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More Albertans seeking doctors' help with mental health issues during pandemic, numbers show

In March and April, doctors’ visits for anxiety and other mental-health issues were up 12 per cent over the same period in 2019, Alberta Health says.

Virtual visits common now but not sustainable in long term, experts say

One family physician says the virtual care billing codes introduced in March are hurting her practice. (Shutterstock )

More Albertans are seeing their family physicians about mental-health concerns during the COVID-19 pandemic, frequently through virtual visits rather than regular appointments.

But some experts say it's not ideal for doctors to have to deal with complex issues such as mental-health concerns using technology instead of face-to-face interactions.

In March and April, 138,291 Albertans spoke to family doctors specifically for anxiety-related care, according to the physician billings submitted to the province.

That is 12-per-cent higher than the same two-month period last year, when 123,420 Albertans saw their doctors about mental-health concerns, according to data obtained by CBC News.

In March and April of this year, doctors submitted 214,755 claims for both in-person and virtual care visits specifically for anxiety-related issues — and of the total, 65,581 were claims for virtual visits. The province defines a claim as a service delivered by a physician to a patient.

"I think we're all facing circumstances, with family, worries about health, financial concerns, all sorts of things," said Dr. Bailey Adams, a family physician practising in St. Albert.

"I think it's a good sign, in my opinion, that patients chose and recognized it was a good place to turn to to get support for that."

At the start of the pandemic in March, the province introduced physician billing codes for virtual appointments. New codes for remote visits allowed doctors to see patients through video conferencing or by telephone and bill the province.

"We know this pandemic has created anxiety in many Albertans. That's why the Alberta government provided new billing codes for virtual patient care to improve access to anxiety-related supports," Alberta Health told CBC News in an emailed statement.

Physicians can now bill for phone calls or online therapy for patients with mental health problems.

Introduced as a temporary measure, the virtual billing codes have since been made permanent.

Mental health experts say many Albertans have been seeking help for anxiety issues in the past few months.

Dr. Peter Silverstone, interim chair of the University of Alberta's psychiatry department, said about 3,500 people have registered for an online program on mental health through the Centre for Online Mental Health Support since April.

Most of them had anxiety, he said.

Dr. Peter Silverstone, interim chair of the University of Alberta's psychiatry department, says many people have reached out to the Centre for Online Mental Health Support for anxiety-related issues. (Supplied by Peter Silverstone)

"When you think about what leads to anxiety— uncertainties about your health, about your future, about your job, about your family, you couldn't visit people, you couldn't do anything," Silverstone said. "Those are totally expected reasons to increase anxiety and many of us were talking about this at the time."

But some mental health experts say virtual visits alone can't replace all of the in-person care. 

"I think that the future will involve a mix of both in-person and what we call e-mental health, electronic mental health, and that offers huge, huge opportunities," Silverstone said.

Dr. Melanie Marsh-Joyal, a psychiatrist in the emergency department at the Royal Alexandra Hospital, said there are a lot of positives with virtual health care, which can provide people in remote communities access to a healthcare professional.

"I think that in the short-term, [virtual care visits are] very good and they're important. I think in the long-term for psychiatry, it's actually better if we see people in person," Marsh-Joyal said.

"In psychiatry, in particular, I don't think virtual care provides the most effective context within which to know a patient really well. We rely a lot on our observation of what's going on with the patient and all the non-verbals. You can't see all of that virtually."

Any future decisions about virtual appointments need to be made in partnership with Alberta's physicians, Marsh-Joyal said. She said she doesn't know if that kind of consultation can be accomplished under Health Minister Tyler Shandro.

"We just need to be mindful about how we determine we're going to roll out and maintain some of these virtual practices," she said. "I'm confident that we can do it. I don't necessarily know if this current minister's office is going to be able to work with us. I worry about that.

"But if we can get a working relationship going with the government that's effective and smoother with a lower coefficient of friction, then I think that we can possibly move forward pretty healthily."

The cost of virtual visits

In her St. Albert practice, Adams says virtual appointments have allowed her to help patients during the pandemic. But the increasing number of virtual calls means her billings are lower.

Physicians are paid the same rate for virtual appointments as they are for in-person medical services.

But Adams and other family doctors say their payments aren't the same because they can only bill for physician-to-patient time for virtual visits — and not for any patient work before or after the appointment. 

Adams said the billing code fee structure for virtual care is unfeasible in the long term.

"My practice would close if we didn't have the federal grants to be able to keep our staff members present," she said. "The rates they give us are completely unsustainable to keep a practice open and to take home an earning, let alone cover overhead."

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