The Virtual Way to Getting Better: Helping Reduce Health Disparities Online

The Coronavirus (COVID-19) has markedly altered the landscape of mental health care in the United States. Since the start of the pandemic, a large proportion of therapeutic services have moved online, facilitating treatment at a time when in-person services are less accessible but mental health needs are growing, in no small part due to the widespread effects of the pandemic, including social isolation, financial stress, and loss and death to the disease.

Treatment use and engagement has been historically low among people of color due to factors like lack of availability of, and accessibility to quality and affordable care, stigma about mental illness, as well as experiences of racism and discrimination in therapy settings. For many, these longstanding obstacles to care become all the more intractable when compounded with the massive burden of a global pandemic disproportionally affecting their communities (Centers for Disease and Control Prevention, 2020; Substance Abuse and Mental Health Services Administration, 2020). This presents us with the challenge of finding ways to prevent the health disparities long plaguing people of color from becoming even more pronounced in the face of COVID-19.

A study by Jonassaint and colleagues (2020) focusing on health disparities in the context of virtual mental health care may very well offer a glimpse into how members of traditionally underserved communities may be able not only to access, but benefit, from therapeutic services in the COVID-19 era. Specifically, this study sought to examine racial/ethnic differences in the effectiveness of a computer-based Cognitive Behavioral Therapy (cCBT) program for adults suffering from depression and anxiety in primary care settings. African American and White primary care patients with elevated depressive and/or anxious symptoms were randomly assigned to one of three interventions: (a) a 24/7 cCBT program delivered under the guidance of a care coach (i.e., a college graduate with previous mental health experience), (b) the cCBT program plus access to a moderated internet support group, or to usual care under their primary care physician. Similar to traditionally CBT, the cCBT program consisted of eight 50-minute interactive online sessions, complete with homework practice and six months of remote support after termination.

Findings showed that African-Americans uniquely benefited from participation in the cCBT programs, with improvements in anxiety, depression, and mental health-related quality of life that persisted six months after treatment. The positive effects of cCBT observed for African Americans in primary care did not emerge for their White counterparts, nor were these differences explained by the number of sessions or the frequency of support by the care coach. Differences in treatment effects between African Americans and White were partly attributed to usual care yielding improvement in mental health for the latter, but not for the former. These findings speak to the impact that awareness and availability of mental health services in primary care settings can have for African Americans previously deprived of access to quality mental health care. That is, just knowing about and having the option of mental health screenings and supported interventions makes a positive difference in the mental health outcomes of African Americans.

Evidently, the capacity of professionally-supported online interventions to better serve members of a long underserved community in African Americans starts with making the mental health information more readily available to this population in the first place. Treatment developers should aim to design low-cost interventions that can be smoothy disseminated into general healthcare settings such as primary care offices, free clinics, and community health centers. Maximizing awareness of such treatment options among African American should be a key piece in any implementation plan, given the demonstrated impact of exposure to available mental health services. As for mental health consumers, the option of online-based and similar technology-facilitated treatments can prove a more convenient and less daunting introduction into mental health care from which they can garner benefits. In addition to accessibility, this kind of online interventions may also have some potential to help offset or minimize other treatment barriers, such as mental health stigma and experiences of discrimination and bias.

In conclusion, internet-delivered intervention program like the one in the study discussed here introduce a potential avenue for facilitating not only access to care, but access to effective care for African Americans. Notably, this type of online-based therapy might prove particularly beneficial in these uncertain times, when access to services of any kind is limited due to constraints imposed by the ongoing global crisis that is COVID-19. With mental health care expanding online like never before, the time is ripe for the increased implementation of this and similar internet-delivered therapies into primary care, from which more people of color may derived benefits—thus helping address some of health disparities afflicting these communities.

Reference Article

Discussion Questions

1. Can the benefits of cCBT and similar internet-delivered programs observed for African-American primary care patients also extend to members of other underserved racial and ethnic groups? If so, what are some key considerations to be made in any efforts to implement this type of interventions with other populations?
2. In what ways can we capitalize more on primary care settings as a channel to mental health treatment? Should greater resources be allocated towards the implementation of assessment and intervention efforts in primary care?
3. Of the factors perpetuating disparities in mental health care for people of color (e.g., affordability, stigma, discrimination), which can internet-delivered treatments like cCBT help mitigate the most? Which factors are less likely to be impacted by this breed of intervention? Could new barriers to treatment emerge?

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References Cited

Centers for Disease Control and Prevention. (2020). COVID-19 Hospitalization and Death by Race/Ethnicity Hospitalization and Death by Race/Ethnicity. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

Substance Abuse and Mental Health Services Administration (2020). Double Jeopardy: COVID-19 and Behavioral Health Disparities for Black and Latino Communities in the U.S. https://www.samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf

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