Author: Nicole Fusco, M.S.
Telehealth psychological services are regarded as a critical modality to support and provide treatment to underserved and marginalized populations (Craig et al., 2021). COVID-19 has forced many mental health professionals to expand beyond their comfort zone and use telehealth as their primary means of client care. Similarly, clients have to navigate a new reality of engaging with mental health professionals through video and internet-based platforms. Despite the advantages of using telehealth therapy, the consequences of mistrust, ambivalence toward mental health care, and stigma among marginalized populations toward mental health treatment need to be considered. Therefore, it is important for psychologists to adapt and provide culturally competent care, as well as to find effective ways of engaging individuals in treatment in manner that is culturally sensitive (Silva et al., 2020).
Physical Disabilities
There are unique economic, social, and environmental disadvantages among individuals with physical disabilities. Compared to persons without disabilities, individuals with physical disabilities have worse healthcare outcomes due to distinct disparities that impact healthcare access and ability to afford healthcare (Annaswamy et al., 2020). Also, there is a higher percentage of individuals with disabilities living in rural areas than in urban areas (Zhao et al., 2019). Further, research has shown that depression is more prevalent among women with physical disabilities living in rural areas and barriers to access mental health treatment is more pervasive (Hilty et al., 2019; Khubchandani & Thew, 2016). A few benefits for telehealth therapy among this population include less exposure to communicable diseases, lower transportation costs, and decreased need for paid personal assistance services (Khubchandani & Thew, 2016). However, several barriers remain for individuals with disabilities such as access to the internet, communication barriers, and unique individual challenges. As for communication barriers, most of the telehealth platforms do not have features to customize for individuals who vision or hearing loss and for people with cognitive disabilities (Annaswamy et al., 2020). Further, individuals may experience unique challenges specific to their type of disability while using telehealth therapy. For instance, individuals with mobility issues may find it difficult to remain seated for extended periods of time or have difficulties interacting with the virtual interface. Also, effective communication through a virtual platform may be difficult for individuals diagnosed with an intellectual disability or autism spectrum disorder (Annaswamy et al., 2020).
Rural Communities
The supply of services and professionals is limited for individuals living in rural and remote areas. Individuals living in these areas have to spend money and a significant amount of time traveling to access treatment (Khubchandani & Thew, 2016). Further, rural individuals experience a combination of factors that contribute to disparities in wellness and health such as cultural and social differences, geographic isolation, stigma, lack of transportation, and educational shortcomings (Khubchandani & Thew, 2016). These factors also impede the mental health of individuals living in rural areas as there is a greater risk for depression, suicide, and substance misuse than compared to people living in urban areas. However, the use of telehealth psychological services can address and acknowledge these existing barriers and challenges. Several advantages to using telehealth therapy include increase of access to care, enable more effective treatment delivery, reduce health care costs, and improve professional education (Khubchandani & Thew, 2016). Despite these advantages, a significant disadvantage and obstacle for telehealth therapy is that fast internet service is inaccessible in many low-income and rural communities due to the absence of infrastructure (Annaswamy et al., 2020). Assistance programs and subsidies that make technology affordable for individuals that may have infrastructure available, telehealth psychological services for individuals are likely suboptimal (Annaswamy et al., 2020). Telehealth psychological services can be a key component for integrated care to help improve the well-being and health of individuals living in rural areas (Khubchandani & Thew, 2016).
Overall, telehealth psychological services have facilitated access for some, but significant barriers should be addressed going forward to improve mental health care access and outcomes, as well as ensuring the best possible treatment for the needs of each individual (Annaswamy et al., 2020).
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https://doi.org/10.1037/14943-005