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Telepsychiatry: Raising the bar on access to mental health care

James Varrell, President and Medical Director, Insight

As May—Mental Health Awareness Month—rolls around each year, health care stakeholders are reminded to reflect on the notable achievements and strides made in mental health treatment. The industry continues to forge new paths in terms of technological advancement, research, discovery and awareness, leading to a more holistic approach to care delivery and improved health outcomes across U.S. communities.

In terms of improving access to care, one advancement in particular carries significant weight for expanding care options and lowering costs for patients, providers and communities: telepsychiatry. Telepsychiatry is a form of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation and treatment. A growing segment of telepsychiatry is direct-to-consumer care, which is working to tear down stigma-related barriers to treatment and open doors to expanded referral options and more timely care. In fact, industry stakeholders increasingly recognize direct-to-consumer telepsychiatry as a primary solution for filling mental health care gaps at a time when the need is soaring.

In tandem with the goals of value-based care, today’s patients and providers are no longer willing to settle for limited mental health treatment choices within their community. Similarly, communities should no longer view the long waits traditionally associated with accessing psychiatric care as acceptable, especially when telepsychiatry lays the foundation for more optimal, timely care delivery.

Recognizing the Need for Greater Access

Today’s mental health landscape is characterized by an increased need for services coupled with a dwindling supply of psychiatrists. The reality is that 42.5 million Americans struggle with mental health conditions including stress, depression, anxiety, relationship problems, grief, mood disorders and other psychological concerns. Unfortunately, accessing effective treatment is not easily attainable given the following statistics:

  • More than 55 percent of U.S. counties are currently without any psychiatrists.
  • The mental health landscape is facing shortages in more than 4,600 areas.

In addition, referrals to community-based psychiatrists often have an average 3-6 month wait time—a fact that is especially true for specialty psychiatrists, such as those who have expertise in complex child conditions. To put this need into perspective, the number of child and adolescent psychiatrists in New Jersey would need to triple to adequately support the need in that state alone.

Primary care doctors are often sought out as a resource for filling these service gaps created by growing demand. Yet, many may be uncomfortable prescribing medication for mental health disorders or lack specific expertise on psychotropic medications.

Consider the following scenario:

A 53-year-old female has a history of refractory depression and has tried numerous antidepressant options through her primary care doctor, who is at a loss as to the correct formula for the patient’s needs. The patient’s history reveals that she has had discrete hypomanic episodes, characterized by sudden displays of energy, productivity and noticeably more creativity. These 1-2 week episodes were followed by a decline back to her usual depression. Looking for a second opinion regarding her care, her primary care doctor referred the patient to a telepsychiatrist.

When the telepsychiatrist reviewed her symptoms he made the conclusion that the patient has type two bipolar disorder and needed an appropriate medication regiment.

Fortunately, in this example, the patient suffering from type two bipolar disorder accessed the needed psychiatry expertise in a timely manner by using direct-to-consumer telepsychiatry. After an accurate diagnosis and subsequent follow-up visits with the telepsychiatrist, the patient’s medications were further adjusted, resulting in effective management of the disorder and a satisfied patient.

The Telepsychiatry Advantage

Direct-to-consumer telepsychiatry introduces notable opportunities to improve access to care. Through live, interactive communication with a licensed psychiatrist in a private setting of the patient’s choice, this treatment model diminishes many of the existing challenges to reaching patients in need.

For instance, patients who live in remote areas where mental health services are lacking have access to psychiatry expertise within a few days rather than several weeks or months. Also, stigma becomes less of an issue as patients are able to experience more privacy, and care is more conveniently accessed in the home or a private location.

Appointment scheduling options outside of traditional office hours address the roadblocks of busy lifestyles that are often a deterrent to consistent follow-up and treatment. In tandem, mental health providers can see more patients with this increased flexibility. Direct-to-consumer telepsychiatry can also support greater continuity of care. For instance, some patient populations, like teens and college students, are more willing to continue treatment if a relationship is maintained with the same psychiatric provider during life transitions like moving to a new city for college.

Telepsychiatry is clinically proven to deliver high-quality care that meets the standard of traditional in-person care for diagnostic accuracy, treatment, effectiveness, quality of care and patient satisfaction. Along with the majority of medical associations, the American Psychiatric Association supports the use of telepsychiatry as long as it is used in the best interest of the patient and complies with medical ethics and federal privacy and security regulations. For these reasons, telepsychiatry is increasingly becoming reimbursable by a number of insurance plans.

Forward Looking

Going forward, the industry must embrace the promise of direct-to-consumer telepsychiatry as a critical strategic component to improving access to care. Telepsychiatry is a viable option and an alternative to traditional in-person care for mental health issues that has the potential to better serve communities and improve population health.

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