Direct-to-Consumer Telehealth: The Disruptive Solution to the Behavioral Health Provider Shortage
By Scott Baker, MBA,
The link between behavioral health and medical outcomes is well understood. Providing behavioral health services can help keep some medical conditions in check and prevent hospitalizations and readmissions. However, more than half of US counties are currently without any psychiatrists, resulting in large care gaps and wait times of up to 3 to 6 months. As a result, many patients seek mental health services from primary care providers, who often lack both time and specialized psychiatric expertise to treat such conditions. A more dire situation arises when patients are discouraged from seeking treatment altogether, which can lead to further deterioration or crisis situations.
Amid this provider shortage and growing behavioral health crisis, telepsychiatry is emerging as an effective tool to meet providers’ referral needs. In addition, direct-to-consumer (D2C) telepsychiatry is becoming a more widely utilized treatment option—one that can fill gaps in care at a time when the need for services far outpaces provider supply and address issues before they escalate.
By enabling provider-patient interaction at any time from any location, D2C telehealth helps increase access to care and promotes a more comprehensive response to patient needs, whether physical or behavioral. Making care more convenient often leads to earlier interventions that help ensure patient needs are addressed before issues escalate and require higher-cost interventions.
D2C telepsychiatry: A natural fit for telehealth
The American Telemedicine Association defines telehealth as “the remote delivery of healthcare services and clinical information using telecommunications technology.” The more popular forms of telehealth rely on real-time videoconferencing to deliver services and address patients’ needs, emulating the kind of in-person exchange and connectivity experienced in a provider’s office setting. Continued growth of D2C telehealth underscores the attractiveness of the videoconferencing model, as patients—increasingly empowered in their own care choices—seek direct access to providers and alternative options to more conveniently manage their care.
When it comes to telehealth for behavioral health, telepsychiatry is now used for evaluation, consultation, and treatment throughout the care continuum, and it can be found in settings that range from acute inpatient settings and emergency departments (EDs) to community-based care environments and in-home referrals from primary care doctors and discharge planners.
D2C telepsychiatry takes the burden off primary care providers and expands referral options in areas lacking adequate psychiatric services. With additional providers available, patients are empowered with greater choice, rather than limited by what is within a drivable radius. Beyond primary care providers, community-based professionals such as referral coordinators, benefit managers, and discharge planners can leverage this option to help consumers access qualified behavioral health specialists in a timely manner.
Collaborative care between telepsychiatry providers and patients’ primary care and regular providers can also extend the value proposition of D2C telepsychiatry by improving coordination, increasing clinical exchanges and connecting a patient’s community of caretakers for more holistic care.
The advantages of D2C
D2C telepsychiatry delivers inherent advantages for both patients and providers, including:
Flexibility. Consumers can schedule appointments outside of traditional weekday time slots, including nights and weekends, and can often find available appointments within a few days of their request.
Convenience. Services can be accessed from any private location leading to better continuity of care. For example, consumers can continue treatment with the same psychiatric provider during life transitions, such as moving to a new city for college.
Privacy. Like in-person care, telepsychiatry protects the privacy of patients. In fact, confidentiality may be heightened since appointments are accessed from home, eliminating the potential that patients will see someone they know in a waiting room—a concern that keeps many from seeking out treatment.
High-quality care. Telepsychiatry meets the standard of traditional in-person care for diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction. Along with all major national healthcare associations, the American Psychiatric Association supports the use of this model.
Healthcare organizations interested in utilizing D2C telehealth and telepsychiatry should, of course, consider situational nuances prior to determining the best course of treatment. Conditions such as anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD align well with D2C telepsychiatry. However, it is not appropriate for patients who display suicidal, homicidal, delusional or paranoid symptoms.
In addition, providers should keep in mind that while most people have access to reliable internet connections and smart devices that can support telepsychiatry, not everyone has this luxury. Prior to making referrals, providers should assess a patient’s ability to follow through with the telepsychiatry option.
The potential of D2C telepsychiatry
D2C telehealth models, and specifically telepsychiatry, represent a disruptive care delivery movement that is laying the groundwork for a more connected community and collaborative care continuum. By improving access, these forward-thinking models of care promote early intervention, addressing issues before they escalate and require higher-cost interventions. Ultimately, it’s an optimal framework for improving outcomes and empowering consumers in their care.
Improving Access to Care via Telebehavioral Health
For more than 25, years I have had the opportunity to provide outpatient behavioral healthcare services. During that time, I have observed the tremendous benefits thousands of individuals receive through access to care. My colleagues and I have the privilege of being a part of the process in which individuals make changes that significantly improve their quality of life. In some cases, these changes have literally been life-saving. We are becoming increasingly aware of how prevalent mental health disorders are in our communities, and through that awareness, we have come to realize that for each individual who is able to access effective behavioral healthcare, there are many others who are unable to do so.
Access to behavioral healthcare has been a challenge for decades. Dating back to the Community Mental Health Act of 1963, the vision people have had for access to behavioral healthcare has not been matched by the availability of services. The good intention of the community mental health center movement to “deinstitutionalize” individuals led to an increase in the need for treatment in the community. Unfortunately, the community resources were not nearly enough to keep pace with the growing need for treatment.
In addition to the insufficient number of available licensed behavioral healthcare providers and the limitations on insurance coverage for behavioral healthcare, there are many other factors that can influence accessibility of effective clinical services. People who utilize behavioral healthcare services frequently require sessions with their providers several times each month. The effective provision of treatment models such as Cognitive Behavioral Therapy (CBT) often involves dynamic interactions between the clinician and the patient on a regular basis. The application of CBT includes homework assignments that need to be reviewed and analyzed to ensure that progress is being made. Additionally, many psychotropic medications need to be closely monitored for side effects as well as their effectiveness in treating presenting symptoms, especially at the onset of treatment.
For some individuals, transportation to an office or facility in which behavioral healthcare is provided is not consistently available. Thus, they may not engage in treatment at all or receive insufficient treatment if they are required to travel to the clinician’s office. Other individuals may have access to reliable transportation but have young children and do not have childcare arrangements that will allow them to attend appointments at the clinician’s office.
Mental health disorders can affect individuals in a variety of ways. Some individuals suffer from intense symptoms of anxiety or panic. For those individuals, leaving their home on a regular basis is often not possible. Other individuals may suffer from paranoid ideation to the point that sitting in a waiting room among other patients while awaiting an appointment may be more than they can tolerate. Some individuals suffer from profound symptoms of depression and may not have the energy or motivation to leave their homes and travel, even for treatment of their symptoms.
While progress has been made in reducing the stigma associated with mental health disorders, a great deal of bias still exists. Many people elect not to pursue behavioral healthcare due to concerns about how they may be perceived by others if it becomes known they have received such services. In some cases, privacy may be crucial. For example, a teacher may not be uncomfortable sitting in a waiting room with one of their students while awaiting an appointment with an optometrist. However, that same teacher may feel very uncomfortable sitting in the waiting room of a psychiatrist or therapist and have a student walk in. Privacy in behavioral healthcare belongs to the patient—if he or she wishes to maintain it, our field is required to protect it as much as possible.
Over the past several years, I have observed the benefits that are associated with the provision of behavioral healthcare via telebehavioral health. Improved access to care is among the most significant of those benefits. Transportation issues that often prohibit individuals from receiving care at an office can be eliminated. Individuals with young children can often negotiate their childcare needs much more easily if their appointments do not involve travel to and from an office and dealing with a crowded waiting room. At some points during treatment the condition for which an individual is seeking treatment may be the reason why they do not access services. Symptoms of anxiety and/or panic, paranoid thoughts, or depression may be debilitating at times. If care is brought to the individual in their home, they may be able to progress to the point that they will then have the option of services provided at an office as well as in-home treatment. If in-home services are not available when the person is at a particularly difficult point in their ability to function, the risk of an undesired outcome is much greater.
We are continuing to make strides in our understanding of mental health disorders and in our ability to effectively treat those conditions. Expanding access to care for individuals who need behavioral healthcare treatment is not only an option we should pursue, it is an obligation if we are to reach those who may be in the most need of care.
Joel Friedman, Ph.D. is the Director of Outpatient Services at the Center for Family Guidance, PC. He also provides clinical leadership for two organizations within the CFG Health Network: InSight Telepsychiatry and Inpathy. Dr. Friedman is a licensed psychologist with more than 20 years of experience. He has provided direct clinical care, supervision, managerial services, policy development, and consulting services in a wide variety of settings including private outpatient offices, several different correctional systems, hospitals, schools, and corporate offices.
Anna struggled to leave her home because of her severe anxiety and depression. Because her psychiatrist’s office was more than an hour away, the stress of commuting often made Anna’s symptoms worse. Anna needed a more practical treatment option and believed there had to be one out there. In her search, she discovered telepsychiatry.
Telepsychiatry is a growing and clinically effective way to provide mental health care via online video calls. One of telepsychiatry’s newest applications called direct-to-consumer (D2C) telepsychiatry is quickly becoming a popular solution for many struggling to find convenient and effective care. D2C telepsychiatry allows providers to deliver mental health care to individuals in their homes (or any other private space) using computers, tablets or phones.
For Anna, and the millions of people living with mental health conditions, this innovative option takes away the stress of commuting to and from an in-person office setting. Telepsychiatry sessions are also far easier to fit into busy schedules. With telepsychiatry, Anna could have her sessions at home after her children had gone to bed. Most importantly, Anna could now receive consistent treatment, empowering her to better cope with her conditions.
The Benefits of Telepsychiatry
Unfortunately, Anna is not alone. More than 55 percent of U.S. counties are currently without any psychiatrists at all. Even in areas that do have mental health professionals, there are simply not enough providers to go around. And because most psychiatrists are concentrated in cities, many people outside these areas, like Anna, endure long commutes to reach the nearest psychiatrist with available appointment times.
For those who share Anna’s experience, D2C telepsychiatry offers an alternative. Here are some of the many ways a person can benefit from telepsychiatry:
- Convenience. Anyone can schedule appointments—even outside of traditional workweek hours—and can easily attend sessions using any computer, tablet or smartphone with a webcam in any private space with a reliable internet connection.
- Increased access to care. Telepsychiatry expands choices for providers beyond those who are within driving distance. Any licensed provider in the individual’s state can offer services to them, allowing individuals to connect with the provider most appropriate for him/her.
- High-quality care. With more providers to pick from, a person can choose someone who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs train their licensed providers in best practices of delivering care appropriately and effectively through telehealth. Technical support is also available for pre-session test calls.
- Privacy. Telepsychiatry removes the fear of running into someone you know in the waiting room, while also protecting your information and following state and federal regulations. Many D2C telepsychiatry providers have annual audits to ensure their encryption systems meet HIPPA standards—this is how telepsychiatry providers differ from Skype or FaceTime.
Telepsychiatry makes it possible for people like Anna to receive care in a comfortable, familiar environment. This new form of treatment has the capacity to improve the lives of millions by increasing access to mental health care across the country.
James R. Varrell, M.D. is a child and adolescent psychiatrist who has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry. InSight’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.