Patient-Centered Care

How Telemedicine and Psychiatry Are Improving Access to Mental Health Care

Telepsychiatry brings mental health care to rural areas and underserved communities where trained professionals are in short supply.

Jacquelyn Bengfort

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Jacquelyn Bengfort is a freelance writer based in Washington, DC. A social anthropologist by training, she writes on topics from education to the military, gender to fictional post-apocalyptic worldscapes.

Growing up in Alaska, Dr. Yolanda Evans saw firsthand the healthcare gaps found in rural populations, a divide that includes mental health care.

As an adolescent healthcare provider at Seattle Children’s Hospital, where she sees youths facing issues such as eating disorders and gender dysphoria, Evans has kept those concerns top of mind since joining the faculty in 2011.

“I knew that I wanted to try to serve more rural patients,” she says. “I understand the needs in these communities.”

Remote areas often lack specialists to provide counseling and intervention: A 2017 Merritt Hawkins report found 77 percent of U.S. counties reported a severe shortage of psychiatrists. The Association of American Medical Colleges notes that nearly two-thirds of practicing psychiatrists are 55 or older, setting the stage for a substantial retirement drain.

Meanwhile, 1 in 5 Americans will experience a mental illness in a given year, federal data shows.

It’s why Evans and some colleagues are using videoconferencing technology to reach patients outside a clinic’s walls. Seattle Children’s offers telepsychiatry services not only in Washington state but also in Alaska, Idaho, Montana and Wyoming.

The hospital, which first established a telehealth program in 2001, has long made mental health a core part of its offerings. “Psychiatry was the most requested specialty across our partner sites,” says Dr. Kathleen Myers, a psychiatrist at Seattle Children’s.

The option appeals to many families, no matter their distance from a provider. “It reduces the burdens of missing work, absences from school, commuting to the hospital for a 45-minute appointment and the steps of registration and waiting,” Myers says.

Seattle Children's Offers Care from a Distance

Seattle Children’s employs a mix of technologies to provide telepsychiatry services, depending on the state and partner site being served.

When establishing a virtual-care partnership with Alaska Native Medical Center, Evans traveled to Anchorage to install the software for their telehealth system onto her laptop, while working with IT departments in both locations to ensure sessions are encrypted.

Back at her office, she uses a Cisco DX80 videoconferencing kit that provides a point-to-point connection between herself and clients. A mobile-friendly app-based software option is in the works to make telehealth more user friendly and, Evans notes, “to offer the future capability of potentially connecting to patients in a nonclinical location, such as from their homes.”

Setting up the technology was easy. Licensing and credentialing were more onerous, says Evans, noting that the processes took about a year to complete in Alaska.

The efforts can pay off, says Myers, whose research found that children with attention deficit hyperactivity disorder who received 22 weeks of virtual visits with a behavioral therapist saw better outcomes than peers getting in-person care from a family doctor who had held one virtual consultation with an ADHD specialist over the same period.

“Providers who thought it impossible to develop a therapeutic alliance through telemental health are very surprised to see its effectiveness once they try it,” Myers says.

Telemedicine for minor acute conditions and services such as psychiatry is growing, says Dr. Lori Uscher-Pines, a senior policy researcher for RAND. The ubiquity of video chat has increased patient comfort with the idea of virtual care, but adoption rates remain in the single digits, she notes.

“Costs to establish these programs are going down,” says Uscher-Pines. “It used to be very expensive to purchase a telemedicine cart or provision the broadband capacity required.”

LEARN MORE: Download a CDW white paper about the power of telehealth and other clinical collaboration tools.

Telepsychiatry Gives Patients Critical Access to Care

In Nebraska, 88 of the state’s 93 counties don’t have enough mental health professionals, according to data cited by the American Hospital Association. And many providers are clustered in the state’s more densely populated eastern cities.

“If you look at the numbers, the entire region — all of the Midwest — is underserved,” says Dr. Jennifer McWilliams, a child psychiatrist at Children’s Hospital & Medical Center in Omaha, which launched a telepsychiatry program in 2016. “We’re inspired to improve access for kids who would otherwise not receive any psychiatric care.”

With 250,000 patients spread across a five-state region, Children’s uses geographical analysis to select community sites that can serve as connection hubs, linking McWilliams and other providers with youths who might be better served by the convenience and flexibility of telepsychiatry.

3,200

The number of emergency psychiatric evaluations completed by Northern Light Acadia Hospital using videoconferencing in 2019, double the number logged in 2018

Source: Northern Light Acadia Hospital

Zoom teleconferencing is used to facilitate counseling services. Hospital providers connect via their desktop computers and employ Logitech C270 HD webcams and Logitech Z130 speakers.

“It’s really pretty simple,” says Rebecca Ohlinger, the hospital’s virtual care systems coordinator. “If there’s anything that I’ve learned, it’s that it’s got to be easy or people won’t use it.”

The program has grown rapidly. In 2017, 567 virtual visits were completed. Last year, that number had increased more than fourfold, to 2,346.

Although Zoom is also HIPAA compliant and encrypted end to end, Ohlinger makes sure clinicians disable the built-in recording feature. She also encourages partner sites to use a hard-wired internet connection to ensure dependability during sessions.

Telehealth Technology Helps Organizations Meet Staffing Needs

At Northern Light Acadia Hospital, a not-for-profit acute care psychiatric hospital in Bangor, Maine, mental health counseling and substance abuse treatment are available via telehealth to patients of all ages.

The technology is also used for real-time remote consultations with other emergency departments — expertise that helps teams assess and stabilize a situation more quickly.

“We interviewed leadership at eight emergency departments in rural Maine,” says Rick Redmond, Acadia’s associate vice president of access and service development. “We came to the conclusion — and it was overwhelmingly clear — that the No. 1 need for rural hospitals was psychiatry.”

That inspired a pilot program launched with two rural hospitals in 2011. Today, Acadia providers use a mix of Cisco/Tandberg videoconferencing solutions and Zoom to provide mental health care at 16 hospitals, 41 primary and specialty care clinics, and in private and group homes.

In a follow-up survey of Acadia telepsychiatry partners, 82 percent of emergency room doctors, now able to consult with mental health practitioners remotely, feel an increased sense of comfort working on psychiatric cases.

Zoom’s limited demands on network bandwidth are a big advantage, notes Stacey Pizzuti, Acadia’s telecommunications manager. “Maine doesn’t have a big infrastructure for the internet,” she says. Running Zoom on Apple iPad devices has proved to be a highly mobile and user-friendly solution for providers.

And the arrangement allows Acadia to cast a wider net when attracting new mental health care providers, a longstanding challenge for the organization that struggled to attract talent to the region.

“I can even employ psychiatrists from out of state,” says Redmond. “We’ve got a map with the states color-coded with where our providers are located; we have seven or eight states represented at this point.”

How Telemental Health Programs Provide Easy Access to Care

Rural families can face significant burdens in accessing psychiatric care, and there are many related costs that insurance doesn’t cover. Here are three ways that telemental health programs can offer added relief.

Reduced travel: Accessing faraway care can mean hours on the road or even travel by air. If patients need to be seen over a series of days, families bear the costs of hotel rooms and meals. Bad weather can disrupt plans and further delay treatment.

Reclaimed time: Days off from work or school can create another burden for families who have to travel to seek care. A potential loss of income adds to the hardship. Childcare costs for siblings at home suggest another barrier.

Relieved stress: Delays families face while struggling to secure appointments can mean the difference between a patient in need and a patient in crisis. Being seen more quickly facilitates timely treatment and follow-up care.

Photography By Rick Dahms