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Can telemedicine transform mental health?

July 30, 2017

Editor’s Note: Glen McCracken, MD is the President and Cofounder of eVisit, a healthcare technology startup that enables physicians to better connect with their patients while increasing patient flow and practice revenue. Prior to eVisit, Dr. McCracken served as chief medical officer for two other medical startups including Medexi, a hospital software company and StatHealth Services (now Teladoc). Dr. Glen McCracken, is a Board Certified Emergency Department (ED) Physician with over 20 years experience. 

People who suffer from mental illness not only struggle with their condition, but oftentimes struggle to get care.  This is especially concerning when you consider that mental illness affects 1 in 5 people or 43 million in the US and that number is growing.1   These individuals stand to benefit from behavioral health counseling and support, but unfortunately their need is met with a shortage of mental health professionals.  In fact, according to the U.S. Health Resources and Services Administration, the nation needs to add 10,000 mental health providers by 2025 to meet the expected growth in demand.2

To add to this, individuals with mental health issues often suffer from multiple chronic conditions, suicidal tendencies and substance use disorders.  To help them begin to heal they need extensive medical care and support from multiple providers.  A primary care physician may be seeing a patient for a chronic condition and refer him or her to a specialist.  But, with the shortage of behavioral health providers, the appointment times may be anywhere from a few months to a year out. By then many patients simply give up or forget about it. Or they use the long lead time as an excuse to avoid the social stigma of seeing a mental health professional.  As a result, nearly 60 percent of mental health sufferers go untreated.3

Providers want to meet the growing needs of mental health sufferers, but are simply overwhelmed with a full appointment schedule.  For example, many hospitals and health systems report that they are grappling with huge unmet needs when it comes to mental health.  There are simply not enough psychiatrists and counselors to meet the exploding demand for services.

When it comes to mental health, clearly, a solution is needed.  The provider shortage is likely not changing anytime soon.  However, by harnessing the power of digital health and technology it may be possible to alleviate overwhelmed appointment schedules and expand services to better meet the needs of mental health patients.

Left Untreated, Mental Health Can Have Far Reaching Effects

Without treatment, individuals with mental illness are more susceptible to chronic conditions, substance use disorders, early death, suicide, crime and violence.  This not only impacts the individual but the community as a whole.

Individuals with disorders such as schizophrenia, depression and bipolar disorder are categorized as having a serious mental illness (SMI) and are at a higher risk for suicide.  However, among people with a SMI surprisingly suicide is not the cause of death.  Instead the five percent of Americans who have SMI die from the same things the rest of the population experiences—cancer, heart disease, stroke, pulmonary disease and diabetes.  With their mental illness and lack of interaction with a provider, those with SMI are more likely to suffer from chronic conditions associated with addiction such as nicotine, obesity (which may be associated with antipsychotic medication) and poverty (poor nutrition).  As a result, they often suffer from adverse health consequences earlier in life or commit suicide and die anywhere from 14 to 32 years earlier from than the general population.4  

The consequences of non-treatment are extensive and can lead to social consequences that impact the community such as homelessness, episodes of violence and prison.  In fact, approximately 26 percent of homeless adults living in shelters suffer from mental illness.At the same time almost 24 percent of state prisoners have a recent history of a mental health condition.6To add to this, the Department of Justice reports that violence is closely linked to untreated mental illness.  For instance, in violent crimes where children killed parents, 25 percent of defendants had a history of untreated mental illness. 7

Telemedicine:  How it Can Transform the Mental Health Care Delivery Model

To better address the needs of those with mental illness, providers may want to consider a technology-based approach such as telemedicine.  Using a telemedicine web-based and mobile-enabled software, providers can conduct virtual face-to-face patient visits with video conferencing.  These video consultations allow behavioral health specialists to make an emotional connection and establish rapport with the patient in a private setting.  Without travel delays, no shows and in-office distractions, telemedicine enables providers to gain operational efficiencies through shorter appointment times.  With shorter appointment times practitioners can serve more patients, provide more follow up appointments for those who need it most and potentially serve patients that extend beyond their typical geographic area.

To help practices gain greater efficiency, it’s essential that telemedicine technology provide reporting, offer scheduling options and be offered in a secure, HIPAA-compliant environment.

In addition to supporting providers, this technology-based approach, can make mental health services more accessible and convenient for patients.  With telemedicine in place a patient seeking behavioral health support can get treatment without leaving home – avoiding the perceived social stigma.  With the ease of scheduling and attending appointments from home, more frequent appointments can be scheduled as needed in a secure environment.  It also gives rural patients access to care that might not have been available before.

Finally, a technology-based resource such as telemedicine offers a viable solution with the potential to change mental healthcare delivery.  It can alleviate the shortage of mental healthcare professionals. Plus, it can make mental health services more affordable and convenient for patients.

Use Case Examples:  How Telemedicine Can Make a Difference in Behavioral Health Practices

Many providers have looked to telemedicine as a solution over the years. To better understand how telemedicine can improve care delivery here are a few use case examples of how psychiatrists, psychologists and behavioral therapists are using telemedicine technology.

– One board-certified psychiatrist chose to use telemedicine technology for the comfort, convenience and personalized care it provides to her patients.  She’s extended care by more than 550 visits and increased practice earnings by $48,000 along the way.8  

– A provider in rural Georgia uses telemedicine to address the opioid and heroin addictions that run rampant in the area.  He uses telemedicine to offer extended appointment times on evenings and weekend to talk patients through tough times and help them have more productive outcomes.

– A military psychologist offers therapy sessions to patients in Guam, Japan and Hawaii. Face-to- face sessions help those struggling with anxiety, post-traumatic stress disorder and depression make positive strides in their treatment.

Using a technology-based approach such as telemedicine gives behavioral health providers an important strategy to improve practice efficiency and extend care to more patients.  For patients, telemedicine improves access to care and enhances the patient experience with greater convenience.  Ultimately, telemedicine creates opportunities for more personalized patient engagement and more frequent care sessions that work in concert to reduce the suicide, early death and chronic conditions often associated with mental illness—improving health outcomes and quality of life.

Sources:

  1. National Institute of Mental Health (NIMH), Any Mental Illness (AMI) Among Adults, National, October 23, 2015.

  2. Health Resources and Services Administration (HRSA), National Projections of Supply and Demand for Selected Behavioral Health Practitioners: 2013-2025, November 2016.

  3. National Institute of Mental Health (NIMH), General Mental Health Facts Infographic, accessed May 2017.

  4. Robert Wood Johnson Foundation, Mental Health Conditions and Medical Comorbidity, February 2011.

  5. National Institute of Mental Health (NIMH), General Mental Health Facts Infographic, accessed May 2017.

  6. National Institute of Mental Health (NIMH), General Mental Health Facts Infographic, accessed May 2017.

  7. Consequences of Non-Treatment, www.mentalhealthpolicy.org, accessed May 2017.

  8. eVisit client analysis and reports, May 2017.

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