Trends in Mental Health Care: The Expansion of Telehealth
by Wendy Hoke
Experts estimate that 20 percent of American adults suffer a mental illness each year. These illnesses cost business in the U.S. over $440 billion annually. However, behavioral healthcare has been relegated to the back burner, although this may begin to change in 2016 as stakeholders in the mental healthcare industry – employers, physicians, drug manufacturers, insurer and patients – acknowledge mental health as critical in the productivity and well-being of employees and customers.
Employers are making behavioral health priority. In fact, last October a CEO Mental Health Summit convened at the New York Stock Exchange to discuss approaches to support mental health acceptance, awareness, recovery and prevention in the workplace.
Some organizations, such as Prudential Financial, have begun addressing the issues of awareness and stigma. The company’s leaders are promoting dialog with staff regarding topics that were previously taboo. Ken Dolan-Del Vecchio, a vice president in the firm’s health and wellness department said, “We are working to build a culture in which it is as appropriate to mention that you are struggling with depression as it is to say you are struggling with diabetes. No challenge that faces human beings should be unmentionable. Because, to paraphrase the late Fred Rogers, ‘if it’s mentionable, it’s manageable.’”
In addition to promoting healthy environments, insurers and employers are tackling problems of access to mental healthcare. Over half of all U.S. counties have no mental health clinicians. Concurrently, an increasing number of people in need of mental health services have insurance coverage through the Affordable Care Act, which has driven demand higher to already-lacking resources. Demand will likely continue to grow as state and federal parity laws are implemented.
Executives of healthcare companies indicate they expect to see more implementation of parity laws in the future. For example, New York’s Attorney General reached settlements with two insurers for violations of the parity laws in 2015.
With the system already stretched thin and demand growing, the healthcare industry is more than ready to find cost effective methods to deliver care. Some hospitals and other healthcare providers are integrating behavioral health into their primary care settings. Utilizing tools, such as video conferencing and strategies like on-site integration, these providers connect behavioral health specialists with primary care physicians. The resulting partnerships empower primary care physicians to better manage routine mental health problems and refer patients to psychiatrists on an as needed basis.
A Technological Assist
Mental healthcare providers are increasingly adopting technology to enhance their treatment of patients by conducting virtual visits with them. The U.S. Department of Veterans Affairs conducted approximately 325,000 telehealth visits in relation to behavioral health to more than 100,000 vets at local clinics via video conferencing in 2014.
These virtual services resulted in a reduction of psychiatric admission by 24 percent. Now the Veterans Affairs department is providing the same telehealth services directly into patient’s homes via computers, mobile apps and tablets.
Companies such as Doctor on Demand and Lyra Health are important drivers of change in the private sector by connecting patients with behavioral health clinicians with a simple swipe on a smartphone. At the same time, new technology is seeking to improve the diagnosis of mental illness via biometric indicators. One example includes a virtual interviewer named Ellie, which was developed by the University of Southern California.
Such electronic options will likely be adopted more easily by young people, who are already comfortable with the mobile era and may be much more open to virtual behavioral health services when needed.
The implications for this development mean that it may become much easier to treat the whole person and improve upon health and quality of treatment. The failure to take into account mental health could result in misdiagnosis and inadequate treatment of a physical illness. This in turn could lead to worse outcomes for patients and waste healthcare dollars. Team-based models that embrace collaboration can link the behavioral healthcare specialists with primary care thereby producing improvements to the quality and value of care.
Targeted technology will help increase access to behavioral healthcare. Telehealth offers significant potential in mental healthcare, although its use should be focused to produce the best cost-effectiveness. In addition, scrutiny from consumer groups and regulators may become another factor; however, insurers and employers can utilize the mobile technology to enhance their resources and establish parity to satisfy the regulators.
The increase in telehealth could help to address several roadblocks to accessing mental health services. Approximately 80 million U.S. residents live in an area with a behavioral health professional shortage, according to the U.S. Health and Human Services Health Resources and Services Administration. Frequently in metropolitan cities with an abundance of psychologists and psychiatrists, transportation, time and cost constraints prevent individuals from finding mental health services.
Along with the structural hurdles, a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that less than 25 percent of 45 million adults in America with a mental illness ever received treatment. A crucial reason for the low percentage is both embarrassment and stigma. Telehealth can help resolve those barriers whether it is by email, phone or Skype, and increase access to care for millions of Americans in rural regions without behavioral health professionals.