When it comes to psychiatric care, one of the biggest challenges in the United States is getting care to patients who need it. While it’s typically still preferable to have an in-person consultation with a psychiatrist, video conferencing platforms have been helping to expand access to mental healthcare and solve shortages. When patients have limited access to in-person visits, telepsychiatry can fill a critical gap in care that is already sizeable and likely to continue growing.
For over 90 million Americans, getting psychiatric treatment is difficult, according to the U.S. Department of Health and Human Services. Additionally, over half of the nation’s 3,100 counties had no practicing psychiatrists as of 2014 and nearly three quarters of practitioners are nearing the age of retirement. In recent years, there has been an increase in the amount of Americans that would benefit from remote access to psychiatric care and with telepsychiatry, they can now get the help they need at all hours of the day.
Opening Access to Mental Healthcare Care
Telemedicine has been an effective method of delivering remote care for decades, but was mostly conducted via telephone. With vast improvement in videoconferencing technology over the last decade or so, it’s now possible to provide remote care without losing as much of the “human touch” that makes in-person care so valuable. While there are still challenges that go along with delivering care remotely, most agree that the advantages of telepsychiatry when it comes to cost, viability and effectiveness, now far outweigh the disadvantages.
In the 1980s and early 90s, there was a significant decline in hospital beds available for psychiatric patients, which was a product of widespread hospital downsizing. Downsizing gave rise to waiting lists in the early 2000s and as a result, small ERs became overwhelmed with prolonged hospital stays. However, in 2006, forward thinking doctors began to deploy psychiatrists to people living in underserved, largely rural areas via videoconference over the internet. This enabled psychiatrists who lived in major cities, oftentimes hundreds of miles away, to consult with patients remotely, in real-time and from anywhere.
“For over 90 million Americans, getting psychiatric treatment is difficult. Additionally, over half of the nation’s 3,100 counties had no practicing psychiatrists as of 2014 and nearly three quarters of practitioners are nearing the age of retirement.”
– U.S. Department of Health & Human Services
The Advantage of Telepsychiatry
When it comes to different function areas of remote care, telepsychiatry is among the most effective. Not only does it allow doctors to provide care to patients who may not otherwise have access to care, it’s also arguably equal in its effectiveness compared to in-person treatment and prevents unnecessary and costly visits to the ER. In fact, some patients actually prefer it and are more willing to open up from the comfort of their own homes. According to Mark Binkley, general counsel at the South Carolina Department of Mental Health, it’s actually rare that patients take issue with talking to a psychiatrist on a video screen.
Many patients open up more in the video conferencing scenario, compared to being in a room with someone pointing out their flaws. There are a wide variety of patients that use telepsychiatry right now, ranging from children to the elderly and those suffering from minor depression to those in the midst of a psychiatric crisis.
Benefits of Telepsychiatry include:
- Support for patients whose location limits their access to care, including those in remote or underserved areas, on military front lines or at correctional facilities
- A reduction in the time and money spent on travel by patients and doctors alike
- Additional privacy for patients
- Easy and quick access to top psychiatrists and expert opinions in both emergency and on-call situations
- Allows psychiatrists to work past the age they would normally retire
Smartphones Are Becoming Therapists
At Northwestern University’s Feinberg School of Medicine, doctors are currently field-testing a mobile application that helps determine whether or not patients are at risk for depression. The program is called “Mobilyze” and it has completed an official pilot, according to Computerworld.
It works using context sensing, which helps to identify different patient-states that may be related to depression and offer opportunities for treatments. From GPS, gyroscopes, accelerometers, light sensors and microphones, smartphones already contain numerous sensors that doctors can leverage to monitor patients. Mobilyze utilizes cellphone sensors on a continuous basis, combined with computer algorithms, to detect patient-states. These states include location, activity, social-context and mood.
With a machine-learning paradigm, the application can use sensor data to determine a person’s location, activity level and level of social interaction. However, it does require some user input to define behavior parameters. Patients must define which activities are positive and which are negative. A positive activity may be going to the park once a week to get some fresh air. Mobilyze automatically tracks activity and can determine is if the patient has performed the activity or not. If not, it will remind the user. Getting out of the house to participate in activities and hobbies is a key way that people experiencing depression can improve their mental health.
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Limitations and the Future of Telepsychiatry in Healthcare
There aren’t many limitations to the effectiveness of telepsychiatry, other than the reimbursement issues. Medicare, medicaid and certain third-party payers cover telepsychiatry, but regulations may vary depending on location. We are seeing increasing evidence to support the effectiveness of telepsychiatry, which may lead to more coverage from insurance companies. Additionally government grants for network and electronic healthcare systems are growing, which will allow telemedicine to expand further.
Cost was once a limitation, as bringing high-definition video conferencing technology to patients used to cost tens of thousands of dollars. Security was another concern. Most doctors would not conduct psychiatric sessions over public internet and virtual private networks required specialized expertise that was often out of reach.
However, in recent years, the cost of transmitting high definition video over the internet has dropped dramatically and it is now possible for psychiatrists to connect securely and at relatively low cost to remote patients.