The state of mental health care in the U.S. is dire, and with the telehealth prescription waivers projected to expire at the end of the year, it’s only going to get worse. If a temporary extension is granted, we can leverage technology and present data for clearer decisions moving forward, if it is not, we are leaving patients and clinicians without a clear understanding of how to care for their patients and communities.
According to the 2023 State of Mental Health in America report from the Mental Health Alliance, 21 percent of adults are experiencing a mental illness (over 50 million Americans), with 55 percent of them not receiving treatment. Compounding the issue, there are 350 people for every one mental health provider in the country, resulting in more than half (169 million) of the U.S. population living in a Mental Health Professional Shortage Area.
Quality virtual care is indispensable for providing comprehensive care for mental health conditions in the U.S. and essential for eradicating the mental health crisis. The demand is evident, with adult ADHD evaluations seeing an increase of 400 percent since the PHE, and mental health conditions account for the top telehealth diagnostic category across the country.
ADHD is one of the most addressable behavioral health conditions and commonly co-exist with other disorders, making it imperative to prioritize not only its management but also access to treatment. A final ruling from the DEA that strips all prescribing privileges from virtual visits or non-actions resulting in the expiration of the waivers, which include medications for treating ADHD, could result in the worst possible outcomes for telehealth care and the patients who rely on it for their treatment.
It is a misconception that there are no solutions to address and standardize the quality of virtual care or that virtual care cannot deliver the same quality of care provided in a clinic. Validated, evidence-based, FDA-cleared assessment and monitoring technology exist that telehealth prescribers can use not only to maintain but improve the quality of virtual visits and standardize ADHD care and treatment.
“There was a lot of talk about providing access during the pandemic,” shared Dr. Ben Cheyette, a psychiatrist and the director of ADHD Programming for Mindful Health Solutions. “The question is access to what? Is it just prescriptions? We should be talking about access in the context of safety. Safeguards exist, and we should be using them.”
Data has been presented: quality care, regardless of setting
Last fall, the DEA hosted its listening session on telehealth prescribing after receiving more than 38,000 public comments urging the organization to maintain flexibility in its rules. My organization, Qbtech, was one of 64 selected to share data on the value of telehealth for ADHD patients and tools that support diagnostic validity. We believe we were chosen because our FDA-cleared tools are treatment and setting agnostic and to highlight currently available safeguards for prescribers. This summer we presented again to the OMB, sharing more recent and relevant data around monitoring of ADHD treatment in remote settings.
Both in-clinic and virtual objective ADHD testing measures have been medically evaluated for their effectiveness in aiding ADHD diagnoses and monitoring treatment effectiveness. A recent systematic review of in-clinic objective ADHD testing shows that these tests can determine pharmacological treatment effects within hours of pharmacological titration, which can be used in the long-term monitoring and treatment of ADHD patients.
Additional research indicates that in-clinic and virtual objective ADHD testing are likely more sensitive to physiological changes and could be effective in the early detection of treatment effects, leading to quicker dosage optimization. We will continue this data collection and further development of the evidence base around treatment monitoring.
“In today’s evolving health care landscape, telemedicine presents a unique opportunity to harness rich patient data to advance precision care,” said Georgia-based pediatrician Dr. Melinda Willingham. “By considering data as a vital component in both assessments and treatment response, we empower health care providers to tailor interventions with greater accuracy, elevate the standard of care, and ultimately improve patient outcomes.”
Based on our experience with more than 12,000 clinicians globally, companies and clinicians should consider adding a level of assurance to their clinical practice. This highly visual data can act as an anchor point between patients, referring providers, therapists, prescribers, pharmacies, and policymakers. Leveraging data better informs treatment and enhances patient outcomes, including those receiving care for ADHD.
The next steps for telehealth care
For 20 years, we have supported clinicians across the globe who are focused on high quality, standardization of practice, and incorporating objective data and processes in ADHD care, giving us an acute understanding of the impact this could have on them and their patients.
FDA-cleared objective measurements ensure precise dose optimization and mitigate over-treatment. This type of high-quality, measurable data can safeguard virtual prescribing practices.
“When it comes to ADHD care, this whole event highlights the need for proper diagnosis, better education, and standardized guidelines for this condition,” notes Dr. Perry Roy, an ADHD specialist and board-certified internal medicine specialist practicing in North Carolina.
In agreement with tens of thousands of ADHD advocates and clinicians, we advocate for permanent access through an extension with required safeguards to ensure that access is guaranteed and care is delivered at the highest level of quality. Incorporating evidence-based, regulated, and innovative technology that enables thorough and objective diagnostic evaluations should be required for all ADHD virtual care visits, leading to safe, effective, and accessible care.
Now is not the time to harken back to pre-pandemic protocols. We must embrace the advancements that have transformed how we live today, with safeguards in place, to create a better tomorrow.
Mikkel Hansen is a physician executive.
