Lawmakers Widen Path for Telemental Health to Help Vulnerable Populations

By Michael Stone  |  June 8, 2017

Providing mental health services through telemedicine (usually through remote video conference) has been around for several decades, with Dartmouth’s medical school using the method on black-and-white TVs as early as the 1960s. For decades before that, people had experimented with the idea of telemedicine, as shown in this 1924 cover of Radio News magazine: 

But it hasn’t been until recent years that any significant volume of PTSD, depression, anxiety and other psychiatric patients have been seen remotely, said Dr. Ateev Mehrotra, an associate professor of healthcare policy and medicine at Harvard Medical School and a researcher of telemental health.

This is shown, he said, by Medicare coverage for telemental health going “from basically nothing in 2004 to about 90,000 visits in 2014 — and obviously higher in subsequent years.”

Opening Up Telemental Health for Rural Patients and Veterans

Overall, rural patients covered by government and private insurers that reimburse for telemental health are growing by almost 50 percent annually, Mehrotra said, referencing his study published this year in the journal Health Affairs.

“I think it’s easy to go out on a limb and say it’s probably going to increase even further,” he said. “There is a sense of momentum, that you see it growing and growing.”

But the tool isn’t merely one of convenience. Like with many areas within healthcare, mental health is looking to telemedicine as almost a savior: for veterans and others who feel more comfortable talking with someone in their own home, for rural communities many miles from their nearest psychiatry office, for working parents who can’t get time off or afford childcare, and to compensate for the nationwide psychiatrist shortage that Dr. Peter Yellowlees said is now at an estimated 10,000.

Nationwide psychiatrist shortage is now estimated at 10,000. tweet this 

“We’re constantly being chased by recruiters. … Obviously, the greater the shortage, the more [patients] have to wait, unfortunately,” said Yellowlees, a professor of psychiatry at the University of California Davis and president of the American Telemedicine Association’s board of directors.

Researches haven’t compiled nationwide data comparing in-person vs. remote wait times, perhaps because of the wide variance from community to community.

But when taking into consideration all the hurtles to care — such as rural location and work schedules — telemedicine on average likely would provide a quicker appointment, said Kristen Shealy, a mental health therapist and a counselor at the National Crime Victims Research and Treatment Center at the Medical University of South Carolina.

“Ostensibly, the wait time to see a mental health professional using video conferencing should be less than in person,” she said, “because you’re able to address a number of those obstacles.”

Hundreds of Telemedicine Bills in the Works

U.S. lawmakers are taking notice of the benefits, for mental health and other healthcare realms. Among the 2015 legislative sessions for all states, 42 had introduced a combined 200-plus telemedicine bills.

For 2016, it was 40-plus and 150-plus, respectively, according to a 2016 presentation at the National Conference of State Legislatures.

These efforts mainly focus on provider reimbursement from insurers, establishing board standards and cross-state licensing, according to the Center for Connected Health Policy.

Telemental Health Is More than a Convenience for Veterans

The growth of telemental health comes at a crucial time for one especially vulnerable group: veterans, who commit suicide at an average of 20 per day.

Shealy and Yellowlees noted that in response to this crisis, there has been great headway made by the Department of Veterans Affairs, considered to have the world’s largest telemental health network.

Public entities, like the VA, often fair better (two to four weeks) than private practices (often eight to 12 weeks) in scheduling an upcoming mental health appointment, Yellowlees said.

In total from fiscal years 2003 to 2015, the VA had more than 1.8 million telemental health visits with veterans. It says its efforts are especially critical to those living in rural areas, which are often lacking in mental-health professionals.

From 2003 to 2015, the VA had more than 1.8 million telemental health visits with veterans.tweet this 

Yet even though the central discussion point within telemental health often defaults to rural, Mehrotra said the provider shortage affects all corners of the U.S.

Reimbursement Parity: Making Telemental Health Worth It to Providers

“The supply of mental-health specialists is an issue nationally — urban areas, rural areas, in Boston, where we have a lot of mental health specialists as well as communities where there are very few,” he said. “While this is particularly a problem in rural communities, it isn’t limited to those communities.”

And even though a psychiatrist might have an office a short distance away, she or he often will accept only direct payments, Mehrotra said. “If you have enough of a clientele willing to pay out of pocket and you can get a higher rate, then why would you bother?”

Looking forward, such roadblocks will be alleviated as legislatures and payers continue to expand pathways to services, Shealy said.

“There’s a lot of ongoing efforts to help lawmakers and insurance providers understand the importance of reimbursement parity for a variety of telemental health services,” she said. “And so I think as those efforts bear fruit, we’ll increase access to these specialized services.”

And through this, Shealy said she hopes to see growing benefits for patients, like all the children and adults she works with — in person and, for the past six years, through telemedicine.

“You can really reach people who are in great need, who are going through a lot, and provide evidence-based services to individuals who might not otherwise be able to access those services,” she said. “So it really is quite rewarding.”

 

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