Fear, stress and anxiety grow in locked-down Puerto Rico as the island tries to slow down the spread of the novel coronavirus, pushing mental health professionals to turn to technology to continue providing services. 

For psychologist Marcos Reyes, it’s now more important than ever to increase access to mental health care services through phones and computers to reach patients and avoid acute developments of preexisting conditions. 

“Telepsychology is a resource that has existed for several years, and has been recognized by investigation as a valuable and valid resource,” said Reyes, director of the doctoral clinical psychology program in Carlos Albizu University’s San Juan campus. “Under these circumstances, it turns into a critical vehicle to give access to these services.”

Puerto Rico’s Legislature passed on Monday a joint resolution authorizing psychologists to use telemedicine to consult patients. The measure will be in effect as soon as Gov. Wanda Vázquez Garced signs it and will expire on  June 15. The resolution includes a possible extension of 30 days that would have to be approved by Health Secretary Lorenzo González Feliciano. 

The Trump administration has eased restrictions to make it easier for healthcare providers to practice remotely during the coronavirus crisis.  

Reyes warned that the outbreak could worsen symptoms of people who have preexisting conditions and were already receiving therapy or treatment. He emphasized that people may experience stress and anxiety due to the disruption in their lives and their support systems. 

Nearly half of Americans say the pandemic has affected their mental health, according to a poll by the Kaiser Family Foundation. So far, Puerto Rico’s psychosocial support hotline Línea Paz, operated by the Administration of Mental Health and Anti-Addiction Services, has received 14,532 calls related to Covid-19 since March 14. 

“Mental health services are critical to attend this diversity of problems and address them with the speed they require,” he said. “We need to reach vulnerable people who experience discomfort due to these circumstances to provide services quickly.”

Reyes said the aim of telepsychology is to provide service as similar as possible to a face-to-face session using technological tools like phone calls and video chats. The first resource to get in touch with people, he said, is the phone because it is more accessible than computers. 

Carlos Albizu University’s clinic transitioned to the virtual world almost as soon as Vázquez Garced imposed the lockdown on March 15. Students and professors use Zoom and Microsoft Teams to stay in contact with patients through video calls. 

Reyes acknowledged that there is some concern whether telepsychology can be as effective as in-person therapy and that some patients may be skeptical about receiving services remotely. The psychologist, however, said  telepsychology has proven to be just as effective as in-person sessions and that people are generally receptive to telemedicine. 

“In my experience, one would be surprised by the amount of people that see it as a good option,” said Reyes, who has practiced telepsychology for five years. “You get the most out of it, you can provide the same or even higher quality services.” 

Speech therapy goes online

Lizzette Román, director of Carlos Albizu University’s speech pathology program, said speech therapy should move online and continue during the pandemic because an interruption in services could hinder a patient’s progress. 

 “A patient with Parkinson’s disease, for example, if you don’t complete the treatment plan as established, the patient could regress in their skills because they haven’t completed their objective,” said Román, who has directed the program since 2013. “In children, you see a certain regression in skills when the service is interrupted.”

Carlos Albizu University’s clinic has equipped its staff to continue providing speech therapy online. Román said the clinic services patients as young as three years old to elderly men and women with Parkinson’s disease or who have had strokes. 

In the case of children, she said, the main difference between providing therapy online and in person is that the therapist can no longer rely on toys or techniques like manupaliting the child’s hand to convey an instruction. The advantage of online therapy, Román pointed out, is that parents are even more involved in their child’s sessions because they are active participants instead of sitting outside in an office waiting room. 

“It’s a different way of providing a service, but the quality remains the same,” she said. “You continue to provide the same service.”