Featured in Mental Health Weekly, February 2020
By: Dr. Tahir Khwaja, MD
AristaMD psychiatry specialist
Inadequate mental health care creates problems that are at once financial, personal, and societal. ER admissions and further complications due to inadequate care not only cost patients, but also paying entities such as health insurance companies, employers, and health systems. Within an industry steering toward value-based, comprehensive, and proactive care, mental health care advancement continues to lag. The general failure to support mental health care points to an acute need to address the issue with the best resources available, and the benefits of telehealth position these technologies as a key avenue moving forward.
The benefits of telehealth technology in the mental health sphere
Telehealth and telepsychiatry innovations show great promise in counterbalancing the challenges in access to care and continued mental health management for patients.
Having leveraged telehealth and telepsychiatry for several years now, I’ve seen the numerous benefits of telehealth technologies firsthand. These solutions facilitate stronger primary intervention in service of significantly increased access, improved outcomes, and reduced costs.
The benefits of strengthening primary intervention for mental health through improving resources available to PCPs are multifaceted.
- Documented, rapid access to mental health specialists through primary care helps ensure necessary care reaches populations who are otherwise unlikely to access this support. This immediately improves quality of care and outcomes associated with more proactive mental health management.
- Through primary intervention, patients can access care to begin addressing mental health issues promptly, rather than forgoing care and winding up in emergency settings. In addition, patients and their PCPs can improve their relationship, strengthening trust between doctor and patient, and positively impacting overall quality of care beyond mental health.
- Triaging mental health referrals optimizes specialists’ patient population, so we’re able to spend more face-to-face time with higher-acuity cases. Common instances where patients can be managed within primary care with the support of psychiatrists include: initial visits for depression/anxiety, medication management and adjustment, and behavioral issues associated with dementia, as well as fairly straightforward developmental disorders and autism.
Regarding this last point, my appointments are often filled with follow-up patients who could be directed back to their PCP when they are no longer high acuity. In an ideal clinic setting, I would be able to work at the top of my license with higher acuity patients and the lower acuity patients would be managed by their PCPs.
Remaining challenges with virtual mental health support
Along with the benefits of telehealth, there are challenges endemic to telepsychiatry technologies that should be discussed. To begin with, many providers and organizations have shown resistance to change, particularly with the transition to digital solutions to medical challenges. However, this landscape is shifting within psychiatry as more graduates, comfortable with technology and well aware of access challenges, enter the field.
Within telepsychiatry itself, patients seeking mental health care are typically used to a physical presence and do not always respond well to technology-based solutions. They may become frustrated with technological issues, while other patients may even refuse or walk out of televisits. In general, the shifting demographics of the psychiatry patient population equate to a patient population more comfortable with the proliferation of technology. However, this challenge remains difficult for older patients.
Finally, another limitation of remote mental health treatment is that patients are not getting the full specialist evaluation they otherwise would receive in a face-to-face visit. However, in the case of eConsults, the patient is still present with a real, live PCP who is simply gaining more insight remotely through the eConsult. There is also less taboo involved with getting mental health care through a PCP. Indeed, as a psychiatrist, I am actually removing the words “mental” or “behavioral” from my center name because of the taboo. Walking into a clinic named as such creates a breach of confidentiality, whereas primary care locations do not face this issue.
Looking toward the future of mental health
Telehealth technologies have already begun transforming the health care landscape in the United States. Through my experience, I’ve found eConsults to be one of the most promising paths forward for improving mental health care access and outcomes. Rather than waiting for patients in need of mental health care to maneuver through stigma, lack of coverage, and months-long specialist queues, these innovative technologies can proactively address issues of access to mental health care by bringing care directly to patients in the most ideal settings.