How to Coordinate Mental Healthcare, Physical Care Amid High Demand

November 28, 2023 - The demand for mental health has increased significantly in the 2020s.

Mental healthcare utilization grew 38.8 percent between 2019 and 2022 and spending on mental health jumped 53.7 percent in the same timeframe. The coronavirus pandemic was a key driver of these trends. It was disruptive and destructive to well-being, but it also opened many Americans’ eyes to their desperate need for mental health support. 

As a result, in 2022 telemental health utilization had stabilized at around 1,068 percent of what it was pre-pandemic.

In today’s episode of Industry Perspectives, Georgia Gaveras, DO, co-founder and chief medical officer at Talkiatry, discusses these trends and the state of telemental healthcare.

Georgia Gaveras:

People want to feel better. Doctors literally took this job to help people get better. Insurance companies want to keep people healthy. We all have the same goal. So we decided to go to all these stakeholders, because we said mental healthcare is healthcare, right? So why should it be a luxury item?

Kelsey Waddill:

READ MORE: How Access to Reproductive Mental Health Can Improve Maternal Health

Welcome to Healthcare Strategies | Industry Perspectives. We're coming to you from HLTH 2023 to bring you into our conversations with healthcare technology leaders on important trends in the industry.

In today's episode, our VP of editorial, Kyle Murphy, caught up with Dr. Georgia Gaveras, co-founder and chief medical officer at Talkiatry, to discuss mental health care and psychiatry post-COVID-19, the trade-offs of telemental health and even a bit of career and life advice. So let's get into it.

Kyle Murphy:

Tell me about your background in terms of study and then some of your work. Obviously, you work with pediatric psychiatry. What attracted you to it?

Georgia Gaveras:

I mean, the short answer is, it's just fun. I mean, honestly, it's really cool. You meet a lot of patients, you learn a lot about them, about their families. It's just fascinating. It really, truly is. And if you're going to do something, you better be interested in it, right? I mean, that's the whole point. So yeah, it's just when I started learning about it, it was really cool. And then I was like, "Well, if I'm going to do something for the rest of my life, this is a good thing to do."

Originally, actually, I wasn't going to go into psychiatry. That wasn't my original plan. And then I went to medical school, '99 to 2003, and 9/11 happened in the middle of it. Actually, it happened during my surgery rotation, and I happened to be in Newark at that time. I'm a New Yorker, born and bred. And when that happened, my surgery rotation got canceled. It just was--as you know, what happened on 9/11. So it kind of opened me up because I was really interested in surgery, and then it obviously put a sour taste in my mouth because the experience was horrific. And then I did my psych rotation not too long after that and I was like, "Oh, this is really cool. Really, this I can do." Yeah.

Kyle Murphy:

READ MORE: Exploring Pros & Cons of Direct-to-Consumer Virtual Mental Health Apps

So, obviously, one of the things, the past few years has really shone a light on [the] mental health crisis in this country. It predated the pandemic, but a lot of things became much more salient--

Georgia Gaveras:

Oh yeah, for sure.

Kyle Murphy:

--during that period of time.

Georgia Gaveras:

For sure.

Kyle Murphy:

I'm curious what your perspective is from the clinical side of things but also just at a national public health level because there seems to be a lot of focus on sick care, not as much on preventive care, and even less on behavioral health and mental health. So, curious of your perspective on what you see really at the national level and what you see from professional experience.

Georgia Gaveras:

READ MORE: NY Schools to Offer Telemental Health, USPSTF Updates Anxiety Screenings

Yeah. So I think the pandemic was terrible, obviously. Some good things that came out of it, I think, were prioritizations for people, and it could be something as basic as like, "I hate my job and I am now realizing that life's too short to hate your job," right? Or, "I want to spend more time with my family," right? A lot of people were thrust into seeing their kids for the first time, for better or worse.

Kyle Murphy:

It is true.

Georgia Gaveras:

It's true, right? But I think as far as mental healthcare goes, I think now people were home, they were home alone a lot of times, which is when you really think about it because--I live in Manhattan, in New York City, a lot of people were just home alone in a studio apartment with literally nothing but their thoughts. And that is, we were talking about Russian literature, that is something torturous.

Also, for a long time we've told people, "Separate work and life, so don't work when you're home." Good luck. "Don't work while you're sitting in bed." Literally, the only surface I can sit on is my bed. Those kinds of things. So I think it thrust people into a situation where they absolutely could not ignore it anymore because I think that was a luxury before. You had all these other stimuli that you could... It's like, "I'm depressed, but you know what? I'm going out with my friends, so that's going to make me happy." And it makes you happy for a little bit because you see your friends, and then you have something else. And now it's like, you're done. You're done.

So unhealthy coping mechanisms then set in, right? So Grubhub, Seamless, whatever delivery app you want, their french fries could be at your door whenever you wanted them. You didn't have to exercise because the gyms were all closed. So you didn't have to feel guilty about it, right? Netflix, when it asks you, "Are you still watching?" It's like, "Yes, I am." So all those things that normally we would regulate because we had other things, there was no need to regulate them anymore. So people fell into habits that were...I hate calling habits unhealthy, but...using them in an unhealthy way.

And then people at some point were like, "Wait, this is not even good," and had to actually do something about it. So I think it put a focus on some dysfunction that people were able to suppress. And then it gave people the time and the space. Everyone had Wi-Fi. We were all watching Tiger King. So everyone had Wi-Fi. So you could now engage in mental health treatment. The virtual options that popped up were popping up before the pandemic, for sure, but certainly will have upgraded after.

Kyle Murphy:

Yeah. How did you feel? Obviously, there were a lot of just elimination of red tape. For the first time, healthcare HIPAA [Health Insurance Portability and Accountability Act] rules got relaxed and, suddenly, you can use whatever platform was convenient at the time.

Georgia Gaveras:

Yeah. Well, at least where I am, we took PHI [protected health information] and HIPAA very, very seriously. So it was built into our EMR [electronic medical record] and we were able to do that. But for a lot of people, yeah, I mean, you could FaceTime. Docs were using FaceTime. Docs were using Zoom, just whatever. Because a lot of people, especially--I'm a psychiatrist, a lot of private practice psychiatrists, it's just them in a room with a desk. This was not something that we're going to do. They don't even have EMRs. They're small enough they can do that.

So, now, if you have to see your doctor, that doctor's not going to be able to get a PHI-secure platform and go through the whole thing. They're too expensive. It's cost-prohibitive for them. So they just used FaceTime. And you were like, "You know what? Just whatever you need to do, right?" And that was, I think, the theme of the pandemic, whatever you need to do to get through it. Yeah. I mean, obviously, we want to make sure PHI is secure. I mean, we're at a tech conference.

Kyle Murphy:

Yeah. Yeah.

Georgia Gaveras:

[Inaudible] going on for people if you say that it's not secure. But I think that, at the time, we just had to do it. Really, it was a lifeboat for a lot of people.

Kyle Murphy:

And now, obviously, demand is very high for mental health, and there's actually a lot of competition from direct to consumers. I won't name names, but to me, it's like it gets further fragmented from--like, your PCP is really not necessarily included unless you share this information with them. How do you get that integration so that there is that kind of holistic care that actually includes the physical and the mental, even though we know our brains and hormones are responsible, literally?

Georgia Gaveras:

Yeah. I mean, when we look at mental health, I mean, the connection between mental health and physical health is there. I mean, you mentioned I'm a DO, right? So "mind, body, spirit" is the mantra in osteopathy, but it's very clear. People with depression are less likely to do things like follow up with their preventive care, mammograms, colonoscopies, all those kinds of things. They're less likely to adhere to their medications. They're more likely to smoke or drink or do drugs or all the things that lead to unhealthy outcomes for people. So we know that they're there. Depression--we see the people that are depressed get sick more. I mean, this is not news. So yeah, you're right, though. That connection, being able to communicate with your PCP and making sure that everyone's on the same page, it's really hard because there is that balance between people's PHI and HIPAA and all that.

But then it's like, "I really need to tell your PCP that you're on this medication," right? Or, "Your PCP needs to tell me if your blood pressure is going up because maybe you're not able to tell me." So those kinds of things, it's really hard. I mean, when you look at these giant studies, those millions, those are all Scandinavia where everyone has access-

Kyle Murphy:

[Inaudible]

Georgia Gaveras:

... to everything, yeah, it's just like you have access to everything, which at a certain level, doctors are like, "God, I wish I could just see a part of it." Because it would make my life so much easier to know that you were on a medication--maybe you forgot you were on it because you stopped taking it a week ago and it's no longer there. So those kinds of things I wish we had more access to, but I understand, especially psychiatry, and because my background is in addiction as well and my background is with working with children, there's even more protection when it comes to those kinds of things. So you want to respect that. And I'm your doctor. I need to know.

Kyle Murphy:

I'm curious as well, I know you're on the provider side, but from a payer's perspective, there always hasn't been any really robust mental health or behavioral health coverage. It's left to the patient to go seek out these things, and it's usually during a time of desperation or if something tragic is actually happening to them. I mean, how do the different kind of stakeholder groups need to work together to ensure that not only is it available but access is something that's streamlined? Obviously, virtual platforms go there, but that you still need the actual workforce to be able to do this and the different groups to speak together. I'm curious your perspective on how to improve the healthcare system as it pertains to mental health and behavioral health.

Georgia Gaveras:

Yeah. I think the thing is, we all actually have the common goal, right? People want to feel better. Doctors? I literally took this job to help people get better, so it is the whole point of my existence. And then insurance companies actually want to keep people healthy. Finally, I mean, public health advocates would have told you this ages ago, but keeping people from getting sick is a lot easier and a lot more cost-effective than healing them once they are sick. So everyone has the same--we're all approaching it in a different way, but we all have the same goal. So when we started our business--we started Talkiatry--we decided to go to all these stakeholders, and especially the insurance companies, which were... Being in-network for us is super important. Over 95% of our patients are commercially insured. Because we said healthcare, now it's kind of like everyone says it, but mental health care is healthcare, right?

Kyle Murphy:

Yeah.

Georgia Gaveras:

It's part of your health. So why should it be carved out? Why should it be a luxury item? Even if you have mental health coverage, you're not able to find somebody that will take it. So then it doesn't matter if you have it if no one will take it, right?

Kyle Murphy:

Yeah.

Georgia Gaveras:

So we decided it's super important for us to focus on the population that has commercial insurance because they are typically the people that have the hardest time finding in-network coverage. If you have all the money in the world and want to pay out of pocket, bless your heart, that's great, but that's not the majority of people. Okay? It's a very small minority of people. And even them, I mean, if you have insurance, why should you have to pay out of pocket? It doesn't make any sense. So that's really where we wanted to focus.

Kyle Murphy:

It's stressful. I remember going through the pandemic with my team, just people trying to access resources, and it was the backlog, waiting months upon months. But everyone at the same time is telling you how important it is to seek out these services.

Georgia Gaveras:

Exactly.

Kyle Murphy:

But there's that massive disconnect. I'm curious because you mentioned obviously medication, SSRIs [selective serotonin reuptake inhibitors] and other antidepressants are really vital to actually allowing people to moderate their life, really have that balance. I guess, how has regulation from the rules about using virtual platforms and prescribing, I guess how important is having that ability so that you're seeing these people, but they can also prescribe to you and you can get the help that you need? And then how do you ensure then, I guess, coming full circle, that it then gets back to primary care and you get them into this management, regular routine management?

Georgia Gaveras:

Yeah. Well, I mean, this is the second part, I think a lot of it is on the doctors themselves to take that time. There are all these studies about how much time doctors spend on administrative tasks versus clinical care, and then that amount of time for administrative tasks is just longer and longer and longer. So for us, a lot of our partners that refer to us that are primary care partners, we might be on the same platform. So if we're on the same platform, that, of course, makes it a lot easier. Technologically, it's a lot simpler to do that. But sometimes, it's just taking the time.

Kyle Murphy:

I feel like, and you can speak to this, but as a practitioner, it's kind of a lonely thing. You don't necessarily socialize or interact with these people.

Georgia Gaveras:

Totally.

Kyle Murphy:

You refer them, though, but you don't necessarily have that communication except for those guys who golf together every weekend.

Georgia Gaveras:

I'm a terrible golfer. I wish I were better at it. And the thing is, especially when you're working virtually, I mean, we're a telemedicine platform, so everyone's in their living room. So unless you live with a psychiatrist, you're not talking to another psychiatrist for the most part.

Kyle Murphy:

What's it like seeing people in their homes? I've heard anecdotally that a lot of folks who work psychology, psychiatry like to see people in their homes because they get a better sense of what that dynamic is.

Georgia Gaveras:

Yeah. It's interesting. It's a trade-off. So when you see somebody in person, you can tell if they showered, right? You can look under their fingernails. Again, I work with drug users. I can see if they've been smoking something because you can tell. We can just see how they're taking care of themselves. You can see, are their eyes darting around the room? Are they paranoid? Those kinds of things. Obviously, when you're on a virtual platform, that changes.

But the virtual platform, you can meet their cat. You know what I mean? If you need collateral information from their significant other, they'd have to be in your office. They'd have to sign a release form. You'd have to coordinate with the significant other. You have to actually reach them, find time to talk on the phone. Now they're literally right there. They can actually call them over and sit them down next to them, and you can talk to them. You can see what their house looks like. I didn't know one of my patients was a hoarder until I saw them in their home. How would I know?

Kyle Murphy:

It says a lot, right?

Georgia Gaveras:

Yeah. They don't tell you. They're not going to tell you they're a hoarder, right?

Kyle Murphy:

Yeah.

Georgia Gaveras:

So those kinds of things. So it's a trade-off, but I don't think it's necessarily one where one is better than the other. It's just different. It's just different. Also, it's interesting because you're in your home, and depending on what you do, it's interesting for them to interpret what's going on with you. That's big in psychiatry is that kind of relationship. So that's interesting as well to see that dynamic.

Kyle Murphy:

What's it like being a tech founder?

Georgia Gaveras:

Weird. I just think, "I didn't go to med school for this." This is not where I expected to be. So it's-

Kyle Murphy:

I mean, you rubbing elbows with different types of people. Does a conference like this open a lot of doors or avenues to a lot of things?

Georgia Gaveras:

Yeah. It's interesting because when I go to conferences, it's doctors usually, right?

Kyle Murphy:

Yeah.

Georgia Gaveras:

My badge doesn't even have my credentials. It doesn't say that I'm a DO. So no one knows.

Kyle Murphy:

No one knows.

Georgia Gaveras:

And most people here, I think they don't have their degree on there. So it's interesting because you meet people, you have no idea what their backgrounds are. And I always find it interesting when non-physicians or non-medical professionals, fill in the blank, go into something like this. I always want to sit them down and say, "Tell me--how? I know my crazy ride. What was your crazy ride?"

Because again, when I went to med school, this is certainly not where expected to be, but it's super interesting. It's also really encouraging that so many people are interested in healthcare and advancing it, like using technology in healthcare. It's one of those things where medicine's pretty old-school. You know what I mean? I'm just looking at the sponsor list. It's hundreds of names. And I'm just seeing all these people, they're interested in healthcare in some way, shape, or form. Obviously, they have their own financial interests or their academic interests or whatever it is. But in the end, hopefully, this is all towards a common goal of getting people healthy.

Kyle Murphy:

And then, last question, I guess, what are some of your challenges going forward? What are some things you face running an organization and growing it? But then, also, I imagine you're still practicing?

Georgia Gaveras:

A little bit. Yeah, I still see a couple of patients, yes.

Kyle Murphy:

How do you balance it? You talk about work-life balance.

Georgia Gaveras:

I know, right?

Kyle Murphy:

You have a lot of work.

Georgia Gaveras:

I do have a lot of work. Like I said before, I went into this field because I actually really genuinely enjoy it. So I wouldn't be doing it if I didn't enjoy it. So I still see a couple of patients and not very many anymore, I'm going to be honest. But it's one of those things where I chose to do this, so I have a commitment to my patients that I see. So I do that. But also, my business partner is amazing. I mean, he's basically family. Remember, we started during the pandemic. So we were-

Kyle Murphy:

So you know things about each other. Yeah.

Georgia Gaveras:

Yeah. I mean, I'm very well-acquainted with his wife and dogs. We're very close. So just with anything, if you really love your job and if you work a lot but it's because you love it and it's not a burden on you, that's fine. If you're working a lot because you feel you have to, or it's taking a toll on you, then that's where the problem lies, right?

Kyle Murphy:

Yeah.

Georgia Gaveras:

So you just have to make sure that whatever you're doing, you could be a doctor, you could be a podcaster, whatever you're doing, you're doing it for the right reasons. And again, I think that comes out of the pandemic as well, like prioritization and all that. I'm lucky. I'm very, very lucky that I can travel. I have family in other parts, so I can travel and still work, which is really great.

I was a training director at one point, and a lot of medical students or residents, they'd ask me for advice, career advice, "What should I do? What should I be when I grow up?" all that kind of stuff. And I'd tell them, "Think about how you want to live your life first and then find the job that accommodates that. Because if you want to travel the world, being a chair of a department might be a little hard. If you want to be a chair of a department, you're not going to take as many vacations as you want."

Kyle Murphy:

It is funny from a professional standpoint, ambition versus... You're talking about stress and talking about mental health. It's like sometimes you want to bite off more than you can chew, but it actually comes back to bite you in the end.

Georgia Gaveras:

Yeah. And there's this whole thing, especially for women for a long time, it's, "You can have it all." It's like, well, why would you want to? Because if you're going to have it all, then somewhere you're going to have to shortchange, right?

Kyle Murphy:

Yeah.

Georgia Gaveras:

You're going to have to shortchange someone or something. So just think about what is important to you and have that, and that's enough because you're the one that has to live with yourself. That's your life. So think about how you want to live your life, and that's what you got to do.

Kyle Murphy:

We typically don't do life advice on the podcast, but now we have it today. Yeah.

Georgia Gaveras:

I'm a psychiatrist. I can't not give it. I can't not give it.

Kyle Murphy:

Well, thank you so much for your time and...

Georgia Gaveras:

Oh, thank you. This was fun.

Kyle Murphy:

... appreciate it.

Kelsey Waddill:

Listeners, thank you for joining us on Healthcare Strategies | Industry Perspectives. When you get a chance, subscribe to our channels on Spotify and Apple and leave us a review to let us know what you think of this new series. More Industry Perspectives are on the way, so stay tuned.