health clinic can be months, and due to the COVID-19 pandemic, a clinic told one of my students that neither in-person appointments nor telehealth services were available. Other significant barriers to care can include out of pocket costs, insufficient insurance coverage, lack of governmental funding, and a lack of psychiatrists in rural areas. Our college students, however, are seen at no cost because services are covered by school registration fees.

• Students who have suffered from mental illness for many years often wait until they get to college to seek treatment for the first time. They report having delayed treatment due to limited prior healthcare coverage, lack of access to a psychiatrist in their hometown, fear of the stigma of seeking care, and in rare cases, a need to keep treatment from their family. Even as we face the COVID-19 pandemic, colleges should remain places where students feel safe and comfortable seeking mental health care.

• Psychiatrists embedded in a university setting understand the unique needs of the student population. They are familiar with a university’s policies and procedures, and are aware of its resources regarding finances, academics, housing, and disability services. Campus psychiatrists who provide services to students even off-campus can help those students achieve academic success.

• Working with college students often requires family involvement. Receiving a diagnosis of severe mental illness, such as first-onset psychosis or bipolar disorder, can be a traumatic experience for a student and his or her family, and how the family handles the student’s disorder can strongly impact the success of treatment. I have spent countless hours in family meetings over the years, making sure that families understand the ramifications of a student’s diagnosis and how they can support him or her.

Campus psychiatrists are in a unique position to treat mental illness in young adults. I look forward to the day when I can provide treatment without worrying about getting sued for abandonment or for practicing across state lines.

Disclosures:

Dr ChoyisChief Psychiatrist at the counseling center at the University of California, Irvine, past president of the Orange County Psychiatric Society, and a distinguished fellow of the American Psychiatric Association. Website: https://www.121psychiatry.com.