By Dr. James Varrell
The concept of “connected community” holds great potential for elevating and improving behavioral health outcomes for all patients. Connected communities proactively address a patient’s whole health—both physical and mental—and benefit from a comprehensive, multi-faceted behavioral health strategy.
Health care leaders recognize the potential of these models to positively impact clinical outcomes and reduce the need for higher-cost interventions by improving access to care at various points along the continuum. Yet, today’s communities often struggle to achieve this framework amid a severe shortage of psychiatric providers.
The reality is 96 percent of U.S. counties have unmet needs for mental and behavioral health services at a time when demand is soaring.1 Current shortages leave those needing care with less-than-optimal choices. People often turn to primary care doctors, or alternatively, opt for no treatment at all—leading to further deterioration or crisis situations that result in costly interventions.
The good news is that direct-to-consumer (D2C) telepsychiatry can help fill these gaps and improve the outlook on connected community models. While D2C is a relatively new concept, other settings across the care continuum have leveraged telepsychiatry for the past two decades, including hospitals, inpatient units, community-based case centers and correctional facilities.
Leveraged through easy-to-use videoconferencing technology, D2C offerings are opening new doors to psychiatric providers for evaluation, consultation and treatment.
D2C Telepsychiatry: Expanding Access And Referral Options
Growth of D2C telepsychiatry in recent years has expanded as patients become more empowered and seek out convenient ways of managing their care. Patients increasingly prefer “anywhere, anytime” options like the D2C model because it enables access to care from the comfort of home—or other private locations—on their own schedule.
This type of care allows providers to be more proactive and address issues before conditions reach what Mental Health America (MHA) refers to as a “stage four” level of severity. In effect, better patient engagement can trigger greater follow-through with care plans and minimize the potential for symptoms and issues to escalate.
Telepsychiatry often gives providers greater insights into their patients’ environments. For instance, a colleague of mine is a therapist in New Jersey, and she’s been treating one of her patients for years in person. When my colleague started using D2C Telepsychiatry, she was able to see her patient online through real-time video calls rather than in person, and noticed right away that her patient was hoarding her belongings. My colleague was able to learn about her patient’s living condition and other factors that influenced her treatment plans. Further, her patient reported feeling more comfortable and at-ease during their appointments.
D2C telepsychiatry also provides more referral options, enabling earlier interventions and greater access to services. While frequently sought out as a mental health alternative, many primary care providers are uncomfortable prescribing psychotropic medications or lack psychiatry expertise.
By providing a reliable behavioral health referral option, D2C telepsychiatry takes the pressure off of primary care providers. Moreover, collaboration and information exchange between the referring physician and D2C provider can allow for more comprehensive care.
Outside of primary care, D2C expands referral options for discharge planning from acute and inpatient settings. The current mental health provider shortage can slow down referral processes, leading to disjointed transitions where patients must “settle” on whatever is available in the nearby area instead of what is best.
Closing The Loop To A Connected Community
Even as health care leaders increasingly embrace telepsychiatry models, most are currently used in siloes across community settings. However, there’s opportunity to leverage existing resources and establish community-wide telepsychiatry networks to connect all appropriate care settings.
This connected community model improves both information sharing between providers and continuity of care for patients. Patients can use telepsychiatry to see the same provider or same network of providers across different care settings or from home with D2C care. In tandem, primary care doctors, community organizations and telepsychiatry providers can better collaborate on patient care.
Telepsychiatry networks not only improve care outcomes, but also create economies of scale. For instance, health care settings can benefit from sharing a telepsychiatry provider network. This option places less pressure on community resources to recruit and retain local behavioral health providers.
Communities can take steps to utilize a telepsychiatry network across care continuums by:
- Bringing together payers, primary care, hospital systems, outpatient behavioral health, corrections, schools, skilled nursing and other community organizations
- Assessing their current behavioral health resources to identify gaps and opportunities
- Setting multiple locations up with technology to access telepsychiatry
- Establishing a telebehavioral health network of licensed providers who are aware of community services and resources
- Utilizing shared scheduling tools for booking psychiatric resources and appointments
Telepsychiatry helps address the gaps in behavioral health care across the continuum by proactively treating patients’ whole health through the concept of the connected community. By increasing patient access to care and referral options, this evolving model supports timely, proactive intervention, minimizing the potential need for more costly care and enabling better outcomes.
About The Author
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 + Regroup. InSight+ Regroup’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.
Original article posted on Health IT Outcomes
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.
By James Varrell, M.D. | Jul. 17, 2017 – Original article on Physicians Practice
The United States is facing a severe shortage of psychiatrists, in which 55 percent of counties nationwide currently have no psychiatrists available, according to a new report. This shortage is impacting the country’s health care system, particularly for primary-care doctors, who increasingly have to assume these roles to treat mental or behavioral health conditions.
Taking on mental health care often requires more time and resources to adequately assess and treat such conditions, which can further limit the valuable time doctors have with other patients at the point of care.
Moreover, the delivery of specialized mental healthcare can be out of the realm of expertise or comfort for many primary-care doctors. When it is, it makes sense to refer care to psychiatry providers. Yet, due to the current shortage of psychiatrists, patients may need to wait weeks—sometimes even months—to be seen by a local psychiatry provider in their community.
This is where direct-to-consumer telepsychiatry, also known as in-home telepsychiatry, can help fill the gap for primary-care doctors. Telepsychiatry is a type of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation and treatment.
Why direct-to-consumer telepsychiatry?
Telepsychiatry offers several benefits, and meets the standard of traditional in-person care. Telepsychiatry can meet patients where they are, whether at home or in a private office, eliminating time spent traveling to appointments or in waiting rooms. It also allows more flexibility with scheduling, as direct-to-consumer telepsychiatry providers usually work from home themselves and can offer appointments during non-traditional hours, including evenings and weekends.
By eliminating long wait times associated with community-based psychiatry options, direct-to-consumer telepsychiatry enables greater accessibility to psychiatry providers and supports continuity of care. It expands the reach outside the local community, so patients have access to high quality care and a variety of specialized providers. As long as a telepsychiatry provider is licensed in the state where a patient is physically located, they can deliver care. This also opens the door for patients to continue seeing their same psychiatry provider throughout many life transitions; including job changes, college, and vacations.
Just like with in-person treatment, patients meet with the same telepsychiatry provider over time, allowing the patient and his or her consented primary-care doctor to develop a rapport with the remote psychiatrist. By ensuring the mental health of a patient is appropriately addressed, primary-care doctors can better attend to the patient’s physical health.
Key considerations when referring patients
Referring patients to direct-to-consumer telepsychiatry is similar to referring to any outpatient setting. Like other referrals, the process begins with an intake of patient’s medical history and applicable screenings to determine if the patient requires specialty care.
Telepsychiatry is versatile and has been proven effective with all age groups. For patients who worry about mental or behavioral health stigmas, telepsychiatry may help them follow-up with referrals to psychiatry providers who they can see through telehealth as opposed to those they would have to see in-person.
Referral coordinators can help determine if a patient is appropriate for in-home, direct-to-consumer treatment by asking a few simple questions and considering the following:
1 – Can this condition be treated through direct-to-consumer telepsychiatry?
Anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD are all conditions that can be successfully treated using telepsychiatry. Much like outpatient care, direct-to-consumer telepsychiatry is not appropriate for patients who currently may be suicidal, homicidal, delusional or paranoid.
2 – Does the patient have the technology needed to access telepsychiatry?
When considering patients for telepsychiatry, referral coordinators should make sure the patient has access to a computer, tablet or smartphone with video calling abilities. Most people already have one or more of these devices and can access telepsychiatry sessions from home. As long as the patient has an email address and is moderately comfortable using technology—telepsychiatry can be an option.
3 – Does the patient have a safe space for accessing direct-to-consumer appointments?
The patient should have consistent access to a safe and private space in their home, office or another location, such as a community center to have their telehealth sessions.
For many remote referral groups, patients have the option to choose from a list of applicable psychiatry providers based on specialty and area of expertise, and schedule an online appointment at their convenience.
Expanding your referral community
Because telepsychiatry is a newer type of referral option, a practice may want to test direct-to-consumer care on a small group of early adopters to create an easy system for referring before offering this option practice-wide. When evaluating remote referral group options, primary-care doctors should consider:
- Whether the group is a technology company or if real people are behind the service and involved in supporting the process.
- If there are opportunities to meet the potential providers referred beforehand, either in person or via video.
- Whether the group accepts only certain insurance or if all patients are eligible.
- If the telepsychiatry provider will share information periodically with the primary-care doctor, so all parts of the care team can stay involved and informed (with the patient’s consent).
After a few early adopters, a practice can gauge their comfort level with this type of referral option, generate buy-in from staff and patients and roll out the direct-to-consumer referral option practice-wide.
The impact of telepsychiatry
With direct-to-consumer telepsychiatry as a referral option, primary-care doctors don’t have to settle for the limited choices within their community or provide mental or behavioral health services themselves. Using telepsychiatry, doctors can ensure the mental health of their patients is addressed in an effective and timely fashion, which can ultimately have a direct impact on their health, wellbeing and overall quality of life.
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 currently accepts patient referrals for psychiatry and therapy is called Inpathy.
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.