The COVID-19 pandemic has globally altered our daily interactions. We have had to re-imagine our living and working conditions. Due to the possibility of high-risk exposure, many Americans have shifted from the workplace to telework. According to the U.S. Census Bureau, approximately one-third of U.S. households reported working remotely since the beginning of the pandemic.1 This trend has also reformed mental health services. In 2020, telehealth services increased by 154%.2
However, structural patterns highlight economic disparities—individuals with higher educational backgrounds (Master’s and Doctoral degrees) and socio-economic status report greater access to teleworking. These dissimilarities also reflect the cultural undercurrent of intervention disparities. Considering the sociohistorical context of mental health disparities among marginalized communities, we can assess the structural impact of technological advancement on these individuals’ mental health treatment. This article aims to highlight the importance of technological advancement in increasing accessibility of services for Black youth.
What is Telehealth?
Telehealth is any technology that virtually connects a client to their mental health provider. Individuals are provided with the ability to interact via text, video chat, and other communication devices. Telehealth can be operated through computers, tablets, or smartphones. This may take the form of applications where the client interacts with an interface designed to address specific mental health concerns.3 This includes mental health mood apps, online meditation guides, virtual daily journals, mental health checklists, and other electronic tools.
The Accessibility Problem
Mental health services have historically been inaccessible and expensive for underserved populations. The American Psychiatric Association (APA) asserts that ethnic and racial minorities experience psychological health disparities, including later diagnosis of mental health disorders, misdiagnosis, increased chances of disability resulting from mental illness, and increased criminalization and incarceration.4
Approximately 30% of Black Americans live below the poverty line and 11% do not have medical insurance. These statistics underline a pattern of discrepancy of services and access. For example, Black Americans are more likely to frequent community-based clinics and hospitals rather than private practices. Lack of transportation, limited access to locations, and low funding re-enforce racial disparities. Concurrently, the inaccessibility of private practices and research facilities excludes Black people from evidence-based treatments, research, and clinical trials.
In addressing the rise of suicide among Black adoelscents5, it is imperative consider the impact of structural stressors and mental health disparities. Black youth experience higher academic drop-out rates, increased disciplinary action, and isolation within the therapeutic process.6 Telehealth services have been able to address this inequality by expanding accessibility to Black youth and creating a safe space of familiarity, which reduces stressors related to seeking treatment.
Telehealth Services & Reduction of Disparities Among Black Adolescents
As more Americans receive access to technological devices such as phones, tablets, and computers, telehealth services demonstrate an effective shift in treatment. Technology reduces the stressors of transportation, time consumption, and locality.7 In the case of adolescents, clients can focus on academics and work without the added stress of navigating transportation to treatment.
Another positive effect of technological services is increased independence supported by a collaborative treatment approach. For the younger generations, the use of technology is an integral part of their maturation. They use technology as an exploration of play, to interact with their peers, and to acquire knowledge about the world. Their familiarity renders telehealth as an easy medium to navigate. As a result, this increases the autonomy of the adolescent client.
In addressing suicidal behavior, we acknowledge the importance of autonomy in the therapeutic process. As is evident with CAMS-Care, a collaborative framework in treatment supports a healthy client-clinician relationship.8 One-on-one and virtual interactions give the client greater involvement in the process. A client will be more integrated into their own treatment plan if they are tasked with inputting data into an app to record their emotional regulation or if they receive a virtual invite to a video chat with their therapist.
Telehealth acts as an intermediary, providing services. By removing the barrier of “in-service” treatment, technology disperses the accessibility of mental health treatment to a greater number of clienteles. For example, evidence-based treatment can now be accessed virtually by individuals who might not have been aware or targeted by relevant providers. The accessibility of treatment via telehealth is reflected in the cost-effectiveness, reduction of daily stressors, and increased preventative/intervention care. This all positively impacts the long-term effects and stability of mental health.
Addressing the Cons
There are some concerns with telehealth that should be addressed. As with all mental health services, the client needs confidentiality and privacy. There must be safeguards in place to regulate cybersecurity. The threat of lost or stolen information can disrupt the client-provider relationship and cause immense damage. Safeguards such as secured passwords, encrypted sites, and backed-up information can help reduce cyber issues. Although many Americans have access to electronic devices, sometimes these connections are not secure or fully functional. This can cause problems with telehealth services, but the mental health provider can discuss how to navigate any technological issues with the client.
As professionals, we learn to adapt to our clients’ needs. As a natural progression of the scientific methodology, the mental health field has experienced paradigm shifts. Due to the exposure risk of the COVID-19 pandemic, the field has been propelled towards telehealth services and has taken advantage of the benefits of technology.
For Black youth, mental health treatment has been inaccessible, alienating, and stressful. The growing trend of suicidal behavior among Black children and teens highlights the importance of acknowledging structural stressors such as institutional bias and economic strains. A primary framework of CAMS is to “integrate the therapeutic process as a collaborative approach.” As we integrate the acknowledgment of stress factors for Black youth, we adapt to center our client. This supports the mitigation of disparities and establishes a collaborative, autonomous intervention.