Bringing Mental Health Services to Underserved Populations with Teletherapy

To better reach underserved populations, mental health care providers need to increase accessibility, decrease costs, and eliminate barriers to entry for groups facing difficulties in obtaining mental health services. According to the National Alliance on Mental Illness, one in five American adults experience a mental illness. Unfortunately, these numbers can be even higher for certain groups that also tend to struggle more with getting the help they need for economic, cultural, social, or logistical reasons. These factors, combined with a mental health care provider shortage, can make it prohibitively difficult for some individuals to seek help.

One way providers can effectively reach more underserved populations without incurring a high level of extra costs is by offering teletherapy. Studies have shown video therapy sessions to be just as effective as traditional, in-person therapy for treating most mental health conditions. Providing teletherapy can be significantly less expensive for providers by removing overhead costs, and can also improve attendance rates and reduce no-shows and cancellations. It is also more anonymous for clients and removes geographic restrictions, which can make it easier on clients with limited transportation, and gives clients more options when choosing a provider.

In addition to being convenient and effective, teletherapy can also be reimbursable, making it easier for clients to afford mental health services. Medicare’s telehealth benefit now covers certain forms of psychotherapy services. Telehealth is also covered by Medicaid in 48 states and the District of Columbia. Furthermore, 32 states and DC have some sort of private payer policy in place for coverage of telehealth as well.

Teletherapy can solve logistical issues and remove barriers for many different groups that can have limited access to care including:

  • Children and Adolescents: According to the Centers for Disease Control and Prevention, 13-20% of American children experience a mental health disorder in a given year. Of those, only 20% receive treatment. Cost can often play a role in preventing young people from receiving the care they need. Teletherapy can help make mental health care more accessible to children and adolescents, and may be more ideal for teens comfortable with technology that may desire a higher degree of anonymity in care. Additionally, teletherapy can eliminate the need to miss school to attend in-person appointments, providing less disruption to a client’s daily routine.
  • Older Adults: The American Association of Geriatric Psychology estimates that 20% of older adults experience some type of mental health concern. These conditions often co-occur with other physical health issues and can go undiagnosed. Older adults can struggle with the cost of mental health care, and may have difficulty travelling to appointments due to physical health concerns or lack of transportation. Teletherapy can address these struggles by allowing people to see their therapist remotely. Furthermore, Medicare’s telehealth benefit includes psychotherapy codes, making teletherapy more affordable for older adults.
  • Minority Groups: Minority populations have the same level of risk for mental health disorders, but access treatment at much lower rates. Mental health care is often less accessible to minority groups, and people seeking care often anticipate lower quality or experience language or cultural barriers when receiving treatment. By reducing geographic barriers, teletherapy can increase options for people when choosing a provider and help them find someone who is a good fit.
  • Rural Residents: According to the US Department of Health and Human Services, 60% of rural Americans live in a mental health provider shortage area. Combined with lower incomes, high levels of stigma, and a potential lack of anonymity in a smaller community, seeking care can be difficult. Teletherapy allows rural residents to access mental health services more privately with less travel.

We can begin to address the mental health care provider shortage by expanding the utilization and reach of current providers to underserved populations in need of services. Teletherapy is one way to do this, and it can be effective for treating many conditions. To learn more, download our tip sheet:

Download our free tipsheet

How to Improve Therapy Session Attendance, Reduce No-Shows & Cancellations

No-shows and cancellations for therapy appointments are more than just annoying, they can be detrimental to you, your clients, and your practice. If a client cancels a session at the last minute, or if they simply don’t show up, you’re not able to bill for that session, and you’re stuck with a non billable hour in the middle of your day that could have been filled with another appointment. In addition to being frustrating, studies have shown that high rates of cancellations can lead to diminished clinician confidence and affect one’s ability to provide effective care. Poor session attendance rates also impact clients, as they don’t receive the full benefit of therapy and can go on to struggle with persistent symptoms.

For many clients suffering from depression or anxiety, trying to improve their session attendance can be something of a catch-22 situation. Attending sessions can be made more difficult due to symptoms of their anxiety or depression, but in order to see improvement in their symptoms, they need to attend therapy. Clients may miss their first appointment due to a perceived stigma, or because they’re having difficulty taking the first step toward seeking help. Therapy can be a difficult experience, and often clients feel worse before they feel better, which can also lead to cancellations or no-shows if the individual does not experience immediate symptom relief. Alternatively, if they start to feel better, they may quit early and still miss out on the full benefit of in-person counseling. Other issues that can lead to cancellations, no-shows, and low session attendance include logistical concerns such as transportation, disability, or difficulty finding childcare or getting time off from work.

There are many ways you can improve session attendance at your practice, a lot of which aren’t expensive or labor intensive:

  • Give clients as much freedom in scheduling as possible. Giving more options for scheduling can result in fewer cancellations or no-shows.
  • Confirm appointment dates and times immediately after making the appointment with a printed card, so misreading handwriting or making a typo in a phone calendar cannot occur.
  • Give adequate appointment reminders in the patient’s method of choice: phone calls, text messages, emails, or postcards in the mail.
  • Offer rewards for attending sessions by giving discounts on bills, or penalties for no-shows or late cancellations. Create a clear no-show policy and work with clients to troubleshoot when they are struggling with repeatedly no-showing. Consider discharging clients who repeatedly no-show or cancel.
  • If a client no-shows for an appointment, follow up to find out why and reschedule promptly. You may notice patterns that can help you improve attendance in the future.
  • Offer video therapy sessions to your clients. Teletherapy can be a great way to lower the barrier to entry for those seeking help, and has been shown to be just as effective as in-person treatment for a variety of conditions.

Of these, teletherapy may be the most major change to make, but it can also be the most impactful. To learn more about how to bring teletherapy to your practice, and why it’s becoming more and more popular, download our free tip sheet.

Download our free tipsheet

Physician, Heal Thyself: The Importance of Self-Care for Mental Health Care Providers

It is well known that therapists (psychologists, psychiatrists, social workers, counselors) need to maintain good mental health in order to be effective. In fact, entire books have been written on the topic of how those in the helping professions can take care of themselves. The phrase “compassion fatigue” has been used to describe the phenomenon of psychological distress or indifference which arises in those who are repeatedly called upon to care for others, extend themselves emotionally, or generally support those who are suffering. The degree of compassion fatigue may relate to the severity of the suffering, or the frequency of these calls, though most seasoned clinicians have had at least a few moments when they felt “burnt out”. These experiences, though, should not go unnoticed or unattended to, as compassion fatigue or burn-out can result in diminished quality of treatment for clients or patients.

So why is it so hard for providers to heed their own advice and practice self-care?

Physicians often have not experienced the ailments they’re treating. However, if it is possible for a provider to walk in the shoes of the client, why wouldn’t they take that opportunity? Understanding what it’s like to call a therapist, navigate payments or insurance, even feeling what it feels like to wait in the waiting room of a mental health provider is worth doing.  Beyond that, actually using the therapy tools can help providers to better understand their work with their clients. Training seminars with experiential or participatory components are often the most effective and compelling because they give the provider a chance to really understand what it’s like to be a client going through the intervention. Having personally examined one’s core beliefs, or spent some time on building one’s own exposure hierarchy can enable therapists to be more effective when using these tools with clients. It opens one up to see the challenges and opportunities that exist.

This is not a novel idea. Indeed, Freud suggested that therapists engage in analysis and a survey study in 1994 examined therapists’ engagement in therapy. As the field has shifted to some degree, so have the types of therapy in which clinicians are encouraged to engage. There have been calls in the literature recently for psychologists to utilize mindfulness-based positive principles and practice and studies have found that MBSR interventions can be effective when taught to therapists-in-training.

Many providers describe feeling too busy as a primary problem, and feel that they don’t have the time for self-care. Often clinicians feel pulled in a number of different directions: direct client contacts, administrative tasks, note taking, supervision, etc. New technology tools, though, can help providers streamline some of their processes to increase efficiency and “make” time. Video conferencing software can save travel time to meetings, and EHRs and billing programs can reduce time spent on note-taking and administrative tasks. Additionally, new mental-health and wellness tools such as Pacifica can make engaging in self-managed CBT more engaging and time-efficient. Pacifica has a library of meditation and relaxation tools, customizable reminders for health behaviors, mood tracking, and a suite of thought record tools for reflecting on one’s own challenging moments. Taking a few self-care moments to check-in with yourself is important, regardless of which side of the room you’re sitting on.

Healthy Habits for Your Mind

In honor of Mental Health Awareness Month, we’d like to discuss the importance of taking preventative steps to maintain mental wellness.

In the same way that you brush your teeth every morning to prevent cavities or get exercise to fend off heart disease, there are things you can do regularly to help develop and maintain mental wellness. While there will always be situations that warrant more focused attention and intervention, these healthy habits can go a long way for many people, even those who aren’t dealing with a mental health condition that rises to the level of needing professional help.

Engaging in positive thinking: Some people find it helpful to take a moment before going to bed to jot down what they’re grateful for, or what they particularly enjoyed that day. Studies have shown that spending time recounting positive experiences can enhance well-being. Focusing on the positives isn’t always easy, but when we get in the habit of seeing the bright side, we often find that our mood improves. Taking a moment at the end of your day to identify what went well is a step in that direction.

Cultivating social support: Humans are social creatures, and spending time with others can go a long way towards mental wellness. We all go through tough times, and having someone to talk to about that difficult day, or celebrate that happy moment with, can be wonderfully rewarding. Current technology makes it easy to meet new people, with sites such as MeetUp and Facebook Groups. Considering how important it is to not feel alone in life, developing and nurturing relationships is a key part of maintaining good mental hygiene. Social support groups can also be particularly helpful when the participants have been through a shared personal experience, such as a group around bereavement or addiction recovery.

Engaging in relaxation or mindfulness activities: This one might seem obvious, but developing a regular practice of relaxation or mindfulness can help manage day-to-day frustrations and also help when a more significant stressor arises. Different people find different activities rewarding. Some people prefer yoga, others mindfulness meditation, and some others might enjoy unwinding during a simple walk with the dog. It might take a little trial and error to find what works for you, and that’s OK.

Keeping track of activities to develop a sense of mastery and purpose: These lists can take a lot of different forms, depending on your needs and goals. Sometimes when life gets stressful it can be easy to lose track of things. Using lists can help you stay on top of day-to-day tasks. Additionally, after you’ve ticked off your list of to-dos, these can do double duty as a list of accomplishments. Journaling can also be helpful, and give you the space you need to take a few moments to reflect on your goals and values.

One of the things which drew me to psychology (as compared to other health specialties) was the fact that you can’t always visibly see what’s going on with a person, and the very significant variations that exist between individuals. Unfortunately, this “invisibility” can sometimes mean that problems go unidentified until they have escalated. Regularly checking in with yourself and thinking about where you’re at mentally can be helpful to address these potential issues before they become more serious.

Self-care and good preventative mental hygiene is particularly important for individuals who regularly have a high “helping quotient” such as parents of small children, caregivers, and even mental health providers. Anyone who has flown on an airplane has heard that “you need to put on your own oxygen mask before assisting others with theirs”, and this adage is definitely also true when it comes to maintaining mental wellness. So, today, take a moment to attend to your own mental hygiene. You’ll thank yourself later.

Pacifica’s suite of tools are ideally suited to help people stay on top of their mental health and take positive steps to maintain their wellness. Tools include gratitude journaling, peer support communities, relaxation and meditation activities, goal setting, and much more. During Mental Health Month, you can get 50% off a Premium subscription to Pacifica when you upgrade on our website using the code MHMONTH2017. Log in at to upgrade.

11 Mental Health Podcasts Worth Checking Out


Podcasts are a great way to learn and stay on top of a variety of topics including everything from news, entertainment, sports, and comedy, to mental health and wellness information. Here we’ve selected a few podcasts on different aspects of mental health that we think are worth a listen.


The Mental Illness Happy Hour – Candid and humorous conversations about mental health. Hosted by Paul Gilmartin, former host of TBS’s Dinner and a Movie. Guest hosts include comedians and mental health professionals.



Anxiety Slayer – Hosted by Shann Vander Leek & Ananga Sivyer. This podcast is focused on meditation and relaxation-type activities such as breathing tools and self-affirmations.



The Dark Place – Hosted by Joel Kutz. Each episode is an open conversation about the guest host’s experiences of struggles with mental health. Joel is a young producer and crisis hotline volunteer who describes that no topic is “too taboo” for The Dark Place.



The Anxiety Guy – Hosted by Dennis Simsek. Dennis is a former professional tennis player and anxiety sufferer who now describes himself as a “happiness machine”. On the podcast he shares his experience with anxiety and tips for other sufferers.



The Hilarious World of Depression – Hosted by John Moe, comedian and former NPR correspondent. This podcast is a series of open and funny conversations about depression between Moe and various guest comedians including Peter Sagal, Andy Richter, and Paul F. Tompkins.



Not Another Anxiety Show – Hosted by Kelli Walker, who is a registered nurse, wellness coach, and previously suffered from agoraphobia. Some episodes are conversations with other experts, while in others Kelli offers information and practical tips about how to manage anxiety.



The Struggle Bus – Hosted by Sally Tamarkin and Katharine Heller. The hosts are quick to assert that they don’t have professional training other than “lots of feelings and opinions”. Listeners write in with questions or concerns and the hosts reply on air with tips and feedback



The One You Feed – Hosted by Eric Zimmer, The One You Feed is a podcast that describes itself as a discussion about habits, meditation, and various mental health topics. Guests on the show include many well-known writers and experts in meditation and psychology such as Sharon Salzberg, Stephen Hayes, and Tara Brach.



The Hardcore Self-Help Podcast – Hosted by Robert Duff, a psychologist in Southern California. Dr. Huff responds to listener questions on topics related to mental health such as anxiety, depression, and relationships. Dr. Huff tries to avoid jargon and be down-to-earth in his show.



ADHD ReWired – Hosted by Licensed Social Worker Eric Tivers, this podcast focuses on ADHD. The podcast shares stories, interviews individuals who have dealt with ADHD, and offers tips for those coping with ADHD to increase their productivity and functioning.



Happier – Hosted by Gretchen Rubin and co-hosted by her sister Elizabeth Craft. Rubin is the author of the book The Happiness Project and the podcast provides tips and tricks to “increase happiness”. These tips are often of the “life-hack” variety and provide listeners ideas on how to improve their quality of life.