With the technology used in telepsychiatry becoming more reliable, inexpensive, and ubiquitous, there has been a corresponding increase in mental health professionals who are turning to remote treatments. In fact, psychiatry has been at the forefront of telemedicine use.
The general consensus thus far is that telepsychiatry is particularly useful for rural populations, children, the military, and those in institutions like prisons. In other words, telepsychiatry reaches people who otherwise wouldn’t have access to mental health services. (There is a severe shortage of child and adolescent psychiatrists). Telepsychiatry can also lessen some of the barriers often cited to obtaining mental health treatment, including cultural, shame, cost, and distance.
Many states, often in conjunction with state university medical and public health departments, have recently initiated telepsychiatry programs. The South Carolina Department of Mental Health established a program in 2007 to provide telepsychiatry in state hospital emergency departments. Also in 2007, University of Alabama’s College of Community of Health Sciences joined the Alabama Department of Mental Health (and others) to launch a telepsychiatry program, focusing on rural populations. New York State’s Office of Mental Health runs the New York Consultation and Telepsychiatry Program (NYCaT) aimed at children, and last fall West Virginia University’s WVU Healthcare received a government grant that will cover four years of telepsychiatry programs for an addiction treatment clinic. The Centers for American Indian and Alaska Native Health at the Colorado School of Public Health also run a telehealth program that includes mental health services.
That’s just a handful of examples, but they demonstrate the range of applications and growth of telepsychiatry. While the interest and investment is there, acceptance is by no means guaranteed. Here are five potential obstacles to telepsychiatry adoption.
Cost: States vary greatly in their definitions, approach, and regulation to telehealth (or telemedicine) according to a recent report from the Center for Connected Health Policy, State Telehealth Laws and Reimbursement Policies. While the majority of states reimburse telehealth through Medicaid; some do not, including Connecticut, Iowa, Massachusetts, New Hampshire, New Jersey, and Rhode Island, plus the District of Columbia. Amongst those that do reimburse, there is a wide range of what and who is reimbursed, and when.
Privacy: “Increased video-conferencing over public networks also creates the potential for unauthorized access to protected health information.” This is from a recent article in Current Psychiatry. The authors’ recommendations: use VPNs and encryption; train health professions in data storage and telemedicine ethics.
Legal: A provider must be licensed in every state they provide care. So a health care provider in one state that is conducting a telepsychiatry session with a client in another means they must be licensed in both states. There are 9 states, however, where the medical boards have instituted special telehealth certifications. As telemedicine becomes more common, look for this issue to become a hot topic.
Habits: Old habits die hard, and not every mental health care provider sees the value of telepsychiatry, or wants to invest the resources in training and adopting new modes of treatment. A study by the California HealthCare Foundation, which focused on telepsychiatry adoption in 7 emergency departments, found that in every case, there were initial problems getting support from involved parties, including doctors, nurses, and psychiatrists. From the study: “Some of the spoke sites felt that they had neither the time nor the energy to devote to telemedicine efforts.”
Lack of training or incorrect training: “Training is critical,” writes Mark Vanderwerf in his chapter Ten Critical Steps for a Successful Telemedicine Program. He recommends “layered” training, that is, training presented in progressive stages, and it should be formal to increase its perceived value. For the first level, he suggests course materials, a syllabus, registration, and testing, and even a certificate awarded to those who pass the course. The second layer includes on-site evaluations, and the third includes support and “refresher sessions.”