It’s no secret that the Covid-19 pandemic caused major disruptions to the many services that Albertans rely on—the delivery of mental health services included.
One of the silver linings of that period was the ability for researchers to conduct what are called natural experiments.
Calgary Counselling Centre researchers have recently published a paper using a natural experiment of patients who received in-person care before and virtual care after the start of the pandemic. It showed that virtual counselling sessions by phone or video call are as effective, and possibly more effective in some cases, as in-person sessions.
“There was so much concern about virtual counselling, because for really since the second world war or before, if not before Freud’s time, this work was all done in person,” said Calgary Counselling Centre CEO Robbie Babins-Wagner.
“The paper help confirms that, yes, we can continue to do that. There aren’t risks to clients, meaning clients are benefiting from care, and they’re happy, and they’re pleased with the outcome of care.”
Published in a top-tier journal
The paper was published by the American Psychological Association.
“This was published in a top-tier journal. Had the statistics and math not been at a high enough level, it would not have been accepted for publication in this journal,” said Babins-Wagner.
Natural experiments are when the natural conditions of the world, which are outside of the control of researchers, lead to conditions that are comparable to those found in controlled experiments. These types of studies are often found in psychology and economics because of the ethical concerns of researchers putting individuals into groups that could have detrimental effects on participants.
Centre researchers used the natural experiment created by the pandemic, and took the increased distress that people felt as a result of the pandemic, into account when researching the efficacy of tele-mental health.
“We actually statistically adjusted for that increased distress, meaning that we looked at whether increased distress was a factor in the positive outcomes. We found that it wasn’t,” Babins-Wagner said.
The study sample size included 19,460 people, of which 16,852 had received in-person treatment between March of 2015 and March of 2020, and 2,788 received phone or video conference therapy between March 16, 2020 and March 15, 2021.
Babins-Wagner said that researchers also used a propensity analysis to ensure that they were looking at person-to-person in the study, and not getting any outlier data that could have skewed the results.
She said that the results of the study confirm and re-enforce what other studies on the same topic have found throughout the pandemic. Namely, that tele-mental health can be an effective way of delivering quality client care.
The study, she said, backs up that the centre is about delivering the best possible care for their patients.
Delivering client care in the way clients need that care delivered
The Calgary Counselling Centre, said Babins-Wagner, never wants to put anyone on a waiting list to receive mental health.
“We haven’t had a waiting list in 18 years,” she said.
“There’s a lot of media and a lot of news about people not being able to get into care, because of long wait lists. Anybody calling today will be in today.”
When potential clients call into the centre, they’re offered the option of in-person or tele-mental health options.
The latter, said Babins-Wagner, can offer some clients significant benefits in both access to care and comfort of care.
One benefit is not having to travel to have in-person care.
“If you work downtown, or you’re in the Beltline, you still have to walk here. Which means leaving your office or your home, and at least, you’re walking 15 to 20 minutes before the appointment and then walking back after,” Babins-Wagner said.
Another major benefit she said, was the privacy aspect that comes with meeting a counsellor online.
“Many clients have told us they feel safer online. There’s more privacy for them online than there is in-person because they don’t see other people in the office, and they may not bump into somebody they know inadvertently.”
Virtual sessions also allow people to make calls from home, without having to seek someone else to take care of children during a session period.
“In fact, convenience and privacy has been enhanced with virtual care, is what clients tell us,” Babins-Wagner said.
Changing stigma around tele-mental health
Dr. Bruce Wampold, Professor Emeritus at the University of Wisconsin-Madison, who was a co-author of the paper, called the lack of access to mental health, especially in the wake of the pandemic, a tragedy.
“Tele-mental health allows individuals to obtain care from any location, without the challenges of transportation, absences from home or work, and other structural barriers,” Dr. Wampold said.
“To find that mental health services delivered at a distance are as effective, or possibly more effective than in-person services, allows for the expansion of services to those in need.”
Babins-Wagner said that she hoped the results of the paper, along with those like it, would eventually lead to positive changes in the way that care is delivered.
“These kinds of changes take time, and there is a lot of research that shows it takes 17 years for an article to have some influence into practice,” she said.
The paper has already impacted the Government of Alberta, which is funding tele-mental health delivered through the centre.
The paper, Effectiveness of telemental health during the COVID-19 pandemic: A propensity score noninferiority analysis of outcomes, can be found on apa.org.
