This story was originally published by PublicSource, a news partner of NEXTpittsburgh. PublicSource is a nonprofit media organization delivering local journalism at publicsource.org. You can sign up for their newsletters at publicsource.org/newsletters.
By Meg St-Esprit
Balancing college and a service industry job, Roberta’s mental health plummeted during the pandemic. The 50-year-old mother of one in the North Hills, who chose to withhold her last name due to the stigma around mental health treatment, began to see ads for Done.
She was intrigued. The online mental health platform promised a diagnosis and medication without any hurdles.
Roberta had been in need of psychiatric care for years. “I had been slogging through my insurance to see who I might click with. Then, the threat of actually calling and possibly being turned away. It takes a lot of ambition and courage, and focus,” she said.
Done got her an appointment, for which she paid out-of-pocket. It left her feeling “icky” afterward.
“The doctor came in and reminded me of a character from ‘Jersey Shore.’ Seriously, gold chain, tank top and sweating brow,” she said. “I cannot make this stuff up. He diagnosed me with about three questions and prescribed me a controlled substance.”
Done did not respond to a request for comment on this story. In a statement following coverage on “Good Morning America,” Done noted: “All clinicians that work on the Done platform are psychiatric board-certified medical professionals. They treat ADHD and other mental health conditions, are dedicated to educating people on the medical knowledge, with a patient-centered mindset.”
Prior to March 2020, Roberta would have to see a psychiatrist or primary care physician in person to receive Adderall, the medication she was prescribed. The Ryan Haight Act required a face-to-face visit before prescribing any controlled substance.
But in response to the pandemic, regulatory agencies loosened restrictions around telehealth so that patients could continue to receive care. The new flexibility also prompted a rise in online third-party psychiatric platforms like Done and Cerebral. Now, therapy and prescribing can be done virtually.
These platforms, which target users in Instagram and Facebook ads, have received mixed reviews from consumers and medical professionals.
These services found a foothold in the local market, as in communities across the country, due to long waits at many psychiatric practices. A shortage of mental health staff, a rise in demand for crisis mental health services and burned-out professionals have created an untenable situation for many people in the region seeking care. Nationally, the demand for mental health services has nearly doubled since pre-pandemic times, according to a 2021 survey by the American Psychological Association. Wait times to see a new practitioner can be long, which is frustrating and even dangerous to those in crisis.
Increased local access to telehealth was essential to Pittsburghers during the pandemic, especially for talk therapy. However, the relaxed federal laws surrounding prescription medication have had both positive and negative effects on patients in the region.
The benefits of loosened restrictions
“Two years ago, before the pandemic, my no-show rate was ridiculous. It was up to 30% to 50%,” said Dr. Tania Kannadan, a psychiatrist with Allegheny Health Network [AHN]. “When they opened up telemedicine, it went down to nearly zero.”
The downside: “For two years, I was an overheated engine with back-to-back appointments every day,” Kannadan said.
For Nia, a 48-year-old mother and educator who lives in the Ohio River Valley, telehealth felt like a godsend.
She’s struggled with her ADHD symptoms for years but has had a difficult time navigating Pittsburgh’s provider network. “It’s been madness trying to find someone to prescribe my medication,” she said.
When she began to see ads for online psychiatry services, she was interested. Nia also liked that she could seek out Black practitioners — something that the Pittsburgh area is short on.
After exploring the crop of online services, she began seeing a nurse practitioner located in Philadelphia via ZocDoc. He prescribed her Vyvanse, a regulated amphetamine that could not have been prescribed virtually two years ago.
For Nia, the benefits of the eased restrictions outweigh the risks. “If people are going to abuse meds, they will find a way even if they go in person,” she said. The risk of abuse “shouldn’t prevent people like me who really need it from having greater access.”
Roberta said she felt no confidence in her first online doctor. She waited a month to even try the script, which then made her feel jittery and nauseated. Eventually, amid legal troubles embroiling Done and other companies, her pharmacy — and several others she tried — refused to fill her script.
Both Cerebral and Done have become embattled in legal issues due to the high rate of stimulants they prescribe. At various points over the last several years, major pharmacies such as Walgreens and CVS have halted filling stimulant prescriptions from the companies.
PublicSource reached out to Cerebral for comment but did not receive a substantive response.
Roberta switched to Plushcare, which has a similar business model. “Plushcare has been a much more positive experience,” she said. “I have seen one doctor. She and I discussed a medication I was anxious to try. She suggested we try something else. She was worried about interactions with my antidepressant.”
Plushcare let Roberta know this month that her doctor is leaving. “This is frustrating,” she said. Now with new insurance in 2023, she is hopeful to find someone local, but is not optimistic. Her October effort to schedule with a new primary care physician landed her a February 2023 appointment.
The problem with loosened restrictions
For many patients like Nia and Roberta, online mental health services felt like a solution. Some professionals believe this solution should be tempered with caution.
“Given the lack of access to treatment for mental health and substance use disorders that preceded the pandemic, the suspension of the Ryan Haight Act helped meet the increased demand for mental health services and needed medications,” Tanya Fabian, director of pharmacy research and pharmacy services at UPMC Western Psychiatric Hospital, told PublicSource in an email. “However, with fully online providers, it becomes more difficult to ensure quality and safety, especially for new patients.”
Katherine Pfaff, a spokesperson for the Drug Enforcement Administration, told PublicSource in an email, “The current flexibilities are contingent on the Covid-19 Public Health Emergency,” which shows no signs of ending.
Kannadan, the AHN psychiatrist, said that returning entirely to pre-pandemic restrictions is not an option. There are many benefits to telehealth services. They just need to be regulated more closely.
“I have patients in Erie and the southern tip of Washington County,” Kannadan said. “They used to drive three hours to see me for a very simple appointment.” The changes in telehealth have allowed her to provide more continuous care to these families without such a burden on their time and finances.
ADHD diagnoses in adults doubled between 2010 and 2017, according to a report from the medical journal JAMA. Overall, amphetamine prescriptions have also risen, increasing 2.5-fold between 2006 and 2016. These numbers are expected to continue to climb when new data is aggregated. An informal survey by ADDitude found that 22% of adult respondents began medicating their ADHD during the pandemic.
Kannadan sees the rise in amphetamine prescriptions as part of the larger drug addiction crisis in the country — but one that can be reined in if the DEA provides more oversight.
Accessing mental health treatment in Pittsburgh
While Pittsburgh does have a shortage of mental health professionals, the situation is not as dire as it may at first feel for those seeking treatment, Kannadan said. She points to in-state telehealth providers like Nulton, located in Johnstown, or Talkiatry, which functions virtually in a similar manner to many brick-and-mortar institutions.
The length of waitlists can also be misleading. Many patients, said Kannadan, call to get an appointment during a time of crisis but decide not to keep their appointment when the time comes. For those who do keep appointments, she said, “The waitlist isn’t as long as you think it is.”
People seeking mental health services in the Pittsburgh area should call practices directly. While the city’s major hospital systems, UPMC and AHN, have central scheduling centers that work great for most appointments, those with urgent mental health needs can check to see if a facility has its own triage line.
In addition, Allegheny County partners with UPMC’s resolve Crisis Services for emergency care that can transition patients into ongoing treatment. Individuals can also show up at any emergency room, with or without insurance, for immediate psychiatric intervention.
Fabian noted that the current problematic telehealth services arose to meet a need. While there is room for improvement, there are redeeming factors if oversight is improved.
“The shift we are seeing,” she said, “is an attempt to safely fill a critical gap in access to care for those with mental health or substance use disorders while ensuring that there are appropriate safety measures in place to avoid creating a whole new set of problems.”
The Jewish Healthcare Foundation has contributed funding to PublicSource’s healthcare reporting.