With behavioral health needs soaring in the US, many providers have adapted their service models to offer telehealth mental health services. Telehealth encompasses a range of activities that enable providers to interact with clients through the use of technology, which often includes video conferencing. Providers can also use telehealth to connect with other people involved in a client’s care, including family members and other healthcare professionals.
In the past, telehealth was primarily used to bring services to a wider population, particularly those living in rural areas without easy access to in-person services. With the onset of the pandemic, more providers and clients are embracing telehealth. Delivering telemental health services can improve access and continuity of care for people living with disabilities and immunocompromised patients. It also reduces the need for individuals to find time off from work or secure childcare in order to see a provider in person.
For agencies, the increased demand for telehealth mental health services can help them expand the reach of their services, even after the pandemic ends. With more clients discovering that telehealth services can work for them, agencies have the opportunity to extend their mission beyond their previously limited geographic reach.
There has been a continuous progression towards the integration of primary care and behavioral health. The expansion of telehealth has helped fuel this integration. Telehealth can help connect patients with mental health providers soon after seeing their primary care physician. For example, healthcare network Trihealth has piloted a program where patients speak to a behavioral health provider through telehealth on the same day as their primary care appointment.
Technology also enables providers to better coordinate care and communicate among each other. For instance, telehealth can help integrate mental healthcare services into emergency rooms, where approximately 1 in every 8 visits in the US is related to a mental health or substance use concern, according to AAMC. Hospitals can leverage telehealth by utilizing real-time, remote behavioral health consultations in emergency rooms. The recent expansion of reimbursement for telehealth services has allowed more behavioral health providers to participate in such integrated care.
There is evidence that telemental health can help improve outcomes. A study of over 100 participants found that an online depression care management program led to “lowered depression, better overall mental health, increased satisfaction with mental health and coping skills, and increased confidence in handling depression.” The same report from the University of Michigan cites a pilot study on telehealth CBT counseling, stating that there were “statistically significant clinical improvements and high satisfaction ratings from client caregivers and providers alike.” As more providers embrace telemental health throughout the ongoing pandemic, there will be a renewed interest in tracking the effectiveness of telehealth in terms of outcomes and client care.
Although stigma surrounding mental health needs has been gradually declining in the US, there are still many individuals who would prefer not to visit a therapist in person. Telehealth enables clients to attend their appointments from the comfort of their own home, mitigating privacy concerns. Some organizations have asserted that telehealth counseling can be less daunting for particular groups, such as children, adolescents, and individuals living with developmental disabilities.
Research into telehealth effectiveness began decades earlier and there is significant evidence that it can be just as effective as in-person services for many populations. The U.S. Department of Veterans Affairs has found that PTSD interventions are equally effective whether delivered in person or over video conference. A study published in the Psychiatric Times states that “clinical outcomes of telepsychiatry interventions are comparable to face-to-face treatment delivered across diverse patient populations and diagnostic groups.”
Despite these studies, there are certainly individuals who report feeling more engaged with in-person counseling and there are some services, such as certain assessments for medication assisted therapy, that must be delivered in-person. Telehealth will be important in expanding access to mental healthcare, but will certainly not replace in-person services.
Prior to COVID, not all states guaranteed that telehealth services would be reimbursed at the same rate as in-person visits. The onset of the pandemic led to a rapid expansion in reimbursement for telehealth mental health services to ensure accessibility to care. However, many of these policies are still temporary measures in response to COVID-19 and it remains to be seen which state and federal regulations become permanent.
There are still some concerns regarding the security of delivering services over non-medical platforms, such as Zoom. Companies like Zoom have responded by upgrading their security measures and developing solutions that allow for HIPAA-compliant video therapy. Secure Electronic Health Records systems enable clinicians to work remotely and document their services securely.
Some individuals may have difficulty accessing the technology needed for telemental health services. Whether due to financial constraints, discomfort with using technology, or lack of internet access, some individuals may be unable to participate in remote services. Providers can help support individuals and their families with guidance on how to properly set up their technology for sessions and how to get the most out of a telehealth session.
A secure, reliable electronic health record system can help agencies successfully deliver telehealth mental health services.
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