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Telepsychiatry as a growing frontier in mental health

Adding a telemedicine option to psychiatry services makes it easier for people who are reticent to get care, such as veterans with post-traumatic stress disorder.

bigstock-First-Aid-Smartphone-42751702-300x300Telepsychiatry is a growing frontier in mental health, where psychiatrists are in short supply and stigmas abound. This evolution is helped by Medicaid coverage and a majority of states that require private insurers to cover telemental health services, regardless of delivery method.

Most weeks, from his office at UC Davis, Dr. Peter Yellowlees uses videoconferencing technology to hold telepsychiatry clinics on Indian Health Reservations. At the end of each clinic, Yellowlees, the president-elect of the American Telemedicine Association, and his patient will be joined, in person, by the patient’s primary care physician for a brief discussion.

This type of care—with two doctors consulting each other and a patient at once—is all but unheard of in traditional psychiatry practice, where one patient’s doctors could be in different cities or states. But it’s possible through telemedicine.

“You simply can’t do that in a normal out-patient clinic,” Yellowlees said. “You can collaborate better beyond walls.”

In the mental health field, where psychiatrists are in short supply and stigmas abound, telepsychiatry is a growing frontier. Medicaid programs in 49 states cover telemental health services, and 30 states and the District of Columbia also require private insurers to cover these services, regardless of how they’re delivered, according to a recent ATA report.

“There’s a whole range of areas where we can provide a better standard of care using video than we can in person,” Yellowlees said.

When a patient meets a psychiatrist via videoconference, they tend to be less inhibited. “You can have very good relationships,” Yellowlees said. “Seeing patients on video can be very intimate.”

And telepsychiatry facilitates a more egalitarian relationship because the patient can be on his or her own turf—rather than in the doctor’s office. “You’re actually on equal footing on video,” Yellowlees said.

Adding a telemedicine option to psychiatry services makes it easier for people who are reticent to get care, such as veterans with post-traumatic stress disorder, Yellowlees said. Telepsychiatry also makes servicing inmates in correctional facilities safer for providers, he said, and is attractive to celebrities and others who want to maintain privacy. “There are groups of patients that actually find it easier to be seen on video,” he said.

The first telepsychiatry sessions, using video equipment that looked like old-fashioned television sets, took place in 1958 at the University of Nebraska, Yellowlees said. The movement expanded as a way to provide treatment to people living on Indian Health Reservations and to NASA astronauts.

Telepsychiatry exploded in the last decade with the advent of smaller devices, such as tablets and smartphones, and the increase in broadband availability. When Yellowlees bought his first video conferencing system in the 1990s, he paid more than $100,000. “Cost is no longer really an issue,” he said.

Yet barriers, mostly administrative obstacles, remain. Doctors providing telepsychiatry treatment must be licensed in the state where their patient is located, and that can be expensive and inconvenient, Yellowlees said. And the credentialing process by hospital systems could be simplified.

Nevertheless, telepsychiatry is on the upswing, and it will be key in dealing with the combination of population growth and a shortage of psychiatrists. With telepsychiatry, he said, doctors can work more efficiently to see more patients in less time.

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