5 Tips for Managing Stress and Preventing Burnout in the Workplace

Are you tired of work? Have you been experiencing burnout in the workplace? If yes, you are not alone; a recent survey revealed that 77% of respondents – nearly 4 out of 5 people – have experienced burnout at work. For those of you working in the medical, human services, and education sectors, it is even more likely that you need a break.

So what is burnout? If you think you are experiencing it, online surveys such as the Maslach Burnout Inventory or seeking a mental health professional can help you clarify. But in simple terms, World Health Organization characterizes it with three dimensions:

  • Energy depletion or exhaustion;
  • Negative feelings or lack of pleasure at your job, such as becoming cynical or critical;
  • Reduced efficacy at work, such as low productivity or struggling with concentration.

These symptoms could have dire consequences if left ignored or unaddressed. According to the Mayo Clinic, sustained burnout can lead to the following:

  • Mental health and mood issues, such as fatigue, insomnia, sadness and anger, and alcohol and substance misuse; and
  • Physical issues, such as heart disease, high blood pressure, Type 2 Diabetes, and vulnerability to illnesses.

Fortunately, many employers are pushing for policies to ensure employee mental wellness, such as increased time off and after-school childcare. In this blog, we’ll cover five additional tips to manage work stress and help you get through tough times at work.

 

Build Strong Relationships

We, humans, are social creatures. Like any other environment, social support at work and outside of work is necessary for workplace well-being. Research has shown that good social interactions regulate our hypothalamic-pituitary-adrenocortical (HPA) system – the stress response system in our body, protecting us from psychological and physical diseases.

There are many scientific studies proving that good relationships decreases burnout at work. For example, a psychology study revealed that good coworker relationships are associated with lower burnout and higher job satisfaction. Obviously, not everyone is comfortable with making friends at work, but we still recommend that you try to connect with even a few that you share commonalities with. Or, in most cases, you may NOT LIKE the people you work with – they may be hostile, competitive, undermining your efforts etc. As this happens to most of us, it’s important to find a buddy (or two) who can also be a mentor and help you manage the politics in the workplace. Every job that I’ve had over the years, there was ALWAYS at least one key person that I was well connected to – this helped me navigate the challenges and difficulties.

 

Stay Active

Sometimes, mental exhaustion can hit in the middle of the day. Instead of reaching for another cup of coffee, try getting some movement! There are many research studies showing the cumulative benefits of staying active. For instance, a research study on 99 adults showed that 30 minutes of moderate aerobic exercise on a stationary bike improved mood and cognitive flexibility afterwards. This means a light run or a brisk hike during your lunch break is enough to energize you and help you mentally prepare to get back to work.

Don’t have 30 minutes? That’s fine, too. Science has already proven that 10 minutes of walking a day can literally lead to a longer life. Or try some at-home yoga after work; many Youtube videos are only 10 minutes long, and as long as you watch out for injuries and stretch effectively afterwards, they are amazing ways to boost your mood while staying healthy! Here is one for beginners.

 

Good Sleep Habits

Ever noticed you feel more cranky when you’re sleep deprived? Studies have shown that sleep loss is linked to burnout in the clinical field, and this holds true in other workplaces as well. On the other hand, quality sleep helps you grow new neural pathways in the brain, and thus enhances attention, creativity and decision making.

For good physical and mental health, the National Sleep Foundation recommends around 7-9 hours of sleep per night. However, the necessary hours do vary between people, according to sleep expert Russel Foster, so focusing on building good sleep habits suitable for your energy levels is more important. Go to bed and wake up at similar times every day, across weekdays and weekends; invest in some curtains to keep your bedroom dark; adjust your room temperature to be cooler; and avoid caffeine and nicotine, including chocolates and soda, in the late afternoon and evenings. Finally, focus on progress and not perfection. Sleeping well three days a week is still better than none!

 

Practice Mindfulness

Mindfulness refers to the state of awareness where you focus on feelings and sensations of the present moment. According to research, mindfulness protects us against stress and burnout, helps cultivate better self-compassion, and even reduces blood pressure and cortisol (the stress hormone) levels.

Practicing mindfulness is easy to do but hard to put into practice. If you’re like me and your mind is always going and it’s hard to shut down, you can schedule some time out of the day and do it for just five minutes. The Mayo Clinic has outlined instructions for each on this website; or, here is a simple, 5-minute Body Scan exercise for you to try during a break. This will help you maintain a peaceful mind through and after work.

 

Establish Work-Life Boundaries

Work-life balance has never been easy but with more of us working from home resulting from the pandemic, establishing appropriate professional boundaries is even more important. These boundaries can be mental, such as setting certain “work hours” for yourself and tracking the tasks you allow yourself to do; or physical, such as turning off email notifications after work. If you work from home, changing in and out of work attire, and establishing an office space or corner can also help separate work and personal life. Some people even carry two phones so they are not ‘bombarded’ with notifications and messages during off-hours. You shouldn’t have to pay the price of working from home by working around the clock. And you will be more productive at work with a balanced life in the long run.

Workplace burnout is extremely common but know that you are not alone in today’s “gotta-get-everything-done-right-now” society. Hopefully, these five tips will help you prevent burnout from creeping into your professional life.

Remember that you work to live, not the other way around!

American Hospital Association Urges DEA to Issue Special Registration for Telemedicine Controlled Substances

The American Hospital Association (AHA), on behalf of its nearly 5,000 member hospitals and health systems, sent a letter urging the Drug Enforcement Agency (DEA) to take immediate action to allow telemedicine prescribing of controlled substances before the Public Health Emergency (PHE) waivers expire. The letter exhorts the DEA to publish the proposed rule for a special telemedicine registration, something the DEA has said it would do since 2009 (yes, 13 years ago; not a typo). 

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At Children’s Mercy, telemedicine boosts access to highly sought-after subspecialists

by Bill Siwicki

Children’s Mercy Kansas City is a pediatric health system with the highest-level designations in neonatal and pediatric intensive care, trauma and emergency services, fetal health and transport services.

 

THE PROBLEM

Children’s Mercy supports the children of Kansas and Missouri, with the next children’s hospitals being hours away in all directions. This extensive geographical region has forever been a significant challenge for patients and their families to access pediatric specialty care.

“The high demand for pediatric specialty providers and the constraints many families face regarding transportation, time off from work and school, and finances, made it obvious that traditional models of outreach healthcare were not sustainable,” said Morgan Waller, director of telemedicine business and operations at Children’s Mercy.

“Supportive leadership and persistent visionaries decided telemedicine was the solution to this continuously growing problem of too few specialists and pediatric patients with complex healthcare needs scattered and isolated all over rural Kansas and Missouri,” she added.

 

PROPOSAL

Because of the distance barrier to care and recognizing that the value telemedicine can provide to achieve the Triple Aim goals of improving specialist access, quality of care and affordability, Children’s Mercy Kansas City began to identify telemedicine and technology options to help treat patients across the regions served.

“After assessing options, which at the time Children’s Mercy began this initiative, in 2011, were very limited, it was decided that InTouch Health, a division of Teladoc Health, offered the best telemedicine platform to support regional telemedicine outreach clinics,” Waller recalled. “It was the dedication to quality, reliability and patient/provider experience that set Teladoc Health apart.

“Without any doubt, the devices InTouch Health offered a decade ago, in conjunction with their proprietary network, delivered unprecedented provider and patient experiences,” she continued. “To truly have a solution to the access challenges for these pediatric patients, Children’s Mercy needed to be able to replicate the same standard of care virtually, as that delivered in person, up to the highest level of encounter.”

That means providers hundreds of miles away must be able to listen to breath sounds; look into the eyes, nose, mouth and ears; and view the scalp and skin up close or magnified, and do so uninterrupted by poor network quality or other technology noise.

“To argue for sustainability, investing in the highest quality technology ensured early adopters within Children’s Mercy would lead the way and inspire new subspecialists to leverage virtual care services to treat more complex conditions and meet the needs of more patients across the region,” she explained.

 

MARKETPLACE

There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report.

 

MEETING THE CHALLENGE

Telemedicine-enabled clinics were established in two locations in Kansas and two in Missouri with plans for more. The facilities are identical to traditional healthcare clinics, with the addition of Teladoc Health real-time, two-way interactive audiovisual technology that supports the use of JedMed digital ancillary exam devices.

BSN and RN tele-facilitators trained in multiple specialty assessments support the patients in person and the providers located in Kansas City to ensure that the standards of care are met (up to level 5 clinical encounters) for these complex appointments.

 

RESULTS

“Telemedicine improves access to highly sought-after subspecialists,” Waller stated. “Rather than traditional outreach programs where providers would fly or drive for hours to see clusters of patients in rural areas, telemedicine allows providers to see patients during the time they would otherwise be in transit, and the reach is theoretically limitless.

“Since establishing the telemedicine department in 2012, the number of subspecialty encounters via telemedicine has steadily grown,” she continued. “Prior to COVID, almost 2% of all ambulatory subspecialty care was facilitated via telemedicine. Children’s Mercy has continued to support the patients and families in Missouri, Kansas and the surrounding region by maintaining their commitment to telemedicine and regional outreach.”

Appreciating what a critical role the specially trained BSN and RN tele-facilitators serve in meeting the hospital’s standard of care, and patient and family and provider experiences, for complex care delivered over distance, Children’s Mercy has continued to onboard these talented nursing professionals.

“Additionally, telemedicine has shown the ability to lessen the financial burden for families by eliminating the costs of traveling considerable distances for care, food, lodging and/or childcare,” Waller noted. “Parents and children miss significantly less time from work and school when seen in a telemedicine clinic.

“Having a mature, centralized telemedicine department also allowed Children’s Mercy to rapidly switch to telemedicine appointments in the home during the spring of 2020,” she added. “Within three weeks, the organization had all subspecialty practices and allied health services (51 separate service lines) ready to not only care for patients and families remotely, but to schedule, document and bill these encounters (not including the limitations of some electronic solutions at the time).”

At the height of the lockdown, Children’s Mercy Kansas City converted 65% of ambulatory appointments to telemedicine in the home. Still, as the pandemic wanes, demand for telemedicine continues.

 

ADVICE FOR OTHERS

“Many organizations still are not utilizing telemedicine to its full potential,” Waller cautioned. “It is disappointing that the increased awareness and understanding of telemedicine brought to the world by way of the pandemic has been limited to the patient home experience.

“Although an equally valuable practice, direct-to-patient telemedicine has limitations,” she continued. “If the country and the world is going to cope with worsening shortages of physicians and healthcare providers, going beyond the traditional models of care for all types of services is necessary.”

Leaders in healthcare will be those who seek out high-quality telemedicine technologies that connect to peripheral high-definition camera-enabled exam devices and digital stethoscopes while utilizing available bandwidth efficiently to maintain connectivity, regardless of extraneous conditions, she added.

“They will enable RN tele-facilitators to practice within the full scope of their licenses to partner with physicians, advanced practice nurses and physician assistants to deliver highly specialized care for complex patient conditions in the least intrusive ways possible,” she said.

“They will outfit all patient care areas with the virtual sophistication required to replicate the standard of care via telemedicine for all services offered in person,” she concluded. “And leaders in healthcare will recognize that achieving a mature delivery system in 2022 and beyond requires a dedicated team of telemedicine professionals working alongside traditional experts in healthcare at every level.”

Emotion AI: Why It’s The Future Of Digital Health

by Aaron Labbé

Have you ever heard of emotion artificial intelligence (AI)? Emotion AI, or affective AI, is a field of computer science that helps machines gain an understanding of human emotions. The MIT Media Lab and Dr. Rosalind Picard are the premier innovators in this space. Through their work, they sparked the idea to help machines develop empathy.

Empathy is a complex concept with a lot of strings attached to it, but on a basic level, it means having an understanding of another person’s emotional states. In theory, if machines can have that level of understanding, they can serve us better. Particularly in areas such as healthcare, applying empathetic AI can be very impactful.

 

How is emotion AI used in healthcare?

There are various types of emotion AI. The first kind detects human emotions. In mental healthcare, this kind of technology has great potential in diagnostics. In regard to physical health conditions, they can be used to monitor resilience in conditions such as cancer. This is beneficial especially because the importance of holistic and integrative care is now widely recognized.

The next level of emotion AI not only detects human emotion but has the ability to respond accordingly. One great example of how this can be used is with the population who live with dementia. People living with dementia may have a hard time understanding their own emotional state and even more so communicating how they’re feeling to their caregivers. That puts a heavy onus on caregivers to constantly read and decipher how they’re feeling, which is a hard task when you’re already overloaded.

This opens up the opportunity for emotion AI to look at things like biometrics or psychometrics that are less reliant on self-assessment—such as facial expression, speech cues or behavior. Emotion AI allows us to predict what a person’s state is with a level of competency that can be as good or even better than what a caregiver could tell us. In our use case at LUCID, we use this data to curate personalized music to help with the psychological symptoms of dementia.

This can increase compassion toward caregivers. Caregivers are facing increasing levels of burnout and may encounter fatigue when doing this type of monitoring. Having AI come in to assist can both provide the patient with better care and increase stamina for caregivers.

 

What are some drawbacks or concerns around affective AI?

When AI gets involved with human emotion, there are understandably a lot of alarms raised. There’s a gut reaction (stemming from television and Hollywood) that if machines understand emotion, they could gain sentience and potentially manipulate our emotions. This is a valid concern, but at the same time, these machines are given a very limited playground to play within. Training responsible AI is vital, by which they’re given data in order to do good with that information. That’s why we must push for responsible ethics in AI.

Technology and computing are developing faster compared to government legislation, so there may be gaps in policy. That’s where foundations like AI For Good come in. These frameworks and institutions are important because they help develop professional ethics to promote a positive culture around AI.

Bias is another concern for the AI community. If datasets are biased toward a certain type of population, the AI won’t be reliable when you extrapolate it out to the larger population. Many of these data collection efforts trained the AI on specific types of people—people who either volunteered for trials or could afford certain products. Would it reliably predict emotions for people who aren’t within that population? That’s a hard problem for AI at large, which professionals in this field work very hard to circumvent.

Luckily, there are strategies to prevent bias in emotion AI. It’s essential to actively collect participant bodies and samples from people who are from all walks of life wherever possible. You have to put in an effort to distribute this data collection as widely as possible. Another solution for bias is to develop a truly mobilized product to train the AI—a product that’s cheap, accessible and globally distributed so it can cover as many cultural representations as possible.

 

How are empathy machines currently used in digital health?

Technology has the advantage that it can stitch itself into a patient’s life beyond what a doctor can. As we move toward a longitudinal, person-centered approach, that gap can start to be filled with the use of AI. With the rise of integrative care, many digital health ventures are now leveraging emotion AI.

Twill (formerly Happify) is one example of using emotion AI in mental healthcare. Its Intelligent Healing platform uses AI to learn about one’s health needs and recommend a course of action. Its health chatbot is trained to provide personalized care and support in an empathetic way.

LUCID also uses an AI recommendation system to suggest music based on one’s mental states. It leverages biometrics and self-assessed data as inputs to classify a user’s emotional states. By learning about someone’s mood and their response to music, the algorithm adapts to better help them.

Although empathy machines and emotion AI may sound intimidating, they’re helping fill the gap in patient care, which traditional health models sometimes fail to do. Patient monitoring and longitudinal care use a lot of human resources. One doctor claimed, “Building and maintaining a longitudinal, person-centered care plan is really hard work. It takes a lot of resources. No healthcare provider is going to do it if it costs them more to do the plan than the benefit they derive from it.”

The sooner we can get machines to be more empathetic, the better our digital healthcare tools will become. It can open up many opportunities if, through technology, we can truly understand how people are feeling at all times—and empathize. Emotion AI is one of the most important pillars of digital health because if we have a better understanding of what’s going on with the patient, we have a better way of treating them.

The Online Therapy Bubble Is Bursting

BY JAMIE DUCHARME 

Hebah Arroyo, an Illinois nurse practitioner, began working for the startup Done in the spring of 2020. She was drawn to the San Francisco-based company’s promise: to provide stigma-free online ADHD care, including prescription refills and virtual sessions with clinicians, for as little as $79 a month.

“It was my first telehealth role,” she says, “so that was exciting for me.”

Three months later, she resigned. “I quickly became unhappy because there was not any support for the clinicians” and the quality of care was lacking, Arroyo says. She regularly saw four patients an hour, a grueling pace that she says didn’t allow time for holistic treatment.

In a statement provided to TIME, a Done representative said clinicians can make their own treatment determinations, including length of sessions. “Done was founded with a member-first mentality, meeting members where their needs are, and providing access to high quality care in an accessible and affordable approach,” the statement reads.

But in Arroyo’s opinion, the business model wasn’t set up to serve either patients or clinicians. Everything, she felt, “was based on growing the company.”

Prioritizing growth above all else—even if it means cutting corners along the way—is a common mentality among tech startups. Now, that alleged business practice is bringing scrutiny to many of the startups that popped up or thrived during the pandemic to target mental-health treatment: an area of medicine in desperate need of innovation, since it prices out many people seeking care, historically excludes people of color, and is so inaccessible that about a third of people in the U.S. who have severe anxiety or depression don’t get treatment.

Startups like Done and its competitors, which promise to remotely treat everything from anxiety and insomnia to ADHD and substance-use disorder, say they can help fix some of those issues by offering convenient mental-health care at affordable monthly prices. Recently, though, some of the shine has worn off this industry. TIME interviewed six mental-health professionals who formerly worked for telepsych or substance-treatment startups, some of whom asked to remain anonymous because they still work in mental-health care. Regardless of their employer, they had similar complaints: appointments were too short to properly treat and assess patients; clinicians were overworked; and policies around prescribing drugs and treating complex cases often weren’t rigorous enough.

Clinicians aren’t the only ones with concerns. Federal investigators are probing prescription practices at Done and Cerebral, a popular startup that offers virtual therapy and medication management for depression, anxiety, insomnia, ADHD, bipolar disorder, and substance-use disorders for as little as $99 per month—and that some former employees have said overprescribes stimulants for ADHD. In May, pharmacy giants including CVS and Walmart stopped filling controlled-substance prescriptions from Cerebral and Done clinicians, a move Done said it was “disappointed” by in its statement to TIME and that a Cerebral executive declined to comment on. Cerebral has since stopped offering controlled-substance medications.

There are other signs the telemental-health bubble is popping. Digital health investments fell by $4 billion in the first half of 2022, compared to the first half of 2021, according to a report from digital health firm Rock Health. And virtual-care startups including addiction-counseling service Halcyon Health and ADHD-treatment and therapy provider Ahead shut down this year.

The industry must do better if it is to live up to its promise, says Dr. John Torous, director of the digital psychiatry division at Boston’s Beth Israel Deaconess Medical Center.

“Digital health still has to be health,” he says. “A lot of telemental health tried to push the boundaries at the expense of patients.”

For a long time, telehealth was pitched as the future of medicine, even though adoption of the technology lagged behind hype about its ability to streamline and improve access to care. Then, the COVID-19 pandemic pushed life online and telehealth usage increased exponentially. When the American Psychiatric Association (APA) surveyed its members in May 2020, almost 85% said they used telepsych platforms for all or most sessions, compared to just 2% before the pandemic.

“COVID really pushed both patients and providers to try something that previously was this mysterious unknown,” says Samantha Connolly, a clinical psychologist with the VA Boston Healthcare System who researches telehealth. States and federal agencies waived restrictions on providing care across state lines, and the Drug Enforcement Administration began allowing clinicians to remotely prescribe controlled substances without an in-person evaluation.

In March 2022, influential health groups including the American Telemedicine Association (ATA) and the APA urged the government to make remote-prescription privileges permanent. “We’re asking for something that’s very reasonable, which is to continue, as much as we can, the access to care that now has been maintained for two and a half years,” says Kyle Zebley, senior vice president of public policy at the ATA.

Research has shown that remote prescribing can improve access to treatment for conditions including substance-use disorder, and that telepsych care is effective for treating many mental illnesses. “The key ingredient of the care we provide is talking, and that is something that can be done effectively from a distance,” Connolly says.

But in practice, some virtual-care startups seem to be falling short, according to people on the inside. Multiple clinicians who spoke to TIME said the fast pace and high volume of appointments made it difficult to establish the strong bond with patients that’s necessary to make progress in mental-health care.

Christopher Solomon, a recovery coach who worked for Halcyon Health before it shuttered in April, says he used to meet patients in person because he was frustrated by how difficult it was to form a rapport online. Even though traveling to meet patients face to face defeated the point of the app, “you didn’t build that connection” otherwise, he says. “It’s very hard to feel someone’s emotion through a screen.” (Halcyon Health co-founder Andrew Bryk says that’s just one person’s opinion, and company data showed high patient engagement and satisfaction.)

Sharaya Collins, a New Jersey-based psychotherapist who worked with Cerebral for about a year, also says she found it difficult to establish strong connections online, and she didn’t feel the platform was prepared to address the limitations of virtual care. Collins says she can remember at least two instances when patients were exhibiting suicidal behavior and she had to wait an “unacceptable” length of time to receive guidance from a manager on the messaging platform Slack. “To do all of this through telehealth was unnerving for me,” she says.

A psychiatric nurse practitioner who left Cerebral after six weeks also says she grew uncomfortable with how the company handled complex cases. The platform allotted 30 minutes for psychiatric evaluations, in-depth screenings that she says typically take at least an hour. The nurse practitioner eventually demanded more time for these appointments—a decision that resulted in a pay cut, since she could see fewer patients per day, but was the only way she felt she could do her job responsibly. (A Cerebral representative said it is standard to pay clinicians based on the number and type of appointments they complete.)

On one occasion, the nurse practitioner alleges one of Cerebral’s doctors forced her to see and prescribe medication for a patient with symptoms she felt were too complex to treat virtually. After that incident, she quit. “The model sounded good to start,” she says. “But the patient wasn’t getting enough.”

Cerebral CEO David Mou declined to comment on specific patient cases, but says the company closely follows clinical guidelines and has implemented a robust suicide-prevention system, through which crisis counselors reach out to patients displaying suicidal intent in their messages within an average of nine minutes. “We have very clear policies around what we treat and what we don’t treat and when you should ask for help,” Mou says.

Still, Cerebral often felt like a “therapy machine” that prioritized profits over people, says one psychotherapist who left the platform after about a year. “They started taking on so many clients. They were just hiring people that may not have really been qualified,” she says. “To me, it seems like they got greedy.” After a fundraising round in late 2021, the San Francisco startup was valued at nearly $5 billion.

Mou, however, says the company’s mission is “very clear: to democratize access to high-quality mental health care for all.” Two-thirds of Cerebral patients have never sought mental-health care before, the company says.

Others in the industry have also grown disillusioned by the intersection of business and mental health. Jason Meisel, a New York City-based nurse practitioner, formerly worked at Ahead, a virtual mental-health provider that shut down in June. He says patients often got “lost in the shuffle,” and multiple days sometimes passed before they heard back from a provider. He also felt that the platform wasn’t careful enough with its hiring decisions, bringing on clinicians who were fresh out of school and unprepared for the workload.

The feeling was “let’s just hire more and more people, jump to more and more cities, let’s get more patients and more money,” Meisel says. “As opposed to, let’s slow the f-ck down and get the foundation [right].” (Ahead co-founder Dr. Andy Rink, who left Ahead before it shut down, declined to comment on employee perceptions of the company.)

Much of the scrutiny on telepsych startups focuses on their prescription practices. Two former Cerebral employees told Bloomberg that they recalled Mou, in his prior role as chief medical officer, saying 95% of patients who see a Cerebral nurse should leave with a prescription. According to the former employees, Mou also said the rate could not be 100%, or the company would be a “pill mill.” (In an interview with TIME, Mou stressed that Cerebral clinicians are not under prescription quotas and the company “would never, ever prescribe medications to patients who don’t need it.”)

At Ahead, Meisel also says there was pressure to prescribe drugs or refill patients’ existing prescriptions using the online pharmacy Truepill, which he feels was financially motivated since Truepill invested in Ahead. “There was a push,” he says. “I just ignored it.” (Truepill and Rink did not respond to that allegation when asked by TIME. In a statement provided to TIME, Truepill CEO Sid Viswanathan said the company has “always been aligned with the mission to provide accessible, quality mental healthcare,” but no longer invests in Ahead.)

After leaving Done, Arroyo, the Illinois nurse practitioner, also took a job at Ahead. Appointments at Ahead were longer and she felt supported. But despite her more positive experience at Ahead, Arroyo thinks stimulants are being prescribed too liberally across the industry—in part because most online evaluations are too short to make a solid assessment, and in part because some companies advertise aggressively on social media and draw in patients who expect to leave with medications. “It’s very easy to rope people into believing they have ADHD,” Arroyo says.

Rink wrote in an email to TIME that, while remote prescription is a nuanced issue, “to give a blanket ‘no’ answer to remote management of ADHD is to say that most ADHD patients should not have been treated during the pandemic.”

A business model intertwined with social media also attracts a specific type of customer. Federal data show telehealth use is highest among people who are college-educated and wealthy; white U.S. adults are also more likely to use telehealth than people of any other racial or ethnic background, except those who identify as American Indian or Alaska Native. “It sort of makes you wonder, what is the agenda with the companies?” Arroyo says.

Joel Nigg, director of Oregon Health and Science University’s psychology division and a leading ADHD expert, shares some of Arroyo’s concerns. “Pretty much everybody in the country, if not the world, experiences quite a bit of distraction these days,” he says, but that doesn’t necessarily mean they have ADHD, or that they should be prescribed drugs. Stimulants can be harmful to patients with heart conditions, for example, and they can also exacerbate anxiety disorders—so if clinicians don’t have time to do thorough assessments, they could end up overtreating or mistreating people, Nigg says.

Despite the controversy surrounding some mental-health startups, Zebley, from the ATA, believes telemental health has lived up to its promise. “There’s no turning back,” he says. “Telehealth is here to stay.”

If anything, Zebley says, scrutiny from the government, pharmacies, and the media suggest the regulatory system is working, and companies are being held appropriately accountable. “Just because there are those that have allegedly violated the standard of care, and in some cases the law, doesn’t mean you erect these massive barriers that will inhibit access to clinically appropriate services,” he says.

Some of the controversy “may, in the long run, be beneficial for the field, because it’ll help people spot the things that are not ethical or evidence-based or useful,” Torous says. “There was so much excitement about telehealth, which is justified, but people are kind of saying it’s a panacea”—and the reality has proved different.

For Torous, skepticism about certain telepsych companies is separate from his belief in the promise of telehealth as a whole. Studies have repeatedly shown that virtual mental-health care can work, and that both patients and providers like the experience. The problem isn’t with telehealth as a concept, he argues, but with the way it’s being implemented by startups trying to maximize profits. Squeezing in as many appointments as possible might deliver on that goal, but it won’t fulfill promises made to patients, Torous says.

“Providers can’t be quick,” Nigg agrees. “They have to take their time and really do the full evaluation and get the right information.” That’s especially true if drugs are involved, he says. Deciding which patients need medications is always a challenge, and it’s “multiplied and magnified in a telehealth setting where there’s even more danger of missing stuff.”

Policymakers have a role to play in fixing some of these issues. Regulations around telehealth, interstate care, and remote prescribing changed essentially overnight when COVID-19 began spreading in 2020, and “those policies need to be cleaned up,” says Bhavneet Walia, an assistant professor of public health at Syracuse University who researches telehealth. She says there should be stronger policies specifying which drugs can and can’t be prescribed solely through telehealth and which virtual services can be reimbursed through insurance. That transparency is vital if telehealth is going to stick around, she says—and the data suggest it will.

“As we are facing out of the pandemic, the highest rate of telehealth use is actually still in mental-health therapy,” Walia says. “Even when patients can technically drive to their therapist, they prefer a visit via telehealth.”

The clinicians who spoke to TIME are split on the role telehealth should play in the mental-health field, however. Some still use virtual appointments in their own practices, where they can control factors like appointment length and prescription policies. Others feel in-person care is still the best way to form a good relationship with patients. Some say hybrid care, with occasional in-person visits to supplement virtual ones, makes the most sense.

But none of them said they’d be eager to work for another mental-health startup.

“With a startup, there’s going to be a lot of risk, there’s going to be a lot of failures, there’s going to be a lot of changes,” says Collins, the therapist in New Jersey and former Cerebral employee. “It’s just too much.”