In honor of May being National Mental Health Awareness Month, we at TeleQuality think it’s the perfect time to highlight how technology is transforming one of the most misunderstood and most important areas of medicine. We’re proud to serve various community service boards, behavioral health, and mental health providers making a difference in their communities across the country. This month is the perfect time to honor the hardworking mental health organizations in our nation by featuring how telemedicine is transforming the delivery and quality of care for mental and behavioral health patients.
So how are broadband, health IT, and 21st century technology solutions impacting mental health care? Let’s dive into the world of telepsychiatry and telemental health to learn how they’re expanding access to mental health care like we’ve never seen before.
The Need for TelePsychiatry
One of the most under-discussed and stigmatized areas of health care is mental illness; yet data shows our nation’s mental health needs are rapidly increasing.
According to Mental Health America:
- 1 in 5 adults have a mental health condition. That’s equivalent to 40 million Americans and more than the state populations of New York and Florida combined.
- Youth mental health is worsening. Severe depression in youths increased from 5.9% in 2012 to 8.2% in 2015.
- More Americans have access to services but most still lack access to care. 56% of American adults with a mental illness do not receive treatment.
It’s clear these statistics show the demand for mental health care is rising, but the provider pool and supply is quickly dwindling. Even though there are about 28,000 psychiatrists in the U.S., 3 in 5 currently practicing are 55 years of age or older and will age out soon, according to AAMC data. This problem is severely exacerbated in rural America where providers are in even shorter supply showcased in this New American Economy report:
- Rural and remote areas simply have little to no access. More than 60 percent of all counties in the U.S.- including 80 percent of all rural counties- do not have a single psychiatrist. In rural counties, just 590 psychiatrists serve more than 27 million Americans.
- The difference between state by state access is striking. In states such as New York, there are more than 612 psychiatrists per 100,000 residents; however, if you move to rural Idaho you can expect less than 1 psychiatrist for every 100,000 people.
- Mental health professional shortage areas are prevalent. According to the HRSA, over 123 million people are living in mental health professional shortage areas.
While medical schools and teach hospitals are attempting to fix the problem citing a 5% increase in psychiatry residencies from 2010 to 2015, telemental health or telepsychiatry is the perfect solution to allow practicing physicians to treat patients across their state virtually and greatly increase access to these services for the most vulnerable populations.
Telepsychiatry is the process of providing a variety of services such as psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education, and medication management from a distance through telemedicine technology, often using videoconferencing. Telepsychiatry can be implemented in a variety of settings, including:
- Private practices
- Outpatient clinics
- Correctional facilities
- Nursing homes
- Military treatment facilities
Research has found telepsychiatry to be effective in treating a number of mental health conditions such as PTSD, depression, and ADHD, and may even be preferable to in-person care for some conditions that pose physical limitations such as autism or severe anxiety disorders. Additionally, mental health is one medical field in which doctors don’t have to lay hands on a patients meaning telepsychiatry needs less telemedicine equipment/health IT tools and mental health workers can get more out of a digital session than in-person visit compared to other disciplines.
Video-based telepsychiatry provides a number of benefits to patients and healthcare providers, including:
- Improving access to mental health specialty care that might not be available otherwise
- Bringing care to the patient’s location no matter where they’re located
- Helping integrate behavioral health care and primary care
- Reducing emergency room trips and providing increased access to psychiatric crisis invention when needed
- Reducing delays in care
- Improving continuity of care and follow-up
- Reducing the need for patients to use time off work, acquire childcare services, etc. for appointments that are far away
- Reducing patient transportation barriers (lack of transportation, paying for transportation, etc.)
- Reducing the barrier of stigma
While some opponents question how comfortable patients will feel talking virtually with a psychiatrist, studies are showing patients, especially younger generations, are comfortable and familiar with video communication as it becomes more and more prevalent in our everyday lives and they may in fact prefer it over traditional in-person methods.
A Resource for Psychiatric Crisis Treatment
The deinstitutionalization of psychiatric patients that began in the 1960s, which brought 558,922 state beds in 1955 down to 37,679 today (half of which are used for forensic cases only), has led to an overcrowding of psychiatric patients seeking treatment in emergency rooms. But hospitals can’t take on this influx of patients and recent polls are showcasing how terrible these outcomes are getting. A 2016 poll of ER physicians found:
- Lack of access to psychiatrists and insufficient bed counts are producing disproportionally longer wait times for psychiatric emergency patients sometimes lasting as long as 1-2 days.
- Only 16.9% of emergency physicians reported having a psychiatrist on call to respond to psychiatric emergencies in the emergency departments while three quarters of those physicians reported seeing patients at least once a shift who require hospitalization for psychiatric treatment.
Telepsychiatry provides an excellent way to partially alleviate this growing emergency psychiatry shortage. Psychiatrists can be ready and on-call to quickly join a video conferencing session at the ER to provide direction and treatment in these crisis situations without needing to rely on an in-person physician.
Reimbursement & Payment
The benefits of telemental health are enormous but let’s get down to dollars and cents. Who’s reimbursing these services and how much?
- Medicare: check out this guide from CMS on information, rules and guidelines on submitting reimbursement claims for telehealth through Medicare. Make sure to do your research as the OIG just released a report indicating over $3.7 million in improper telehealth payments last year.
- State by State Guides: The American Telemedicine Association (ATA) publishes two guides annually detailing the physician practice standards and licensure, and coverage and reimbursements for services by each state. Check those out here. The Center for Connected Health Policy also publishes a state-by-state Telehealth Laws and Reimbursement Policies guide which you can access here.
Are you a mental health provider or a patient that’s used telepsychiatry? We want to hear your feedback and thoughts! Comment below on your experiences with telemental to get the conversation going!
Are you looking into setting up your own telepsychiatry system? Check out our additional resources below to get you started!
- American Psychiatric Association’s Telepsychiatry Toolkit & Best Practices in Videoconferencing-Based Telemental Health
- E-Psychiatry: ATA & APA Telepsychiatry Guidelines
- mHealth Intelligence: Telepsychiatry Opens a New World into Behavioral Healthcare
- New American Economy Report: The Silent Shortage- How Immigration Can Help Address the Large and Growing Psychiatrist Shortage in the United States
- mHealth Intelligence: Telemental Health in the Heartland
- American Telemedicine Association: Telemental Health SIG
- EBG Law: 50-State Survey of Telemental/Telebehavioral Health
- Webinar: Telepsychiatry- Re-Imagining Psychiatric Care in Rural Communities