Many people with mental illness in America struggle, and have struggled, to get the care they need for any number of reasons. Through the last decade though, telehealth has proven its potential to help by providing affordable, convenient, and private care all through video chat. There is, of course, a long way to go before therapists are able to consult with and deliver care anywhere to anyone, but growth in the future of this rapidly growing field looks bright, to say the least.
Here is a snapshot of a few obstacles facing the mental health industry and how telehealth is poised to reach millions in the years to come.
The Challenges of Delivering Mental Healthcare in America
Mental health is a loaded term for many Americans. In October of last year, John Oliver featured a segment on how treating mental health in our country is fraught with difficulties. He cited research from the Substance Abuse and Mental Health Services Administration that found 10 million Americans each year suffer from a serious mental illness, but comparatively few talk or are well informed about it. Three key reasons why include: Access to help is often limited, people often ignore signs of mental illness, and insurance policies can make treatment both prohibitively expensive and inconvenient.
Part of that nationwide lack of knowledge could be a reflection of the fact that there just are not enough mental healthcare providers to go around. "90 million Americans live in designated mental health provider shortage areas, whereas just over half of that number, 55 million, live in primary care shortage areas," Dr. Jennifer Gentile said in Amwell, a mental healthcare telemedicine company. "The bottom line is there are not enough providers to meet the needs of over 61 million people who need care every year."
But even if those local mental health professionals were available, many Americans could not afford their services.
Ignoring the Need for Help
The stigmas, the dearth of healthcare professionals, and the shoulder shrugging at a policy level have created both a public health crisis and a massive economic problem. USA Today’s Liz Szabo reported that "neglect of Americans with serious mental illness costs the nation $444 billion a year — mostly from lost earnings." In many cases, this leaves patients to suffer alone, when they are most likely to struggle with some form of addiction, homelessness or being put in jail.
"The American health care system is ripe for disruptive innovation, and nowhere is that need greater than in the delivery of mental health services," said Dr. Lloyd Sederer, the Medical Director of the New York State Office of Mental Health. He points out that most mental disorders could be diagnosed before a patient reaches his or her mid-20s, but "more people turn to non-stigmatizing medical settings throughout their lifetimes than to specialty mental health care."
Even with early diagnosees though, with benefits as they are,many people would still struggle with their coverage options and the payments associated with treatment.
Lack of Sufficient Coverage
For two decades, United States law has required that insurance providers limit benefits for mental healthcare provision no lower than those for medical or surgical benefits. The most recent such law was the Affordable Care Act’s parity mandate, which stated that coverage for people in small group and individual markets must cover mental healthcare provision equally alongside nine other essential health benefits. That went into effect in 2014.
But these laws don’t do enough to help mental health patients get the treatment they need. In October 2015, the Washington Post’s Janell Ross reported on a study from the National Alliance on Mental Illness that she called "truly disturbing."
According to the study:
- Patients across the country struggle to find therapists and psychiatrists covered by their health insurance plans.
- Mental health patients are more frequently denied treatment for coverage and for medication.
- Insurance companies can be opaque about what limits exist on services and treatments covered under their plans — if they’re covered at all. A patient might not know whether his or her treatments are covered until after signing up for a plan.
This all adds up to a substantial number of mental health patients who have to pay for expensive treatments and medications themselves - or de-prioritize treatment based on their financial situation. Further, mental healthcare is seldom a matter of seeing a therapist for a one-off visit. Repeat visits and many rounds of medication are often necessary to treat a problem, which isn’t just expensive, but also a major time commitment.
How Telehealth Can Help Solve Those Problems
Vera Gruessner at mHealthIntelligence points out transportation and mobility issues hold back many would-be mental health patients from putting their health first and seeking the help they need. For example, a person in a rural community might have to drive more than an hour each way for therapy. Or, someone with limited mobility — think senior citizens and disabled veterans — might simply be unable to travel long distances for treatment. Telehealth services, with their ability to remove commute time and cost, in addition to the cost of provider overhead, are a promising and viable solution.
Dr. Leonard Egede of the Medical University of South Carolina in Charleston recently led a study where he used telemedicine to treat seniors for depression. Per his findings, he said in Reuters, "At our facility, we have almost 40% of people who live in rural areas, so this is a good opportunity to be able to provide care for them without them having to drive long distances." He also noted that being able to treat seniors in their homes helped alleviate the stigma some people still associate with mental illness.
As mentioned previously, telemedicine technology also helps reduce overhead costs, savings that can then be passed on to mental health patients who might not otherwise be able to afford care. Timothy Elliot, a professor with the Department of Educational Psychology at Texas A&M University, tells iHealthBeat that videoconferencing offers low-income patients in rural Texas an affordable and convenient way to speak with mental health professionals. "In rural and small towns, one of the things that has impressed us is that residents become very comfortable with the technology very quickly," he says. "They take comfort from the fact that they can see a therapist they won't bump into at church or Walmart."
Dr. William Hazle, a psychiatrist in Idaho, reports similar success in reaching patients across the state with such a large, rural population and a legal code that, until recently, made it difficult for residents to receive telehealth care.
A Success Story in East Tennessee
In January 2015, the Trinity Health Foundation of East Tennessee announced it would award $150,000 to the Helen Ross McNabb Center, a behavioral health center with locations in and around Knoxville, to develop a telepsychiatry program that would fold into its continuum of care.
"With a national shortage of psychiatrists, it is rare and fiscally challenging to provide mental health services in rural areas," the Trinity Health Foundation announced at the time. "For states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations between provider and patient."
After a sample size of only a few months, the money appears to have been well-spent. McNabb Center nurse practitioner Katy Nottingham told the Knoxville News Sentinel that, although she was initially skeptical of telepsychiatry, she’s found that adolescents and young adults take to the platform easily. Nottingham said that these patients in particular seem to feel less intimidated by the idea of psychiatric care when it was delivered via a familiar medium, in the privacy of their own home.
McNabb Center CEO and President Jerry Vagnier is optimistic about the program, though he notes it’s in its very early stages. "We have served over 200 contacts through this medium, so we’re learning as we go," he told local television news station WATE 6. "And it’s getting better and better as we improve that process. We think we’ll serve upwards of 750 or better throughout the course of the year."
In sum, the wide world of telemedicine is growing rapidly. With near seamless adoption by age groups young and old, these services save time and money on the part of the provider, the patient and the businesses who employ the aforementioned patients. Further, they free everyone from the geographic constraints, thereby offering potentially better fits based not only on diagnosis or insurance type, but also on personality and personal preference.
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Tags: Providers, Telehealth