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Therapy Demand Has Led to New Methods in Lieu of Traditional Mental Health Care


Since the start of COVID-19, many individuals have experienced higher levels of depression and anxiety. A survey conducted by the American Psychological Association (APA) found that three-quarters of psychologists who treat anxiety disorders reported an increase in demand for treatment, while 60 percent of those who treat depression saw an increase in demand.

When the pandemic first began, providers like Lily Brown, PhD, an assistant professor of Psychology in Psychiatry and a director at the Center for the Treatment and Study of Anxiety (CTSA) in the Perelman School of Medicine at the University of Pennsylvania, and Thea Gallagher, PsyD, an assistant professor of Psychiatry at Penn and a director at the CTSA, saw an immediate increase in individuals who sought therapy. But with restrictions and lockdowns, it made getting patients in for therapy sessions more difficult.

“Across the country, while the pandemic and uncertainty loomed, so many people were brave enough to reach out for the first time for help. At the same time, mental health experts have had a challenge trying to juggle such an increase in demand,” Gallagher said.

Brown added, “It was a really painful time for therapists to be in a position to tell people, ‘we just don’t have the capacity.’”

In response to the pandemic, emergency orders were put into place allowing the use of telehealth services. While the technology has been in use for years, this emergency order opened the doors to help provide more treatment options for the many new patients grappling with mental health issues. Some barriers to treatment remained, such as waitlists due to limited availability of therapists, but telehealth services have been able to help combat some other common barriers for treatment access, such as travel and time commitments.

“Many individuals were able to receive therapy for the first time due to the availability of telehealth. Telehealth offers more flexibility to patients, who may only need to take off an hour from work or childcare. Plus, research has demonstrated that telehealth is equally efficacious compared to in-person therapy,” Brown said.

Mental Health Support for Frontline Healthcare Employees

The pandemic proved to be an extremely trying time filled with fear and uncertainty for many essential workers, specifically healthcare employees, who were on the frontlines. Penn Medicine recognized this and aided in this effort through a comprehensive website called PennMedicineTogether created by the Workforce Wellness Committee to provide support to staff and families, including carefully curated resources for individuals who might be on therapy waitlists or unable to have one-on-one treatment at that time. PennMedicineTogether also points employees to virtual mental health support, via Penn COBALT.

Within two weeks from concept to launch, Penn COBALT was created to serve as a virtual mental health platform for the entire Penn community to utilize. Peers, resilience coaches, therapists, and psychiatrists were all readily available for support with the option of anonymity.

Since the launch, approximately 10,000 employees (roughly one in four) have accessed COBALT as a resource. Not only has this site been used to help individuals cope with the stress of the pandemic, but also the death of George Floyd, protests around racial injustice, and election-related stress this past fall.

Kelley Kugler, senior innovation manager at The Acceleration Lab who oversees COBALT said, “This isn’t just a pandemic response; this is a comprehensive tool for everything happening in the world.”

The success of COBALT can be attributed to the multitude of different services available and tailored to what that individual needs. To date, COBALT has facilitated over 1,400 self-scheduled one-on-one appointments with mental health and wellness providers. Of those appointments, 22 percent were with non-clinical, volunteer resilience coaches; 53 percent were with psychotherapists; and 24 percent were with psychiatrists or psychiatric nurse practitioners. The remainder were with chaplains, peers, exercise physiologists, nutritionists, pain management specialists and other providers that made their time available to support the health and wellness of the Penn community during this challenging time.

COBALT now hosts over 150 resources that are available to an individual on their time. The available resources include group sessions on various topics, as well as requested personalized sessions for individual groups, podcasts, mindfulness sessions, along with videos and articles that are readily available whenever needed.

“Through COBALT, we’ve learned the variety of support patients are looking for these days. Reworking how we think of therapy with a platform like COBALT has helped create a greater spectrum of care. We may see treatment options like COBALT move into patient care in the future,” Gallagher said.

COBALT continues to adapt to the needs of each individual seeking help. The site and services provided are currently transitioning to a longer term sustainable model. Instead of relying on passionate individuals volunteering their time, they will now have their time and expertise appropriately acknowledged, supported, and compensated.

“Nontraditional mental health services that organizations like Penn Medicine have implemented aren’t going anywhere, if anything they will become more robust,” Kugler said.

Mental Health Care Post-Pandemic

While COVID-19 case numbers are finally dropping, experts are preparing to continue supporting the increase in demand for mental health support.

“What COBALT and other nontraditional mental health services have showed us is that it is important to provide a spectrum of care and services for people. Not everyone needs a full round of psychotherapy. Some people benefit from self-directed resources, resilience coaching, therapy skills groups, support groups, or psycho-educational videos, for example,” Gallagher said.

There is one other silver lining to the increase in therapy demand. With the rise for therapy services continuing, therapists like Brown and Gallagher hope to see stigmas continuously broken surrounding mental health as the future of mental health care evolves.

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