Despite a number of barriers, industry observers and clinicians say telemental health is an effective method both for delivering care and dealing with the dearth of mental health service providers.
Telemental health — the delivery of long-distance psychiatric and psychological services through electronic means such as video teleconferences — has been used by the U.S. Department of Veterans Affairs and other government agencies for more than 20 years. In the past 10 to 15 years, increasing numbers of mental health practitioners outside government have followed suit. Today, the United States has roughly 200 general telemedicine networks, and industry leaders predict telemental health will be one of the most impactful fields within telemedicine in coming years.
“The market penetration [of telemedicine] is at 15 percent currently, and it’s growing at a clip of 18 percent each year — which is very high growth” says Harrison Tyner, Co-founder and CEO of WeCounsel Solutions LLC, a Chattanooga, Tennessee-based company that seeks to increase access to mental health care through technology. “These years we’re currently in are ... the growth stage in the industry.”
The Same but Different
The goal of telemental health is to deliver services across distances while closely emulating an in-person session. The same care is rendered, and the session is conducted in the same manner, notes Joshua Klapow, PhD, clinical psychologist, Chief Science Officer of ChipRewards Inc., a Birmingham, Alabama-based company that assists companies in developing health incentive programs.
“The psychotherapeutic process is not fundamentally different,” Klapow says, “but the delivery is.”
“I think skeptics would say you miss out on ... that sort of intangible feeling of being in the room with someone, or that you’re less able to pick up on body language. Those are fair questions to raise, but going back to the research, those things haven’t proven to be problematic.”
— Donovan Wong, MD, Medical Director of Behavioral Health at Doctor on Demand
Technological advances make it possible for clinicians to monitor patients’ vital signs and access their charts and similar information while the session is underway, Tyner adds.
With a nationwide shortage of roughly 25,000 psychiatrists, one of the primary reasons for telemental health’s rapid growth is that it holds promise for substantially increasing access to care, particularly in rural and remote areas. The National Alliance on Mental Illness reports that approximately 25 percent of American adults suffer from a diagnosable mental disorder. However, about 60 percent of those adults do not receive treatment. Many of those who go untreated live in areas where providers are often unavailable.
“Maybe around 50 percent of counties in our country don’t have access to a mental health provider,” says Donovan Wong, MD, Medical Director of Behavioral Health at Doctor on Demand, a San Francisco-based company that strives to increase access to health care through telemedicine.
Industry observers see telemental health as an important component of addressing that disparity.
However, like other nontraditional means of care delivery, telemental health has faced skepticism. Some practitioners and researchers have raised digital privacy issues. Others hold that direct human contact is essential to mental health work and healing. And some question clinicians’ ability to build rapport with patients from a distance.
There can be sensory, technological or other barriers to delivering telemental health services effectively, industry experts acknowledge, but they say those issues can be resolved relatively easily. Not being able to smell a patient to detect possible alcohol abuse or lack of personal hygiene, for instance, can impede treatment, Dr. Wong notes. However, he adds, such information often can be obtained from family members or from healthcare providers who are in close proximity to the patient.
If the quality of video technology — including audio and lighting — used by both provider and patient is good, the clinician is still able to detect nuances, such as body language and inflections in tone, in a patient’s behavior, Klapow says. Moreover, the technology to deliver telehealth is improving, proponents say.
Dr. Wong also points to research showing good outcomes among patients who receive telemental health services. According to a 2013 review in Telemedicine Journal and E-Health, multiple studies have found telemental health is as effective as in-person sessions across multiple age groups, in varied settings and for a range of conditions. It can even be better than in-person care in some instances. While telemental health helps bridge the distance between patients and providers, it also may encourage otherwise reluctant patients to seek care. Some patients may feel more comfortable meeting with a psychiatrist via video conference than in an office because of the stigma surrounding mental health issues.
Additionally, if patients have inflexible work schedules or if circumstances such as inclement weather arise, meeting online can save transportation- and work-related time and money, Tyner says. Similarly, because providers are in short supply, telemental health may save resources that providers would otherwise expend on travel to meet patients at distant locales.
“With telemedicine, they’re able to [see patients] from one central location and spend more time treating the patient, as opposed to driving to the patient,” Tyner says.
Bigger challenges, according to advocates, lie in legal roadblocks that hamper telemental health’s full potential to increase access to care.
“There are all kinds of artificial barriers involved,” says Gary Capistrant, Chief Policy Officer of the American Telemedicine Association. “Licensure is an important one.”
Strict license regulations and practice rules make it difficult for a provider to treat patients in multiple states. However, those barriers are diminishing. As of mid-2015, nine states had adopted the Federation of State Medical Boards’ Interstate Medical Licensure Compact, designed to streamline interstate provision of care.
Reimbursement issues are also becoming more manageable.
“When I started, there were 11 states that had legislation requiring private insurers to reimburse for telemedicine,” Tyner says. “Now there are 29.”