Telemental health involves providing mental health services using live, interactive video conferencing. In other words, a patient doesn’t need to drive to a doctor’s office to receive mental health treatment—he or she simply needs 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. In addition, provider organizations struggle to recruit and retain mental health specialists. As a result, non-mental health providers (e.g., general practitioners) are often placed in the position of serving patients who have severe mental health problems without the proper resources. Some patients in remote areas face the decision to either travel long distances for mental health services or forgo treatment entirely.
The following statistics illustrate the need for proper mental illness and substance abuse treatment in the United States:
- Approximately 1 out of 5 adults experience a mental illness in a given year.
- Approximately 1 out of 5 teenagers, ages 13 to 18, experience a severe mental disorder at some time in their lives.
- Approximately 10 million adults with a substance abuse disorder have a co-occurring mental illness.
- Approximately 24 percent of state prisoners have a recent history of a mental health condition.
- Serious mental illness costs the United States $193 billion in lost earnings every year.
In addition to the high numbers described above, there is a critical mental health provider shortage. A report to Congress found that 55 percent of the nation’s counties have no practicing psychiatrists, psychologists or social workers.
Telemental Health Benefits
Telemental health is a cost-effective way to improve access to specialty mental health services in rural and under-served communities. It also bridges the gap between the social stigma and mistrust of mental health providers that exists in many communities. Numerous studies have shown the effectiveness of telemental health services.
- The provision of telemental health services to patients living in rural and under-served areas has significantly reduced psychiatric hospitalization rates.
- Low-income, homebound seniors experienced longer lasting effects of telemental health than those who received in-person mental health services.
- Mental health providers rarely have to perform any physical services on their patients, so telemental health 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-face mental 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 significant issues involve state law. Each state seems to have a different way of monitoring mental health providers. This disparity among state laws creates significant legal and regulatory issues, including privacy, security, follow-up care, 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 the policy and the state of residence. Although 44 states reimburse for telehealth-provided services under their Medicaid plans, less than half of the 50 states require insurance companies to provide some form of reimbursement for telehealth services.
- Online platforms may make it more difficult for providers to establish good rapport with their patients. For example, it is more difficult to detect non-verbal cues using telemental health services.
- 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 only in the 1990s that telemental health care services truly came into their own. Despite the early success of telemental health care 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 of widespread telemental health services remains positive.
Telemental health services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. In 2010, the Veterans Health Administration established a National Telemental Health Center capable of offering telemental health treatment for all mental health conditions with a focus on post-traumatic stress disorder, depression, compensation and pension 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. Another potential negative effect could involve patients prematurely giving up on all types of treatment after using ineffective apps.
Along with other aspects of telehealth, telemental health is predicted to grow rapidly over the next few years with more customers and health care consumers requesting the technology. To ensure best practices, major clinical associations have developed and released best practices and guidelines. For more information regarding telemedicine, contact AUI.