On Feb. 27, the World Health Organization warned that the novel coronavirus, or COVID-19, had the potential to balloon into a global pandemic. The same day, the U.S. ramped up testing, and the stock market experienced its worst week since the financial crash of 2008.

On UNLV’s campus, these messages reached psychologist Dr. Michelle Paul, director of The PRACTICE Mental Health Clinic.

“On that day, and maybe even a few days before, we started contingency planning,” Paul said. “We beefed up our clinic policies around sick leave, purchased more hand sanitizer stations, and increased our cleaning routine.”

More importantly, however, Paul and her team began conversations around the possibility of delivering clinic services 100% virtually.

For Paul and her students, it wasn’t a new concept. The PRACTICE — a community mental health training clinic — has been providing telemental health services since 2012 through its partnership with Communities in Schools of Northeastern Nevada.

Through the partnership, staff and student clinicians deliver telemental health care to students with the Elko and Humboldt County school districts.

“We’ve seen good outcomes over the past seven years with the kids we’ve served in rural areas of the state,” Paul said. “The outcomes have been universally positive, and we were able to draw on our experience in this area to get telemental health services in place for our patients locally.”

From Feb. 27 through March 16, Paul and her team worked quickly and efficiently to ensure that the clinic would remain open, even if its in-person operations ceased, and its physical facility closed.

They updated their telehealth policies, bolstered their HIPAA-compliant technology and platforms, notified clients, and developed an internal protocol for how students and supervisors would work with patients remotely.

So they were ready — March 16 — one day before Nevada Gov. Steve Sisolak closed nonessential businesses in the state, and asked residents statewide to stay at home. The clinic was also prepared to follow UNLV’s direction for employees to work remotely and for the university to streamline essential services for students.

“We’ve been able to create distance without being completely separated from our patients,” Paul said.

Therapy in virtual spaces

Ensuring continuity of psychological services is vital, she said, especially in a crisis like the coronavirus pandemic, and also in a state like Nevada, which ranks 51st in the nation for access to quality mental health care.

“The people that are coming in to see us are already suffering from psychological distress, and the COVID-19 crisis adds on an additional layer of stress and worry,” she said. “Some of our patients were already vulnerable, so we can’t abandon them now, especially when we have the resources to provide them with the psychological first aid that they need.”

Telemental health services are effective in most regards for diagnosis and assessment, across many populations and in disorders in many settings, according to 2013 research by the University of California-Davis.

“Effective therapy can be done in virtual spaces,” Paul said, adding that insurers such as Medicaid have loosened restrictions on telehealth care in light of COVID-19. “Providing telemental health services helps to expand access, save time, and potentially shorten wait times.”

Paul has witnessed positive results not only from individual sessions, but also from remote consultations and group psychotherapy. A pilot program offered to students of Roseman University gave busy students the opportunity to schedule remote mental health consultations to assist them in coping with the stress of graduate study. 

Through the program, students could conveniently access mental health support over a break between classes.

“Services like this show that even in an urban setting – when traffic or parking is bad, or work is busy, it’s possible to see a mental health provider,” said Paul. “It can be the difference between getting help and not getting help.”

Furthermore, much can be accomplished, Paul said, in a remote, group psychotherapy session led by a skilled leader who can successfully navigate interpersonal dynamics in the context of a larger group.

It’s another way that The PRACTICE has been innovative, as virtual group psychotherapy is still a nascent concept for most clinics around the country, she said.

“I think the profession is just starting to sort out the efficacy of conducting groups remotely,” Paul said. “And with COVID-19, the field is kind of being pushed to answer those questions even more quickly.”

“We’re all going to be forced to think about the manner in which health care is delivered, not just in Nevada, but across borders and even globally,” she added.

Paul is hopeful that her clinic, and others around the country, will come away from the COVID-19 pandemic with lessons learned, and ideas for how to advance telemental health care. She’s also hopeful the clinic’s ability to nimbly respond to the current crisis will make her student clinicians prepared like never before to work in the local community as mental health care professionals.

“I’m immensely proud of our staff and students,” Paul said. “I think we have worked very hard to be a piece of the solution to Nevada’s mental health and mental health workforce crisis by being innovative. Our innovative practices set us up to be ready for this community crisis, and be an example for other clinics looking to be a solution, too.”