Telepsychiatry Addresses Growing Mental Health Needs

The United States is facing a shortage of behavioral health specialists. According to the Health Resources and Services Administration, the country needs an additional 6,400 mental health professionals to serve patients’ current needs. More than 121 million Americans live in communities where there is a shortage of behavioral health specialists. This gap persists as patients’ needs for quality, immediate, compassionate care are growing. 

Telepsychiatry can be the lifeline that patients, clinicians, hospitals and health systems need.

Behavioral Health Care Need Is Growing

According to the National Alliance on Mental Illness, nearly half of the 60 million U.S. adults and children living with mental health conditions do not get treatment.

Millions of people who would seek care struggle to find clinicians to deliver the assistance they need, or have found that they must wait to get an appointment with a specialist. In fact, according to a 2018 study from National Council for Mental Wellbeing, 96 million Americans (38 percent) have had to wait longer than one week for mental health treatment.

Many hospitals and health systems have few or no behavioral health specialists on staff or in the community, so distance also can be a barrier to care. The 2018 National Council for Mental Wellbeing study found that nearly half of Americans (46 percent) have had to, or know someone who has had to, drive more than an hour roundtrip to get mental health treatment.

With care becoming more and more difficult to access outside the hospital walls, Americans increasingly have turned to the emergency department (ED) to address their behavioral health care needs. According to an article published in September 2019 by the American Association of Medical Colleges, ED visits related to mental health and substance use issues increased more than 44 percent between 2006 and 2014. Suicidal ideation visits grew by nearly 415 percent.

The COVID-19 pandemic did not ease ED pressures. According to a report published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report and cited by the American College of Emergency Physicians, during shelter-in-place orders early in the pandemic, ED visits for persons of all ages declined 42 percent compared to the same period in 2019, but ED visits for psychosocial factors increased.

As a result, patients are waiting longer in the ED to receive mental health care — even the youngest of patients. A study released by Yale researchers in spring 2021 found that rates of pediatric mental health-related ED visits that lasted more than six hours rose from about 16 percent in 2005 to nearly 25 percent in 2015. Stays longer than 12 hours increased from 5 percent to nearly 13 percent.

Even though the need for behavioral health care within the hospital settings is significant, 96 percent of acute care patients do not receive a psychiatric consult. Evaluating patients with potential involuntary issues is difficult.

And the COVID-19 pandemic has exacerbated these deficits.

COVID-19 Exposed Mental Health Care Deficit

Mental Health America (MHA) outlined the pandemic’s impact on Americans’ mental well-being in its 2021 State of Mental Health Care in America report. According to MHA:

• Since the pandemic began, more than 178,000 people have reported frequent suicidal ideation.
• In a single month (September 2020) 37 percent of respondents reported having thoughts of suicide more than half of the days of the month, or nearly every day.
• The number of people reporting frequent thoughts of suicide and self-harm was higher between March and September 2020 than at any time since 2014 when the MHA Screening program began.
• From January to September 2020, 315,220 people took MHA’s anxiety screen, a 93 percent increase over the 2019 total number of anxiety screens. Nearly 535,000 people took MHA’s depression screen, a 62 percent increase from the 2019 total.
• The proportion of youth between the ages of 11 and 17 who accessed mental health screenings was 9 percent higher than in 2019.

MHA also noted that throughout the pandemic, youth between the ages of 11 and 17 have been the most likely to score for moderate to severe symptoms of anxiety and depression.

Concerns about adolescent mental health became so great during the COVID-19 pandemic that the American Medical Association (AMA) addressed the crisis at a June 2021 meeting of its House of Delegates. Speaking for the AMA, group member Michael Simon, MD, said, “Nearly every setting is seeing children suffering from lack of care. The pandemic exacerbated a problem we already had and made it a catastrophe.” One delegate said approximately half of the beds in his Boston ED were filled with behavioral health patients. Another delegate said her community hospital had converted an educational conference room into space for 15 adolescents in need of mental health care.

Telepsychiatry is a model that is playing an important role in delivering a more sustainable mental health care model across the United States. By bringing specialists to the bedside via a virtual health platform, telepsychiatry can help hospitals and health systems meet widespread demand. Through its immediate access to quality care, this model may help reduce patient wait times and the length of hospital stays while improving patient health outcomes and satisfaction across the nation.

Virtual Health Can Provide a Mental Health Lifeline

While smartphone apps and a strong broadband connection can connect patients to the everyday help they need, telepsychiatry also is an effective tool on inpatient floors and in EDs.

Using secure, virtual health technology, telepsychiatry programs expand care access by allowing frontline clinicians to consult with remote board-certified psychiatrists, behavioral health professionals and licensed social workers. Together, these teams work to treat a broad range of mental illness, from depression to addiction and psychotic disorders. The goal of Envision’s program, for example, is to fit seamlessly with our partners’ clinical and operational workflow, guaranteeing fast response times and robust clinical documentation.

The average hospital loses approximately $7.8 million per year from ED boarding. Telepsychiatry platforms bring experts to a patient’s bedside within minutes, reducing the number of involuntary holds and potentially eliminating the need for longer waits or overnight stays. Patients receive the quality care they need and can get home to their loved ones more quickly. Telepsychiatry also benefits patients — and clinicians themselves – by freeing up trauma and emergency specialists to focus on other critical care patients in the ED.

Additionally, a virtual platform can keep patients and their care teams better connected after discharge. Backed by Envision regional medical directors, for example, our dedicated team of remote clinicians regularly communicate and collaborate with hospitals, health systems, physicians and local case workers on the ground. A telepsychiatry partnership also offers hospitals and health systems access to other virtual health service lines.

Telepsychiatry Has Been Helping Patients for More Than 60 Years

While the adoption of telepsychiatry has rapidly gained steam over the last two decades, the service is not a new phenomenon.

It began in the 1950s when University of Nebraska clinicians used a two-way closed-circuit TV to connect with colleagues at the Nebraska Psychiatric Institute and the Norfolk State Hospital, which was about 100 miles away. In the 1960s, U.S. Department of Veterans Affairs expanded mental health care through the use of videoconferencing. That program reduced admissions by an average of 24.4 percent and days of hospitalization by 26.6 percent.

According to a May 2020 Harris Poll, 27 percent of Americans were using telepsychiatry to access mental health care early on in the COVID-19 pandemic. Of those who were using the service, nearly two-thirds (62 percent) said they would not be able to receive the care they needed without telepsychiatry services. 67 percent said virtual health services had helped them maintain their treatment regimen. 75 percent of respondents said they want to continue on a virtual health platform even after the pandemic ended.

A year later, in May 2021, American Psychiatric Association found 6 in 10 Americans would use virtual mental health services, and 38 percent already had.

Today, telepsychiatry platforms feature the following:

• End-to-end support facilitated by regional medical directors
• Focus on clinical management and quality
• Highly-trained, monitored and mentored full-time psychiatrists
• Behavioral health training and education for partner clinicians
• Full credentialing
• Centralized online scheduling system
• Service guarantee and quality assurance

Telepsychiatry Improves Overall Health

By expanding access to care and empowering hospitals and health systems to address patients’ growing behavioral health care needs, overall health improves.

In January 2021, the American Heart Association (AHA) published a Scientific Statement exploring how mental health challenges impact cardiovascular health. The AHA noted that patients’ general and work-related stress are associated with an up to 40 percent increased risk of developing or dying from heart disease. Glenn N. Levine, MD, FAHA, chair of the Scientific Statement writing committee, said, “Research has clearly demonstrated that negative psychological factors, personality traits and mental health disorders can negatively impact cardiovascular health. On the other hand, studies have found positive psychological attributes are associated with lower risk of cardiovascular disease and mortality.”

By treating patients using a combination of on-site clinicians and remote specialists, telepsychiatry provides a complete care model that reduces the impact of clinician shortages, improves patient outcomes and enhances a hospital’s ability to provide comprehensive care in its community.