Turning to technology to provide accessible, cost-effective behavioral and mental health services

Telemental health involves providing mental health services using live, interactive video conferencing. In otherwords, a patient doesn’t need to drive to a doctor’s office to receive mental health treatment—he or she simplyneeds to log on to a computer.

The need for telemental health

Rural and under-served communities often suffer from limited access to specialty mental health services. Inaddition, provider organizations struggle to recruit and retain mental health specialists. As a result, non-mentalhealth providers (e.g., general practitioners) are often placed in the position of serving patients who have severemental health problems without the proper resources. Some patients in remote areas face the decision to eithertravel long distances for mental health services or forgo treatment entirely.

Telemental health is acost-effective way toimprove access to specialtymental health services inrural and under-servedcommunities.

The following statistics illustrate the need for proper mental illness and substance abuse treatment in the UnitedStates:

• Approximately one out of five adults experiences a mental illness in agiven year.
• Approximately one out of five teenagers, ages 13 to 18, experience asevere mental disorder at some time in their lives.
• Approximately 10 million adults with a substance abuse disorderhave a co-occurring mental illness.
• Approximately 24 percent of state prisoners have a recent historyof a mental health condition.
• Serious mental illness costs the United States $193 billion in lostearnings every year.

In addition to the high numbers described above, there is a critical mental health provider shortage. A report toCongress found that 55 percent of the nation’s counties have no practicing psychiatrists, psychologists or socialworkers.

Telemental health benefits

Telemental health is a cost-effective way to improve access to specialty mental health services in rural andunder-served communities. It also bridges the gap between the social stigma and mistrust of mental healthproviders that exists in many communities. Numerous studies have shown the effectiveness of telementalhealth services.

• The provision of telemental health services to patients living in rural and under-served areas hassignificantly reduced psychiatric hospitalization rates.
• Low-income, homebound seniors experienced longer lasting effects of telemental health than thosewho received in-person mental health services.
• Mental health providers rarely have to perform any physical services on their patients, so telementalhealth is more plausible than other types of telehealth services.
• There is little or no difference in patient satisfaction with telemental health when compared with face-to-facemental health consultations.
• Although mental health professionals are in short supply, mobile devices are not.

Telemental health challenges

While telemental health touches on some federal laws and regulations (e.g., HIPAA), most of the significantissues involve state law. Each state seems to have a different way of monitoring mental health providers. Thisdisparity among state laws creates significant legal and regulatory issues, including privacy, security, follow-upcare, emergency care, treatment of minors and reimbursement.

The following are some other common telemental health challenges:

• Insurance may or may not cover telemental health—coverage for all types of telehealth depends on thepolicy and the state of residence. Although 44 states reimburse for telehealth-provided services undertheir Medicaid plans, less than half of the 50 states require insurance companies to provide some formof reimbursement for telehealth services.
• Online platforms may make it more difficult for providers to establish a good rapport with their patients.For example, it is more difficult to detect non-verbal cues using a telemental health service.
• Not all patients have, or understand, the technology needed for telemental health services.

Growth of telemental health

While telecommunications have been used for decades to provide some behavioral health services, it was onlyin the 1990s that telemental healthcare services truly came into their own. Despite the early success oftelemental healthcare services, wide-scale implementation remains dependent on policy and funding initiatives.However, with many states recently passing or voting on telemedicine parity laws, the outlook for the future ofwidespread telemental health services remains positive.

Telemental health services can be offered through intermediary companies that partner with facilities toincrease care capacities, or by individual providers or provider groups. In 2010, the Veterans HealthAdministration established a National Telemental Health Center capable of offering telemental health treatmentfor all mental health conditions with a focus on post-traumatic stress disorder, depression, compensation andpension exams, bipolar disorder, behavioral pain and evidence-based psychotherapy.

Also driving growth in the industry is the development of new technology, such as mHealth (mobile health)apps. Still, this is a delicate area as the apps may also provoke anxiety with self-diagnoses. Anotherpotential negative effect could involve patients prematurely giving up on all types of treatment after usingineffective apps.

Conclusion

Along with other aspects of telehealth, telemental health is predicted to grow rapidly over the next few yearswith more customers and healthcare consumers requesting the technology. To ensure best practices, majorclinical associations have developed and released best practices and guidelines.