Health
More Teens Are Opting for Virtual Therapy
Before the pandemic, Virginia-based psychologist Dr. Patrice Berry had little experience conducting client sessions via video call. Now, even though Covid restrictions are largely no longer in place, around 40 percent of her consultations still happen this way, meaning she can work with patients from anywhere in the state.
When it comes to patients aged 18 and under, who make up about 50 percent of Dr. Berry’s client base, up to 60 percent of them are opting to be treated virtually, also known as telehealth. It’s often the only option for families that can’t transport their child to an in-person session, and it makes scheduling easier: Students don’t have the added stress of being late for school after a morning session, or rushing to leave school to attend in the afternoon. Being one of the few African-American therapists in the area, Dr. Berry is also highly sought after by Black families.
“I also have clients with significant social anxiety, where starting online is more comfortable for them. And I work with some clients that have chronic health problems, where sometimes they’re having a high pain day [and can’t leave the house],” says Dr. Berry.
“I’ve worked with teens with long Covid symptoms, or with chronic medical conditions, and having the ability to meet online has really helped. It just gives everyone more options.”
The state of youth mental health in the US
Therapists’ ability to reach more young people with telehealth services is going a long way towards overcoming the youth mental health crisis currently unfolding in the US. Nearly 20 percent of children and young people between the ages of three and 17 in the US have a mental, emotional, developmental or behavioral disorder; and suicidal behaviors among high school students increased more than 40 percent between 2009 and 2019. Mental health challenges were the leading cause of death and disability in this age group during that time.
Up to 60 percent of Dr. Patrice Berry’s clients opt to be treated virtually. Courtesy of Dr. Patrice Berry
Telehealth may have been adopted as a byproduct of the pandemic, but, as with Dr. Berry’s patients, it has remained popular thanks to its accessibility. A 2023 study shows that while by August 2022, in-person youth mental health services in the US had returned to 75 percent of pre-pandemic levels, utilization of telehealth services for youth mental health was 2,300 percent higher than pre-pandemic.
“Pediatric telehealth care for mental health needs filled a critical deficit in the immediate period following the emergence of Covid-19, and continues to account for a substantial proportion of pediatric mental health service utilization and spending,” the study summarized, highlighting the continuing demand for virtual mental health services for this age group.
But since students are mainly able to access independent therapists like Dr. Berry outside of school hours, entrepreneurs are seeing the need to develop telehealth platforms that work in partnership with school districts to offer virtual sessions during the school day. Telehealth mental health startups focusing on young people include Daybreak, which partners with around 80 school districts across the US; Hazel, which is available to schools in 14 states; and Brightline, which is on offer in over 1,000 schools.
When the numbers don’t stack up
According to Daybreak, the National Association of School Psychologists recommends a ratio of one school psychologist per 500 students, but the company estimates the actual ratio in US schools is one per 1,211 students. In the company’s own survey of 1,008 US parents in 2022, 46 percent cite the lack of available therapists outside of school hours as a challenge, and 43 percent complain of long wait times.
“There’s been a record demand for youth mental health services, coupled with a lack of mental health professionals, that has led to high costs of care and unprecedented wait times to find a clinician,” says Daybreak co-founder and CEO Alex Alvarado.
Daybreak co-founder and CEO Alex Alvarado. Courtesy of Daybreak
“This disproportionately affects teens who are at the highest risk of mental health challenges including youth who identify as BIPOC, LGBTQ+, low-income, live in rural areas, are experiencing homelessness, and/or come from immigrant households. Therefore, students must be able to access services at the place they spend the majority of their time — school. Public schools must play a vital role in providing high-quality, affordable and culturally competent mental health services to ensure students have equitable access to these services.”
Daybreak’s services are provided at no cost to families, Alvarado confirms, as many school districts receive funding for these types of programs, and in turn will sponsor specific services like virtual therapy. Daybreak also partners with health plans to share the costs of students’ care, while schools still cover the cost of services that are not billable or for uninsured families.
“Since districts are seeing the impact of school-based mental health support on improving students’ academic success, like improved grades and better attendance and behavior, they are tapping into new funding sources to sustain these services in the future,” Alvarado adds.
Building a telehealth platform that operates across states also means a greater diversity in therapists, and makes it more likely that a student can be best matched with someone that fits their situation and can relate to their background. For example, within Daybreak’s pool of therapists, 14 languages are spoken, 74 percent identify as BIPOC, and 14 percent as members of the LGTBQ+ community.
And the results are promising. Daybreak’s clinical data shows that 92 percent of families report behavioral improvements, while 80 percent of school staff report improvements in attendance, grades and behavior.
Through telehealth sessions with a Daybreak therapist via their schools, teens have worked through issues like gender identity, self harming, anger management issues, anxiety, eating disorders and more. One of those teens is Palm Springs-based Clifford, who, in 2023, was experiencing suicidal thoughts, writing in one of his assignments, “Nobody cares about me. I just want to die.” Over six months, working regularly with a therapist through his school helped the 18-year-old overcome those thoughts and learn coping mechanisms to deal with his own insecurities. As she shares in a video, his mother believes it saved his life.
Through virtual therapy, Clifford learned to overcome thoughts of self-harm. Courtesy of Daybreak
With on-campus resources at capacity, and in-person programs limited to students with severe mental health issues, Danielle McClain-Parks, coordinator of mental health services at Palm Springs Unified School District, says offering telehealth means more students can receive help before their problems escalate.
“We’re able to get help for a student before their needs are significant enough that they’re having trouble functioning, so they can get that help and learn those skills to be able to manage those symptoms early, rather than having to wait until they’re severe enough to need help from somewhere else,” McClain-Parks states in states in a video.
But can screens be a barrier?
Dr. Berry, however, is conscious of the limitations and challenges of telehealth, especially when it comes to teens. Focus and screen fatigue can be a problem. Dr. Berry says she can also miss body language cues via a screen, so will recommend a transition to in-person sessions if she feels it’s necessary.
School-based telehealth programs, Dr. Berry adds, can sometimes be counterproductive if school-related challenges are at the heart of a patient’s issues, so telehealth providers must also offer measures to support those who need another option. Daybreak confirmed that if the therapist believes a student could benefit from extending their care or receiving in-person services, they work with the district staff to make a referral to the appropriate community resources.
Client confidentiality breaches can also be a risk with telehealth. Dr. Berry, for example, often has to check that no one else is in the room or can hear the conversation, and that the client is returning to a safe environment after their session. For clients aged 12 and over, in the state of Virginia where she practices, therapists aren’t obliged to disclose all details of their sessions to parents, but share general progress, and flag serious safety concerns, such as if the patient talks about drug use or a desire to run away from home.
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“I sometimes get concerned [about large-scale telehealth platforms], about whether the sessions truly are confidential, and that their data isn’t being used — with kids, you know you have to be more careful,” says Dr. Berry.
“I would imagine the school systems would make sure that it truly was confidential, and then would help parents to know to listen to their kids, because your kids will tell you if telehealth is the right fit for them or not, or if the therapist is the right fit for them or not. Because some teens hate telehealth, and some love it.”
Still, amid the ongoing mental health crisis among kids and teens, Dr. Berry sees telehealth as a helpful option. “It can be hard for families to find quality mental health professionals,” she says. “If these organizations have the ability to find quality mental health professionals and pay them well, I can see it being successful.”
The post More Teens Are Opting for Virtual Therapy appeared first on Reasons to be Cheerful.
‘Fighting the Five Giants: It’s Time to Renew Our Social Contract’
The concept of a social contract for welfare support and national health, the 1942 Beveridge Report and what this Liberal politician termed the ‘five giants’ – want, disease, ignorance, squalor and idleness – still strikes me as ground-breaking.
Even the old posters used to campaign for its implementation remain as powerful today as they surely were then. In one, the ‘giants’ are portrayed as people. I’m most struck by idleness depicted as a forlorn unemployed man slouching against a lamp post, a factory behind him with a large ‘closed’ sign hanging over it.
In terms of disabled people today, we’d likely have a ‘scrounger’ or ‘fraudster’ sign, perhaps combined with some representation of disease. But maybe ‘hopelessness’ would be a better term than idleness?
The idea of the five giants took hold at a time when there was less division in society. When, good or bad, the delineation between classes was more comfortably understood. When Winston Churchill made the much-shared statement: “Rank me and my colleagues as strong partisans of national compulsory insurance for all classes for all purposes from the cradle to the grave.”
But we now take for granted those measures that led to the founding of our NHS, when political parties cooperated on matters of importance to society as a whole.
The odds were different then. This was in the midst of the Second World War, when a healthy, fighting fit proletariat was required, and there was nothing to take for granted. Those five giants loomed everywhere outside of the gentry and their financial security. My mother remembers the lottery of dentistry during her 1930s childhood – sharing gruesome stories of who could have a filling first in a family of many siblings.
There was pragmatism in the debates back then; an awareness of sickness that was horrifically close to most people’s lives. Now, we have an established narrative, urged on by recent governments – and the overwhelming dross in the mainstream media – which wants to deny the modern equivalents of those five giants as relevant.
We are promised so much in our technological age, on the back of a strain of Conservatism that enjoys promoting the idea that we can somehow sidestep poverty, illness and impairment.
I’m fearful that it’s too late. That we’ve taken for granted for so long the notion of state support that we believed would always be there: a reliable NHS hovering in the background, somehow still operating, even as eager politicians score points for its failings or successes and it shatters under the weight of so much pressure.
I’ve lived through my own sociology experiment in social care and NHS support. I’m my own test subject, pushed through various medical departments and services both as an inpatient and outpatient. My experience suggests that the NHS is not only broken but gorged upon by the private sector with a sly side-glancing secrecy, as it sucks up every chance to make profits.
But I refer to myself as an NHS baby. And to think of this in the broadest sense encourages me to puff up with a strange patriotic and perhaps socialist pride. Even a sense of ownership, from all those years lived through a system that worked to keep me well, and more recently alive, brings me hope.
I remember my GP regularly visiting my home from a young age to examine my joints. I remember the touching trust I felt in most of my doctors and health professionals. They were there for me. They knew me over the course of many years.
Recently, faceless managers and administrators make me feel as though I’m making a fuss, that I don’t understand cost implications, and that I want too much – as if my needs are an outrage.
I can’t even begin to talk about the attacks on benefits, social care, and the 2005 closure of the much-loved means of choice and control gained by disabled people via the Independent Living Fund.
It’s very difficult to argue that the original principles underpinning the NHS remain. If you have no money you can no longer expect a decent, functioning level of support from systems that are supposedly there to manage your health and ability to thrive. These failures begin, as in my case, within the home. With doctors who don’t visit. Services that aren’t available. Dots on a chart; numbers on a spreadsheet. None of which equates to the delivery of everyday workable healthcare and support.
The problem is every one of us will experience illness, damage, sickness, impairment, disability and, inevitably, old age. And so, if we believe in a fair society that operates with compassion and equity, we need to reformulate our own five giants that are relevant today.
A healthy, cared for, society that has few wants at a basic level will surely thrive and, at a personal level, the construction of artificial barriers via attitudes and environment can and should be removed. Very few of today’s politicians have the interest or the humanity to do so.
The pandemic undoubtedly stands as a sombre wake-up call for such disregard. Millions dead and many more living with the ongoing consequences of the Coronavirus. So much for the Brave New World of the unbreakable, never-damaged, uber human! Through my own lived experience, and that of others, I know this is the ultimate lie.
Churchill, as a Conservative, spoke of the ‘cradle to the grave’. William Beveridge was a Liberal politician. And it was a Labour Government that enacted his report to create our welfare state and the NHS. It was an achievement of cross-party cooperation – not perfect, but of a like that we simply no longer see.
With all its flaws, let’s remember all the years so many of us have reaped its benefits. Not simply because we pay in for ourselves, and feel happy to pay in for those who can’t, but because it is the right thing to do.
There is now a grotesque disconnection between governments and public services, resulting in more than poor communication. We are a nation let down, in poor health, disappointed and baffled. Yet the individuals I meet, who care for me so well in hospital, keep my humanity alive and remind me that, in the end, there is good in people and the world.
Let’s remember the humanity those five giants brought out in our society and politics. And prepare to renew our fight with their latest incarnations again today.
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A number of commentators have proposed that the Aged Care Funding Taskforce would, and indeed should, recommend increasing user charges. With particular reference to services delivered through Commonwealth Home Care Program (CHSP), this step would be achieved by splitting care services and ordinary daily living supports; the former would be subsidised and clients would pay Continue reading »
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A landmark event in global public health is taking place in Panama City on Feb 5-10: the 10th Conference of Parties (COP10) of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Since 2003, the FCTC has been ratified by 183 countries, and all of them, including China, have made steady progress in monitoring tobacco Continue reading »
Environment: Humans don’t make history – we play host
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As well as us, the government is betraying our children and they are our future
Under the headline ‘Experts Lament the Appalling decline of the health of under fives in the UK’ the Guardian draws attention to the Academy for Medical Sciences report highlighting the widespread obesity and the rampant dental caries in so many of our young. Not only is this harmful for our children, it is also harmful... Read more
GPs in England at ‘Breaking Point’ Amid ‘Collapse in Morale’
Primary care doctors in England are feeling “despondent” and feel unable to provide adequate care given the current pressures on workloads and funding, Byline Times has been told.
GPs and emergency doctors are picking up the pieces amid long waits for operations, as well as a crisis of mental health underfunding, according to testimony shared with this newspaper.
And a significant number of GPs are leaving permanent positions for locum roles (filling in for those ill or on leave), or leaving clinical careers altogether amid unsustainable workloads and heavy admin burdens.
Dr Kath Fielder, a GP in the north-east, told an EveryDoctor survey for Byline Times: “Everyone I know who is a GP is very tired, despondent and weary. I actually think the predominant emotion is sadness. Nothing works like it should and it’s truly heartbreaking seeing patients receiving substandard care from the entire NHS.
“We in primary care have become a holding bay: for people waiting years instead of months for urgent procedures; managing people with significant mental health problems because they aren’t 'bad enough’ to reach the threshold for a massively under-funded CAMHS [Child and Adolescent Mental Health Services]; writing appeals for PIP [Personal Independence Payment] because so many people are losing their benefits.”
She compared the situation to “handing someone a thimbleful of water when their house is on fire”.
“I rarely send patients to hospital but, when I do, I am truly shocked at how many are sent straight home again," she added. "And this is not criticism of the hospital staff. I know they will be under incredible pressure not to admit anyone and there won’t be any beds for them to lie in. Whilst this is happening we are having increasing restrictions in what we can prescribe; where we can refer and impossible targets to attain.”
Dr Kath Fielder: “Everyone I know who is a GP is very tired, despondent and weary...Nothing works like it should."
Some GPs are now “unable to work” given the conditions, and many more are swapping permanent posts for temporary or ad hoc work.
Asked what the biggest challenges for her practice are right now, she added: “Not being able to give the care we want. It’s that simple.”
Dr Nicholas Souter, a GP based in the south-west, said GP practices had increasingly been incentivised to hire less-qualified Associate Physicians or Advanced Nurse Practitioners (ANPs) over GPs as they were cheaper to employ.
It comes as a new British Medical Association survey of 18,000 doctors found that 55% of respondents said the employment of PAs (physician associates) and AAs (anaesthesia associates) in their workplace had increased their workloads, rather than reduced them.
Just 21% of doctors responding to the survey said the presence of these staff had reduced their workload.
Along with complaints over increased workload, the BMA’s survey also highlighted serious concerns about the use of PAs and AAs regarding patient safety.
Among doctors working in primary care (typically GPs and A&E doctors), 90% told the BMA the way that PAs were being employed in the NHS was a risk to patient safety, with 82% believing PAs frequently or often worked beyond their capabilities.
Dr Souter pointed to a recent case of two ANPs analysing a patient’s bloods, which they said “showed a build up of toxic substances''. One told the elderly patient that her life was under threat and she must go to hospital.
Dr Souter said: “I looked up old bloods and noted this lady had chronic kidney disease.” Her blood toxin levels were always that high – in fact, they were usually higher. “She did not have acute renal failure… So this ANP-to-ANP discussion was all a misunderstanding – the Advanced Nurse Practitioners was reviewing bloods taken by another ANP and neither knew the difference between chronic renal failure and acute renal failure.
"The poor woman was stressed, her family was stressed, an unnecessary ambulance had been sent, an OOH physician had been kept busy.”
The GP said practices should “never” be allowed to have less-trained ANPs outnumbering GPs “but of course, while the Government is under-funding GP practices there is no way to resolve this”.
However, one GP said that recruitment of Physician Associates – which was ramped up following the 2019 Government contract with GPs – followed “years of practices struggling to recruit salaried doctors”.
Another added: “The GP contract has generally speaking buggered up our practice as the funding has not matched the demand. That said, so many factors are making GP a nightmare to work in (and manage) that pulling out one strand is very difficult. PAs in the surgery are very hit and miss. We have had two that have been utter disasters, making more work by wanting constant intervention on the part of their supervisor for the days, having a long list of things they won't do, and referring all kinds of things that don't need referring.
“We have, however, had one who is an absolute legend and has been a pleasure to work with – we wouldn't lose her for the world. The problem is that you don't know what kind you are going to get.”
Six other GPs who spoke to EveryDoctor, and who wished to remain anonymous to speak more freely, echoed these concerns – noting GP practices are struggling to recruit salaried doctors, leading many trainees to choose locum positions for a better work-life balance. This has left full-time partners working extensive hours with additional unpaid admin work.
GPs also pointed to the Government’s 2019 contract with GPs, which they claim has not matched funding with demand.
Several GPs said the current workloads were destroying morale: “On top of my daily appointments, home visits, supervisions, quick reviews, [and] prescribing for the team, I regularly have five to eight sick note requests to action, 50 [test] results and 20 to 30 letters to look at. District nurses tend to send me messages multiple times a day too.
“There has been a huge exodus of GPs in our area so anyone I’m working with is usually newly-qualified. They can’t seem to work at pace, having been trained in the pandemic. I’m frequently having to mop them up too when exhausted or upset over vexatious complaints. Our biggest challenge is retaining GPs because of the above. One has just resigned and is going abroad.
“Morale is terrible. I’m lucky because I have been at my practice for nearly 10 years so most patients are appreciative. But the general public view is we’re rubbish but at the same time want us to do everything/fix everything… and so do secondary [specialist] care.”
In another practice, a doctor described how they have seen a large rise in turnover of GPs: “We have managed to recruit several GPs to replace them… but not in full capacity, because we cannot afford to recruit as many as we need. The new GPs are very recently qualified and so need peer support.”
And they claimed that the recent 6% pay rise for NHS staff in England is not being fully funded by NHS: “[It does] not cover our costs by a long way. Someone at NHS England decided staff costs are about 40% of income. [It’s] more like 60 to 70%. As a result, you are left with a huge dilemma. Our hard-working staff deserve a pay rise but we can't afford it without losing staff to pay for it?”
A&E specialist doctor Dr Huw Evans, based in the West Midlands, said workloads in NHS hospitals meant care expectations had fallen through the floor. His department is constantly under-staffed, with significant vacancies among specialists, he said.
The failure to invest in infrastructure after years of austerity is also visible, with Dr Evans noting: “There are numerous buckets under holes in the roof” of the hospital.
Dr Huw Evans says buckets fill with water from leaks in his hospital due to crumbling infrastructure
“Patients are missing out on the professional relationships that used to be commonplace in the community. As a result, they come to [Emergency Departments] – we never close – where problems that could be dealt with in a few minutes take many hours to sort out."
The breakdown in primary care, including huge delays to get GP appointments, in turn slows down care for those who really need emergency help, he said: “The sight of queued ambulances is the most visible aspect of this. We are not able to offer the level of care that we would wish and have given up on the 'Gold Standard’ aspirations. It used to be that a four-hour breach would cause castigation. Now, any patient who is not a 12-hour breach is a cause for celebration.
“I have worked for the NHS for over 30 years. The NHS is sinking like the Titanic, holed by the iceberg of under-investment. Captain Sunak [is] putting his telescope to his blind eye, telling us he only sees clear water ahead.”
Dr Julia Grace Patterson, EveryDoctor's chief executive, told Byline Times that the Government's "political actions" had "decimated" the NHS.
“NHS GPs are absorbing an enormous amount of pressure currently," she said. "They are doing everything they can to keep patients safe, but this becomes more and more challenging as the situation evolves. The Government is not supporting the current GP workforce, they are often scapegoated for problems that they have not caused, and there is now a move to flood the NHS with non-doctor clinical decision-makers, which is exacerbating the situation.
“Every healthcare professional has a role, and within a fully-functioning NHS with abundant resources, physician associates would be a welcome addition to clinical teams. We definitely hear about some places in the NHS where they are highly valued. However, in many NHS facilities, the burden of responsibility for supervision of their work falls to doctors. This is hugely labour-intensive and even dangerous, given the pressure on the NHS, the rate at which staff must work, and the potential for diagnoses to be missed and patient safety problems to be caused.
“Morale amongst GPs is very low, and the situation must be urgently tackled. The Government must listen to frontline GPs and healthcare leaders to rectify the situation. Politicians are profoundly failing NHS staff and the patients they are devoted to caring for.”
Commenting on concerns over the roll-out of Physician Associates, a Department of Health and Social Care spokesperson said: “The role of Physician Associates is to support doctors, not replace them, and they make a significant contribution to the NHS. PAs work alongside doctors providing medical care as an integral part of the multi-disciplinary team. They carry out clinical duties such as taking medical histories, carrying out physical examinations, and developing and delivering treatment and management plans.
“Regulation of these roles has cross party support and will boost patient safety, with the General Medical Council operating strict fitness-to-practice procedures and setting education and training standards.”
The Government’s Long Term Workforce Plan aims to increase the Physician Associate workforce in England to 10,000 by 2036 to 2037, and the similar Anaesthetic Associate workforce to 2,000 over the same period.
Officials say new regulations will give the General Medical Council responsibility and oversight of doctors, PAs and AAs, allowing it to take a “holistic approach” to the education, training and standards of the roles.
The testimony from GPs and patients was gathered by EveryDoctor
Do you have a story that needs highlighting? Get in touch by emailing josiah@bylinetimes.com
Sunak admits failure
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