More than 40 million adults are affected by mental illness in the United States, according to the National Alliance on Mental Illness. However, not everyone has access to psychiatric services.
According to a 2017 report by the National Council for Behavioral Health, the number of psychiatrists working with public sector and insured populations has decreased 10% from 2003 to 2013. This, combined with an increase in demand for psychiatric services, has “created a crisis throughout the U.S. healthcare system that is harmful and frustrating for patients, their families and other healthcare providers.”
A nationwide psychiatrist shortage means patients are dealing with shorter sessions, extended wait times in between appointments, lower quality of care and, in some cases, a lack of access entirely. More than half of the nation’s counties do not have a psychiatrist at all, according to a 2016 study published in Health Affairs.
In an effort to expand access to some of the nation’s underserved populations and lower the cost of providing mental health treatment, healthcare providers are adopting the use of telepsychiatry to connect patients with mental health professionals who may not have access otherwise.
What is Telepsychiatry?
Telepsychiatry is the use of technology to provide psychiatric care between psychiatrists and patients by using video conferencing and other communications.
Psychiatrists are able to interact with a patient in real-time and evaluate, manage and prescribe medication from their location directly to the patient’s location. Some programs are set up at local clinics or hospitals, where a patient comes in and is led to a secure room for a video conference with a psychiatrist. Others allow patients to log on to a secure connection at home.
In addition to helping bring treatment to a patient despite their location, the American Psychiatric Association credits telepsychiatry programs with helping reduce delays in care, reduce the need for emergency room visits and reduce the stigma associated with seeking psychiatric services.
According to a 2016 report published in the Journal of Behavioral Health Services & Research, telepsychiatry programs generally target specific populations, including:
- Rural communities
- Children and adolescents
- Veterans and military populations
- Correctional facilities
Is Telepsychiatry Effective?
Some studies claim telepsychiatry programs are producing positive clinical outcomes and high levels of patient satisfaction, including a 2015 study published in the World Journal of Psychiatry. Authors claim accumulated evidence indicates telepsychiatric treatment is comparable to conventional treatment.
In the 2016 report, The State and Sustainability of Telepsychiatry Programs, authors wrote “it has been effective for treating many mental health conditions, including panic disorders, depression, and post-traumatic stress.” The study also notes that the telepsychiatry delivery model has helped reduce cost and travel time for both patients and mental health professionals. Dr. Scott Whitacre, Florida Tech psychology professor, has seen its benefits in a prison setting:
“What happens, is once a week our psychiatrists go in and they will see an inmate at a prison and do some telepsychiatry so to speak, talk to them, be able to prescribe medication to them, again. That can be critiqued, some people say it’s a good thing, some people say it’s not a good thing, but the truth is, it saves gas, it saves money, it saves time, it allows the inmate patient to get on medication quicker and faster. It can be a very, very beneficial step forward for a patient.”
Despite research highlighting the benefits of such programs, telepsychiatry lacks industry-wide support.
“It is more potentially problematic to choose online therapy over in-person treatment when both are practical options,” Dr. Steven Reidbord, M.D. wrote in a 2013 article published in Psychology Today. Reidbord explains that in-person treatment “is inherently a social interaction, which may be therapeutic itself.” Also, treatment from a distance could preclude mental health professionals from noticing minor facial expressions or being able to smell alcohol on a patient’s breath or catching dilated pupils.
Telepsychiatry Expansion: Opportunities and Obstacles
Telepsychiatry is one of the fastest growing subfields of telemedicine, according to the 2016 report The State and Sustainability of Telepsychiatry Programs.
While widespread studies highlight the benefits of implementing telepsychiatry programs, expansion has been hampered by regulations and limits on reimbursement.
For example, a 2016 report from the Public Health Institute Center for Connected Healthy Policy states that 47 states offer some type of reimbursement for live video services through Medicaid programs. Of those who provide reimbursement through public programs, rates, eligibility and program restrictions vary. Connecticut’s Medicaid program only reimburses live video for “case management behavioral health services for clients under the age of 18.” California, in comparison, reimburses live video services for a wide variety of medical specialties.
Other barriers include obtaining proper licensure for psychiatrists who want to provide telepsychiatric services across state lines.
Currently, psychiatrists face significant delays in obtaining individual state licenses for providing care in multiple states. In response, a national licensing standard was created to allow mental health professionals a faster way to obtain licensure in multiple states. As of June 2016, 17 states have enacted legislation for the program called The Interstate Medical Licensure Compact, according to the report from the National Council.
The U.S. Department of Veterans Affairs and the Department of Defense have also made policy changes to expand the model. Practitioners working for the VA, despite the state in which they are licensed, can provide care in the VA system and care to active duty military through the DoD.
However, supporters believe more is needed.
Authors of the National Council report note that “federal and state laws and regulations have been inconsistent in keeping pace with telepsychiatry’s growth.” One such law that is cited as an impediment to growth is the Ryan Haight Online Pharmacy Consumer Protection Act, which became law in 2008 and amended the Controlled Substances Act by adding more provisions “to prevent illegal distribution and dispensing of controlled substances by means of the internet.” Authors state that revising and updating the law “would increase the application of telepsychiatry.”