Americans have a lot on their minds. Gun violence, student debt, terrorism, the rising cost of living—there is no shortage of sources these days to fuel sleepless nights. It’s understood that mental health plays a key role in overall physical health. Yet, the numbers show among the large pool of people coping with mental health issues, not everyone has access to treatment. In 2016, 45.1 million adults were classified as having any type of mental illness. Among the 8.9 million adults with any mental illness and a substance abuse disorder, 37.6 percent did not receive any treatment. Four percent of young adults reported foregoing mental health care despite self-reported mental health needs.
Statistics like these beg the question, how can we improve patient access to mental and behavioral health resources? What barriers exist preventing patients from seeking treatment?
Making the Case for Telemedicine
Pros and cons can be assessed in any given situation. But one can’t ignore the growing body of research pointing to the effectiveness of telemedicine in treating patients with mental and behavioral disorders. According to research analysis published in the journal Telemedicine and e-Health, researchers reviewed 59 telemedicine studies published between 2005 and 2015 looking at the feasibility/acceptance of telemental health, medication adherence, improvements on quality of life, and cost effectiveness. The researchers found all studies focusing on medication adherence, as well as symptoms, quality of life and cost effectiveness reported positive outcomes.
Peter Yellowlees, M.D., a professor of psychiatry and director of the Health Informatics Program at the University of California, Davis, and a board member of the American Telemedicine Association, stated in Psychiatric News that patients with social phobia, post-traumatic stress disorder, and social anxiety benefit greatly from telemedicine.
“Satisfaction with telemedicine is frequently better than with in-person services,” said Yellowlees of his research and clinical experience with telemedicine. “Children prefer this, along with anxious patients, paranoid patients, and people who hate driving.”
Mobile apps also appear to have mental health benefits for users. The Pokemon Go craze has experts amazed about how the app has uplifted individuals suffering from mental health issues. Engadget wrote, “Twitter is flooded with stories about Pokemon Go‘s impact on players’ anxiety and depression, with thousands of people lauding the game for getting them out of the house and making it easier to interact with friends and strangers alike.” This suggests that certain demographics such as young adults and children may be just as comfortable, if not more so, using mobile telehealth services as a mental health tool.
Telehealth has long been advocated for improving access to care for people who live in rural or underserved areas. Military service men and women who return from long deployments with PTSD, depression and other mental health issues often don’t seek treatment because of the stigma that can accompany such actions. A telemedicine approach would help them bypass any fear of judgement or shame they may feel inhibiting them from getting treatment.
So, why isn’t telemedicine more widely used in mental and behavioral health?
Where the Disparities Exist
A report from The American Telemedicine Association (ATA) looked at the “complex telehealth policy landscape for licensed psychologists across the country” and found many disparities and challenges regarding telehealth adoption and utilization that prevent mental health professionals from fully taking advantage of the tools telemedicine can offer.
Despite decades of evidence based research showing positive outcomes from telehealth utilization for psychologists, the ATA report explains, “psychology boards, much like other health professional licensing boards, remain mired in a fragmented state-by-state licensure approach which stifles collaboration, service access, and availability.” These restrictions ultimately hinder individuals, who may otherwise be unreachable, from receiving services that could greatly improve quality of life—and, in some cases, save lives.
The report shows that only eight states in the U.S.—Mississippi, Missouri, Nebraska, Nevada, Oklahoma, Texas, West Virginia, and Wisconsin—have a policy landscape that supports telemedicine for mental and behavioral health. 41 states and D.C. need improvement. Colorado received the lowest score, suggesting many obstacles for telemental health advancement.
According to the report, as of May 2016, the Health Resources and Services Administration (HRSA) reported 4,374 Mental Health Professional Shortage Areas (MHPSAs) across the country. Other research has shown that 77 percent of counties have a severe shortage of mental health workers.
The expansion of telehealth in the mental health field could potentially help alter this trend, yet for many psychologists, their hands are tied.
Paving the way
There is still a societal stigma attached to mental illness in this country. For many, the fear of being rejected or isolated by peers and loved ones or the embarrassment of reaching out to a therapist weighs heavily on their decision whether or not to seek help. Other barriers such as financial, time constraints and even transportation can dissuade patients from pursuing a face-to-face visit with a psychologist.
Telemedicine’s rise in popularity across medical specialties can help address this growing need for mental health services. It is widely used in the treatment and management of chronic illnesses such as diabetes, addiction and hypertension as well as in dermatology, radiology and critical care. The wealth of research accumulating pointing to telemedicine’s effectiveness in the mental and behavioral health arena is vast, evoking the need for more supportive policies across the U.S.
There is not a one-size-fits-all solution to mental and behavioral health interventions—every patient is unique and some will benefit from more traditional models of care like face-to-face therapies. However, telemedicine’s application in mental health provides an opportunity to eliminate many of the barriers that keep people from seeking treatment in the first place and ensures that those who need help receive it in a way that works best for them.