Bring Your Own Couch: The Promise of Telemedicine for Mental Health Care
Videochat programs are designed to let us see and talk to people who are not in the same physical place as us. While most of us use them to keep in touch with friends and family, others might find it just as important to keep in regular touch with their mental health care provider. Telemedicine for psychiatry has become a growing trend, as both patients and providers realize that psychotherapy (or “talk therapy”) and medication – the two cornerstones of mental health treatment – don’t always necessitate in-person meetings. Studies have shown that one in five adults with deal with a mental health disorder in a given year. And yet, only 40 percent of adults and 50 percent of children and adolescents with mental illness aged 8-15 report having received mental health services in the past year. A psychiatrist shortage, stigma, insurance coverage, and cultural perceptions are all major reasons why people do not receive necessary treatment, and many of these can be at least partially addressed by telemedicine.
Psychiatrists and other mental health professionals are in short supply nationwide. A federal government report designated approximately 4,000 areas as metal health “health professional shortage areas,” which means these areas have one psychiatrist for every 30,000 people. They estimate that it would take 2,800 additional psychiatrists to eliminate the designations. Furthermore, not only is there a general shortage of psychiatrists across the country, but the distribution is uneven. For example, while Rhode Island is considered to be meeting 100 percent of its mental health professional needs, South Dakota is only meeting about 15 percent.
It seems unlikely that this gap will be closed if current trends hold. A 2010 study (the most recent year available) found that 55 percent of psychiatrists are 55 or older, the second oldest specialty. Although there was a slight increase in the number of graduates from psychiatry residency programs in 2015, that number has otherwise stayed flat since 2007, making it unlikely that there will enough new psychiatrists to fill in the gaps.
Imagine that you’ve been too anxious or depressed to leave your house, but decide that it’s time to get help. Then you find out that due to the psychiatrist shortage, the nearest place you can go to get care is 100 miles away. Are you still motivated to get care? While telemedicine may not create more psychiatrists, it can help alleviate some of the geographical disparities in mental health care. Just like with other areas, telemedicine can be crucial to connecting providers with the patients who need them.
Another benefit of telemedicine for mental health care is consistency. Mental health care works most effectively when it’s consistent and quickly-available, whether it involves regular talk therapy or regular checking and filling of prescriptions. By providing a venue for patients and physicians to see each other on more flexible schedules, telemedicine can help them meet more regularly and allow for more immediate renewal of necessary prescriptions.
Psychiatric telemedicine can even help overcome stigma, one of the major barriers to seeking mental care. When people can obtain regular care in the comfort of their own home, they circumvent some of the potential fears such as someone seeing them going to a psychiatrist. In addition, expanding access can help normalize mental health care – in theory, the more access people have to care, the more people will get care, which makes others less likely to see mental health issues as a sign of weakness or not a serious problem.
Mental health care is already one of the fastest growing areas in telemedicine, and Medicaid programs in 48 states provide some level of reimbursement for this care. As more Americans seek mental health services and more insurance companies are required to reimburse these services at the same rates as other medical specialties, shortages of qualified providers will only get worse. Telemedicine, therefore, is crucial to ensuring that people get the mental health services they need for years to come.
By Erica Hersh