Virtual visits: Telemedicine gives EMS provider another option for mental health services
One therapist shares why virtual meetings work so well for EMTs and paramedics
For firefighters, EMTs and paramedics, the COVID-19 outbreak couldn’t have come at a worse time.
The fire and EMS services were already seeking answers for two significant challenges, among many others, facing their members: the increasing number of both firefighter and provider suicides and firefighters being diagnosed with cancer.
And providing an undercurrent to both of those threats to health and wellness has been the increasing awareness of the impact that emotional trauma is having on first responders everywhere.
Then, just as some momentum was starting to build for providing better mental and behavior health services for first responders, and breaking down the stigma associated with receiving such services, the COVID-19 pandemic shut down such in-office treatments.
Virtual mental health services
With so many everyday activities – from schooling children to work meetings to musical performances – going online, it should come as no surprise that someone thought to taking health service online as well, what we now know as telemedicine.
One practitioner using telemedicine is Dr. Cody Todd of Batavia, Illinois, who started using telehealth (her term for telemedicine which we’ll stick with in this article) in mid-March to continue serving her clients. I recently had the opportunity to talk to Dr. Todd about the switch and how it’s working for her and her clients.
FR1: Tell us a little bit about your practice in general? Who’s your client base?
CT: Fire and EMS are my focus. Occasionally, I’ll take on a law enforcement client, but as you know, policing and firefighting are simply different animals. And so grouping them as first responders where people [other therapists] are like, “I work with first responders,” that’s great, but there are some distinguishing factors between what police are asked to do versus what fire does versus what EMS does, though fire and EMS are more closely grouped together. I would say my practice in general is probably 95% fire and EMS.
Can you share some insight into this methodology for delivering and receiving mental health services online?
In general, telehealth was relatively new to the field. None of us were doing this on the regular basis prior to the COVID-19 outbreak. And there was a little bit of a stigma about any practices that were doing it [telehealth] because, not unlike the fire service, anything that's new we’re like “That’ll never work here.”
So pretty much prior to COVID-19, none of us were doing telehealth, and so we were all a little hesitant, and I know even within myself I was [hesitant].
There isn't a lot of existing literature in terms of how does telehealth work for us [mental health professionals and our patients]. Is it as useful and are our patients going to be getting the same level of care as when we saw each other in person?
So, what’s the experience been like?
From what I've seen over the last couple of weeks, especially with my patients, most of whom were already established with me [through in-person sessions], is that we’ve not seen much of a difference between in-person sessions and telehealth sessions. And I have taken on some new clients over telehealth, whom I have not met in person, and I have the sense that there’s no difference in the service I’m providing to them.
What have been some of your initial impressions about using telehealth to serve your clients?
I’m in Illinois and for us, telehealth can be done by phone or video platform. And the interesting thing, to me, is that it’s giving people more options in terms of the way that they want to take in content.
I've seen some of my clients do some really “whopper” work, work that we've been trying to get after for a while, because they were doing it from the comfort of their home. So, rather than all the “pomp and circumstance” involved with the time and effort of driving to an office, being in this place [a professional office], and all of that, it’s more productive time for me and them.
Interestingly, with telehealth, my patients are also seeing me within my own home, so there's like this extra level of humanity that had been introduced into the “room.” And that’s been remarkably interesting to me, just as a therapist, seeing how this new dynamic has played out. At least that’s my observation, and I literally started doing telehealth sessions on March 20, and prior to that day I'd never done telehealth.
Having made those observations, do you see telehealth as an ongoing treatment option?
I personally think it's great and it's going to remain a permanent part of my practice moving forward. I am going to go back into the office at some point, but like I said, some of the interesting things have been seeing people really push through and do some really good work – work that maybe they wouldn’t have done had they felt pressured, you know, sitting in a room with your therapist versus having that distance between you [when using telehealth].
From the other side of the conversation, what have been the impressions from your clients who engaged with you using telehealth?
I think initially we all were just like this, “This is kind of weird,” but once we just kind of acknowledged it, people just continued to do their work and I honestly haven't seen anyone slowed down by it.
I think some people are probably going to stay with telehealth because they don't have to find childcare and they can take an hour [for their telehealth session] versus you know the time to drive to the appointment, do the appointment, and then drive back to work or home or wherever.
I’m sure some folks are going to want to resume in-person sessions when that’s an option for them again and they're going to come back.
In some ways, they said things felt normal, and it was because it was like the normal thing [meeting with their therapist] that they were doing prior to COVID-19, and it was something they could continue to do. They could continue to invest in themselves, they could continue to learn, they could continue to heal, and so I think that that offered something as well.
It gave them continuity.
Yes! There were some telehealth platforms that existed [before COVIV-19] that were encrypted and HIPAA-compliant, so there wasn't a break in our day. I didn’t stop seeing patients for like two weeks and then we continued. We just went straight through [from in-person sessions to telehealth sessions], so at least that part was sort of normal.
What are some of the positives that you’ve seen with telehealth sessions that firefighters should know about?
I think the anonymity that telehealth provides is particularly important to firefighters. Nobody wants to be seen sitting in the therapist’s waiting room by another firefighter, right? Or passing each other in the hall because one of you is coming to see me and the other has just left my office, because there’s still that stigma about firefighters and mental health and getting help. So, we still have a lot of work to do on that and I think telehealth should be a big part of that conversation.
The other positive that I see is that it can give firefighters more flexibility to have therapy sessions and do their work with their therapist while avoiding conflicts with their work schedules. And we know that in many cases, the challenges also come from working two jobs, working and going to school, and trying to coordinate schedules with their working spouse and children.
Any parting words for our readers?
Get help. Whether it’s in-person therapy or telehealth, get help if you think you’re struggling. And make sure the therapist is a good fit for you because that relationship is the basis for getting you back on track.