As mental health needs increase, technology offers patients new options for treatment
by Melanie Taussig
In 2010 Mark Nolte was feeling down and dejected. At the time he was working in sales. Like many in search of medical treatment, he consulted his primary care doctor. Ultimately he was referred to a psychiatrist and was diagnosed with depression. Prescribed talk therapy and psychotropic medication, Mr. Nolte’s condition improved and eventually stabilized. He refers to himself as “one of the lucky ones”, knowing all too well the perils that can result from untreated depression.
It was a combination of that personal experience along with a desire to make a career change that prompted Mr. Nolte to start talking, quite literally. “Start Talking” is the name of the company he founded in 2013. It was the ubiquity of technology that drove him to see an opportunity to make talk therapy, a practice that helped him battle his own depression, more accessible to patients. Headquartered in Denver, Start Talking provides counseling services to patients via its online platform. No hardware or software needs to be downloaded; all one needs is a smart phone and a Wi-Fi connection to sign up for Start Talking. The service is conducted in video format, a process referred to as teletherapy. This allows both parties (therapist and patient) to see each other on a device screen. Within 72 hours of signing up, patients have an appointment booked with a licensed therapist. Session lengths vary from 20-60 minutes and Start Talking is compliant with the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA.
Wellness has become big business worldwide. With a hunger from people to be more attuned to their own well-being, there has been an upsurge of online platforms and apps that are flooding the mental health space. To date, Mr. Nolte indicates that consumer response has been positive. He credits that in part to the growing need and acceptance of mental health services. Currently only operational in Colorado, Start Talking has served over a thousand patients and is exploring contracts with community health clinics and nonprofit organizations in rural areas of the state. There are plans to expand beyond Colorado within the next two years.
The availability of Start Talking and similar online therapy models provides another avenue to the consumer. There has long been a stigma associated with mental health treatment and that stigma has been a barrier for many to seek treatment. Mr. Nolte sees online therapy as a way to shatter that obstacle. When it comes to seeking treatment, Mr. Nolte indicates that many patients are fraught with concern about privacy and confidentiality. Online therapy provides a channel that can obliterate that fear as people can schedule appointments electronically and remain within the privacy of their home or wherever they see fit to have a counseling session.
The rural reach
Online therapy allows access to an entire group of people who may otherwise not be candidates for therapy: The rural population. In some rural areas, people may have to travel long distances to see a mental health provider, if there is a provider available at all. It has been shown that rural areas in the United States are facing severe shortages of mental health treatment. One of the goals at Start Talking is to reach a greater segment of underserved populations in rural parts of Colorado. The company has been in talks with various mental health organizations that provide services in some of the less populous areas of the state. In some small towns where “everyone knows everyone,” it can be extremely difficult to establish a confidential patient-provider relationship since there is a great likelihood the patient and provider may know each other in another context.
The ability to access therapy online eliminates the possibility of such an awkward encounter and can offer a sense of security to patients who might otherwise feel as though their privacy could be in jeopardy. “If you’re fortunate enough to have a therapist in your small town the last thing you want to do is go park your car in front of the local therapists office” says Mr. Nolte. He indicates such scenarios are not uncommon in underserved areas.
With a rich abundance of rural landscape together with the sprawling urban metropolis of Denver, Mr. Nolte sees Colorado as an ideal place to serve as the genesis for Start Talking. In Colorado there is opportunity to impact those remote areas where services are lacking. Concurrently, the state encompasses a large cosmopolitan space in and around Denver. This is a region in which private practice therapists are plentiful, which presents Start Talking with ample business prospects in a growing market. The therapists who work with the Start Talking platform are contracted workers and incur a nominal administrative fee to use the platform.
A new way for a growing population
Mr. Nolte attests that challenging system norms and moving to an entirely new way of doing things such as teletherapy can be “a slow process.” He adds, “healthcare is an industry that is resistant to change.” Yet, Mr. Nolte believes that with the population growth of millennials, a generation with a proclivity to technology, there will continue to be an increase in demand for all types of online services, including mental healthcare.
“I think we are in a consumer revolution right now,” says Mr. Nolte. He has given careful thought to the design of the company model and created the Start Talking platform in part, to meet the needs of millennials, a generation that is a substantial makeup of the American workforce. “Millennials want to get ahold of a provider at 10pm on a Saturday night if they need to. They want an appointment now or as soon as possible. This generation is going to demand to do teletherapy,” says Mr. Nolte. He is privy to the fact that technology has created a desire for instant gratification that many people have come to expect in today’s world. This is one reason why Start Talking has a commitment to its customers to offer an appointment within 72 hours. This can be of great comfort to a person in need of mental health care as many providers are booked and it can take 4-6 weeks to secure an appointment in some cases.
Not suitable for everyone but a win-win for some
Mr. Nolte attests that teletherapy is not the best answer for every patient but believes it to be advantageous and an alternative for many. Teletherapy can be a good option for individuals who are stable and do not have risk factors such as suicidal ideation, hallucinations, or delusional thoughts. He explains that individuals who have severe mental health issues probably would be better suited seeing a therapist for an in-office visit. “Teletherapy is really designed for people who have mild to moderate issues,” says Mr. Nolte.
For those who are good candidates for teletherapy, using this type of services has its perks. People who engage in teletherapy don’t need to take as much time off from work to attend appointments nor do they have to worry about transportation, which is one of the main reasons people often miss or cancel therapy appointments. In addition, teletherapy allows patients as well as providers to be more flexible with their schedules. Mr. Nolte surmises these are some of the reasons that cancellation and no show rates with online therapy platforms are some 30% lower than with traditional therapy, a finding that came from the first internal pilot that the company conducted.
Telemedicine, the practice of medical doctors seeing patients via the Internet, has been utilized by providers for several years. Now, teletherapy is starting to catch up. The need for increased psychiatric treatment is apparent in many communities and people are slowly starting to talk more openly about mental health. Many medical practices are moving toward an integrative model, which looks at all aspects of a person including physical, emotional, and social functioning. The accessibility of teletherapy allows medical practices to more easily and routinely consult with mental health practitioners and coordinate patient care. Use of teletherapy also provides ease for practitioners, who can schedule clients on their own terms. Additional benefits include the ability for patients and therapists to adhere to scheduled appointments barring circumstances that would otherwise lead to cancelling an office visit such as bad weather. This allows the patient to remain consistent with treatment and for the therapist to get paid. Teletherapy also can be a means to schedule a “last minute” appointment for a client who is having a mental health crisis.
At current, Start Talking has a contact with one Employee Assistance Program and is working to secure contacts with other organizations. While most commercial insurance companies are not yet reimbursing for teletherapy services, Mr. Nolte expects that will soon change. He believes the healthcare system has long been operating in an antiquated fashion and that the voracious appetite people have for all things technology will further propel the use of online mental health services. When the question is posed, “Is this the way of the future?” Mr. Nolte responds without hesitation, “I think it is.”
To learn more about the services available at Start Talking, click here.
Mark Nolte, founder of Start Talking. Photo courtesy of Mr. Nolte.