Telemedicine is a growing trend in health care treatment that provides a technology-based alternative for connecting providers and their patients.

The goal of the technology-facilitated treatment option is to increase patient access to convenient, readily-accessible and affordable health care.

Telepsychiatry is a subset of telemedicine that offers a range of mental health services via video conferencing or other telecommunications means.

Telepsychiatry services might include:

  • Psychiatric evaluations or addiction consultations
  • Therapy or addiction counseling
  • Patient education
  • Medication management
  • Ongoing care and follow-up

How Does Telepsychiatry Work?

Telepsychiatry offers live interaction between mental health providers and patients or a patient’s primary care providers by way of a video screen.

It can be used in different health care or patient-focused settings including:

  • Private practice
  • Outpatient clinics
  • Hospitals and emergency rooms
  • Correctional facilities
  • Educational institutions
  • Nursing homes
  • Military treatment facilities

Oftentimes, patients can simply schedule their video-assisted appointments directly with their mental health care provider.

These appointments generally take place in the same fashion as a face-to-face appointment (i.e., reviewing medical records and other relevant information, recommending or going over prescriptions and answering patient questions) but without the added inconvenience of traveling to a specific location.

Benefits of Telepsychiatry

Telepsychiatry offers several patient benefits including increased access to ongoing mental health care and improved patient monitoring. Telepsychiatry is also important for individuals living in rural areas who are wary of the stigmas associated with seeking treatment for mental health problems or addiction.

This form of technology might also be preferable for individuals with autism, severe anxiety disorders or certain physical ailments who may benefit from receiving treatment in their home.

Telepsychiatry has become a necessity in areas where there is a shortage of specialists able to diagnose and treat specific mental health problems or addiction. The St. Louis Post Dispatch reported that according to federal data, of the 101 rural counties in Missouri, 98 lack a licensed psychiatrist.

The same article reported on federal data that showed one in five children have behavioral health problems, but most go untreated due to cost, lack of access or lack of transportation.

One study by the University of Missouri showed that pediatric patients without access to telepsychiatry had to travel an average of 22.2 miles for treatment. The farthest distance traveled was 300 miles.

Other ways in which telepsychiatry can benefit patients include:

  • Integrating behavioral health care and primary care, thereby leading to better outcomes
  • Reducing time away from work, the need for childcare services, etc.
  • Reducing delays in care
  • Improving continuity of care and follow-up
  • Reducing the need for emergency room visits

In Case of Emergencies

The Agency for Healthcare Research and Quality estimated that one in eight emergency room visits involves a mental health or substance use condition, as reported by the American Psychiatric Association.

Data collected between 2003 and 2013 by the Missouri health department found that the rate of emergency room visits for behavioral disorders in rural areas was nearly 30 percent higher than the urban rate.

Despite these numbers, a 2016 poll showed that only 17 percent of emergency rooms have access to an on-call psychiatrist for psychiatric emergencies. Telepsychiatry provides a way to assess and appropriately treat these at-risk individuals even when a psychiatrist or other mental health professional might not otherwise be available.

Benefits of Telepsychiatry for Addiction

Telepsychiatry services for addiction are limited. But the technology-based tool is a great way for providers to maximize contact with patients being treated for addictions or substance use disorders (SUDs).

An abstract published in the Addiction Science & Clinical Practice Journal asserts that providers treating patients suffering from addiction disorders are most needed when patients are outside treatment settings. Patients with addiction disorders might also need immediate access to medication management or prescriptions to treat substance abuse issues.

2018 article reported on Congress’ efforts to use telepsychiatry as a “critical component” in combating the current substance abuse crisis in the United States. The article reports on two separate, yet corresponding, bills introduced recently to improve patient access to certain prescriptions (i.e. controlled substances) via telepsychiatry to treat addiction disorders and SUDs.

Prior legislation titled the Ryan Haight Act, which was passed in 2008, currently restricts physicians from prescribing controlled substances until they have conducted an in-person examination of the patient or unless they meet other strict federal guidelines.

Is Telepsychiatry Effective?

One study determined that psychiatric consultation and short-term follow-up was just as effective when done via telepsychiatry as it was when provided face-to-face.

The study took place in Canada and involved nearly 500 participants referred by their primary physicians for psychiatric consultations. The patients were randomly assigned to a consultation face-to-face or via telepsychiatry. The treating psychiatrists were given the option to provide monthly follow-up appointments for up to four months.

Results from the study showed that services delivered by telepsychiatry produced equivalent clinical outcomes to services provided face-to-face. Patients in both groups shared similar levels of satisfaction. Cost analysis showed that services provided by telepsychiatry were at least 10 percent less expensive, compared with face-to-face services.

In addition to the data, one media source reported that many providers agree that psychiatry easily lends itself to the technology because of the nature of mental health treatment. Most treatment is done verbally, whether by expressing understanding and concern or coaching the patient through a specific crisis.

Telepsychiatry Challenges and Regulations

Telepsychiatry presents some challenges to providers and patients. These challenges include limited connectivity, security (i.e. proper handling of electronic health records) and technology issues. Other challenges include licensure restrictions, insurance reimbursements and limited clinical training.

Licensure regulations require psychiatrists to be licensed in the state where their patients are located. This presents an obstacle for psychiatrists wanting to practice in multiple states or providing treatment to patients residing or visiting outside their state of licensure.

In 2017, 22 states adopted new legislation titled the Interstate Medical Licensure Compact (IMLC). The IMLC offers expedited licensure – when certain criteria are met – for physicians wanting to practice medicine or psychiatry in multiple states.

Additionally, many residency programs are making a shift towards incorporating telehealth including telepsychiatry into standard medical curriculums. This shift will increase a provider’s education and training – as well as comfortability – related to the use of telepsychiatry.

Electronic Health Records

Privacy on the internet might be another concern for many. Electronic protected health information (ePHI) is electronically-stored patient health information covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Providers wanting to treat patients by telepsychiatry should implement a system of secure communication – along with a way to monitor such communications – to avoid accidental or intentional security breaches.

Communications sent via SMS, Skype or email should be avoided as copies remain on the server containing individually identifiable health care information. Instead, secure messaging (i.e. encrypted communication) and HIPAA-compliant telehealth service providers are best suited to ensure the integrity of patient ePHI.

Cost and Insurance

As of July 2016, over half of all states in the United States – nearly 65 percent – have existing legislation mandating that private insurance cover telemedicine, according to the American Telemedicine Association.

Already, in 48 states, Medicaid programs will reimburse for some telepsychiatry services while Medicare will reimburse for services if the community is deemed rural.

Data regarding the effect of telepsychiatry on treatment costs is mixed, but rural areas seem to acquire the most significant benefit from the technology.

One study found that implementing telepsychiatry in a rural Kansas community reduced costs by more than 70 percent.  Other studies have found similarly substantial savings.

But not all research supports a cost-savings associated with telepsychiatry. Another study with a limited sample size – conducted over the course of one year – found that telepsychiatry cost more than face-to-face treatment.

The authors of the study, though, determined that additional research needed to be done with a larger sample size over a longer duration of time to make a more definitive finding related to telepsychiatry’s overall cost benefit.

    

Jay H. Shore, M.D., M.P.H. “What is Telepsychiatry?” American Psychiatric Association. January 2017. Accessed April 5, 2019.

Deslich, S., Stec, B., Tomblin, S., & Coustasse, A. “Telepsychiatry in the 21st Century: Transforming Healthcare with Technology.” Perspectives in Health Information Management, July 1, 2013. Accessed April 5, 2019.

HIPAA Journal. “HIPAA Guidelines on Telemedicine.” (n.d.) Accessed April 5, 2019.

Mahmoud, Hossam. “Telepsychiatry: Outgrowing Old Challenges.” Psychiatric News, July 5, 2018. Accessed April 5, 2019.

Modai, I., et al. “Cost effectiveness, safety, and satisfaction with video telepsychiatry versus face-to-face care in ambulatory settings.” Telemed J E Health, October 12, 2006. Accessed April 5, 2019.

Molfenter, Boyle, Holloway and Zwick. “Trends in telemedicine use in addiction treatment.” Addiction Science & Clinical Practice, May 28, 2015. Accessed April 5, 2019.

Munz, Michele. “Telepsychiatry helps with mental health burdens in rural Missouri.” St. Louis Post-Dispatch, May 20, 2017. Accessed April 5, 2019.

O’Reilly, R., et al. “Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial.” Psychiatric Services, June 2007. Accessed April 5, 2019.

Spaulding, R., et al. “Cost savings of telemedicine utilization for child psychiatry in a rural Kansas community.” Telemed J E Health, October 16, 2010. Accessed April 5, 2019.

Wicklund, Eric. “Congress Turns to Telemedicine to Take On Substance Abuse Epidemic.” mHealth Intelligence, March 5, 2018. Accessed April 5, 2019.