OnePerspective: VA shows how technology can improve mental health care

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

click to enlargeBy: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

In a 2014 article in The National Psychologist, Mark Ward, PhD, who directed the Oregon rural mental health team at the Portland VA Center, was quoted as saying that telemedicine is saving veterans time and money. “In 2012-2013, the team saved the state’s veterans enrolled in the program over a million miles of driving and the associated costs in gasoline,” he noted. Ward added that his team of six psychologists and 19 other full-time employees had a caseload of 940 active cases in 2014.

The VA’s National Telemental Health Center provides veterans with access to experts on bipolar disorder, behavioral pain, schizophrenia, non-epileptic seizures and insomnia. Veterans access these remote specialists through a referral from their local VA healthcare provider to the Telemental Health Center.  The specialists contact the veteran at a VA site close to the veteran’s home, using secure videoconferencing technology.

Telehealth infrastructure

The VA began to modernize the infrastructure for its telemedicine program in 2009 when its Rocky Mountain Network installed new examination cameras and mobile telemedicine stations. The telemedicine stations were placed in VA outpatient clinics in Colorado and Utah.  Since then, the VA has rolled out this telemedicine equipment in some 2,000 VA locations.

Using encrypted videoconferencing, the telemedicine stations are used for remote consults with patients as well as with outside physicians in 44 specialties. Clinic personnel can also utilize the primary care medical devices that are integrated into the station and provide the information from them directly to the remote clinicians. Recently, the VA began retrofitting the telemedicine stations with audiology equipment so remote audiologists could test veterans’ hearing and tune their hearing aids.

Another key part of the VA’s telehealth plan is a virtual visit service called VA Video Connect. Announced in August 2017 by President Trump and Secretary of Veterans Affairs David Shulkin, MD, this service will allow any VA physician to conduct a telehealth visit with any veteran anywhere in the country, either on a mobile device or on a computer. A proposed VA regulation and a bill that recently cleared the House of Representatives are expected to allow VA physicians to conduct telehealth visits across state lines. The same technology and the same rules will be applied to telemental health.

Telemental health is reliable

There is strong evidence that clinical assessments are equally reliable whether done via telemedicine or in person. Moreover, both patients and providers report high levels of satisfaction with remote consultations. Telemental health also improves patient access. According to the Maine Rural Health Research Center, “Telemental health can address issues related to the location and distribution of specialty mental health providers and reduce patient and/or provider travel barriers.”

The size and scope of the VA deployment show how scalable telemental health solutions can be. The VA program also demonstrates that telemental health can save time and money while maintaining the quality of care. 

About the author

Gigi Sorenson is Chief Clinical Officer for GlobalMed, an international provider of telehealth solutions. She has three decades of experience implementing new care delivery solutions, including telehealth. Sorenson holds both an MS and BS in Nursing from Northern Illinois University in DeKalb, IL. 

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