Telepsychiatry: Reaching More Patients For Better Outcomes

By Dr. Jim Varrell, Medical Director, InSight Telepsychiatry

A 42-year-old woman with chronic anxiety and agoraphobia found herself unable to leave her apartment. She reached out to her primary care doctor who prescribed Xanax, but the medication was only making her feel worse. Unable to go out in public, she found a telepsychiatry provider who adjusted her medication and dosage, connected her with cognitive behavioral therapy, and helped her reclaim her life.

Every year, about 42.5 million Americans struggle with mental illness — enduring stress, depression, anxiety, relationship problems, grief, mood disorders or other psychological concerns. Despite the availability of treatment most people don’t get the help they need, not necessarily due to stigma or denial, but because they can’t: it’s inconvenient or mental healthcare providers aren’t available in their area or within the time frame they need an appointment. To increase access to behavioral healthcare, people need an alternative to traditional doctor referrals, and telepsychiatry can help. Telepsychiatry is a type of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation, and treatment.

A Growing Market
A key driver of telepsychiatry is the serious shortage of psychiatry providers and other mental health professionals in the U.S. Today there are more than 4,600 mental health professional shortage areas making it difficult, if not impossible, for patients to access services. People referred to psychiatry providers by their primary care doctors face long and potentially dangerous wait times — often three to seven months or longer.

The situation is even worse for those in need of specialty providers, such as child and adolescent psychiatry providers. Currently, there are only about 8,200 practicing child and adolescent psychiatry providers nationally. To put this in perspective, New Jersey alone would need three times as many practitioners as it now has to adequately support the number of children in the state.

Telepsychiatry also offers the promise of delivering more effective mental healthcare in primary care practices. The burden of mental healthcare often falls on primary care doctors, yet many are unable to provide the most appropriate behavioral health resources. Adequately assessing and treating behavioral health issues requires more time with the patient than many doctors or nurse practitioners are able to spend. Moreover, while it is perfectly acceptable for primary care doctors to not know the ins and outs of mental healthcare, many don’t feel equipped to treat behavioral health conditions themselves because they lack specialized training. But without referral options, primary care doctors are often forced to do so. Many practices are overwhelmed with changes in how care is delivered and reimbursed, and under pressure to maximize time with patients, making it difficult for doctors to do it all.

Meeting Behavioral Healthcare Needs

• Quality: Telepsychiatry is leading the way in telemedicine for delivering high quality care that meets the standard of traditional in-person care. 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. It supports the patient-doctor relationship required by law to prescribe medications with documentation — a process identical to the traditional outpatient setting. For these reasons as well, it is increasingly reimbursable by insurance plans.

• Continuity of care: In addition to meeting care standards, telepsychiatry positively impacts continuity of care by providing greater accessibility to psychiatry providers. It meets patients where they are. Many patient populations including children, college students, and veterans respond well to this form of treatment, especially since they can maintain the relationship with their same psychiatric provider regardless of location. Other studies have found telepsychiatry can positively impact care for seniors and nursing home residents, reducing costs for the facility as well as improving access to needed care. Age has not been found to be a barrier to acceptance and most seniors readily accept the format.

• Access to care: Telepsychiatry is one of the most effective ways to increase access to care for individuals who might otherwise go without. Providing access to specialists for people in rural and remote areas is a challenge. Telepsychiatry offers a practical and cost-efficient way for psychiatry providers to reach these patients. The logistical benefits extend to those in urban centers as well. In light of the dramatic provider shortage, resources are scarce in all settings driving up wait times and commutes to be seen in-person. Telepsychiatry allows existing behavioral health providers to see more people at more flexible times. Many providers who offer telepsychiatry services do so during off-hours to meet the needs of consumers who have trouble finding time for commutes and waiting rooms, or who have trouble leaving their homes.

• Cost-effective: Behavioral health issues cost $135 billion every year — almost as much as heart disease and cancer treatment combined. Telepsychiatry can help lower costs for both psychiatry providers and their patients. Studies have found telepsychiatry incurs fewer direct and indirect costs than in-person services saving on provider time, medical supplies, technology, and reimbursement, as well as costs associated with the clinical space, administrative support, travel, and time off work. Nowhere is this savings more pronounced than in the rural setting where telepsychiatry has been found to reduce costs by as much as 40 percent. For hospitals and inpatient residential programs required to provide patients with follow-up care options, telepsychiatry can help ensure a seamless care transition with proactive post-discharge outreach, reducing potential penalties for providers under value-based care.

A Solution For Better Outcomes
Telepsychiatry meets patients’ needs for convenient, flexible, and accessible mental health services, helping improve patient outcomes. The convenience of online appointments makes patients more likely to attend their behavioral health sessions than if they were seeing a provider in person — and when people are consistent in managing their behavioral health, their physical health also improves. It also gives patients more options to find the right provider for them and the care that meets their specific needs, and allows typically underserved groups to access care. This combined with less travel time, less time off work and shorter wait times for services means people get the care they need sooner, are more engaged in their health and happier with their experience of care.

About The Author
James R. Varrell, M.D. has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry.