Telepsychiatry in Places Shrinks Can't Reach

New research shows that video conferencing is an effective way to deliver psychotherapy to veterans suffering from posttraumatic stress disorder, or PTSD.

The results of a 265-patient study at Department of Veterans Affairs (VA) clinics appear online now in JAMA Psychiatry. Led by John Fortney of the University of Washington in Seattle, the researchers found that veterans receiving counseling electronically showed significant improvement on the standard Posttraumatic Diagnostic Scale. Delivering services to mental health patients via video conferencing is known as “telespsychiatry.”

The veterans were followed for 12 months. Of 133 patients randomly selected to join the telepsychiatry group, 73 received cognitive processing therapy. The VA says this type of therapy is among the most successful treatments for PTSD. Of 132 patients being seen in person, 16 received cognitive processing therapy.

There were no significant differences between the two study groups in the number of PTSD medications prescribed or the number of patients who took their medications as directed. Receiving at least eight cognitive processing therapy sessions significantly boosted patient scores on the PTSD scale after 12 months, whether they were delivered in person or online.

The United States faces a tremendous shortage of psychiatrists, particularly in rural areas. Veterans returning from war in Afghanistan and Iraq alone comprise 119,482 of the half a million service people in America diagnosed with PTSD. More than one-third of them live in rural areas, and two thirds live closer to a community-based VA outpatient clinic than to a large VA hospital.

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Telepsychiatry Is Taking off in South Carolina

Mark Binkley, deputy director of administrative services for the South Carolina Department of Mental Health, told Healthline that the new study further supports telepsychiatry as an effective, cost-saving way to deliver mental healthcare.

It is just about impossible to recruit a psychiatrist these days, no matter what you pay them, into some of these rural areas.
Mark Binkley, South Carolina Department of Mental Health

Telemedicine isn’t new, but what’s made it increasingly popular is improved technology, Binkley said. South Carolina uses telepsychiatry to provide more than a dozen consultations a day. He said the high-definition screens are so clear, and the sound so crisp, that a clinician doesn’t miss a beat when “seeing” a patient. Doctors can even zoom in to examine a patient’s pupils.

The technology allows emergency room physicians to “dial up” a trained psychiatrist when a patient arrives in a mental health crisis. This can help avert life-threatening situations, particularly since psychiatric hospital beds are so scarce.

Patients in crisis can face long waits, a problem thrust into the national spotlight when Virginia Sen. Creigh Deeds was stabbed in 2013 by his mentally ill son. His son, who later committed suicide, had been sent home after a psychiatric evaluation because there were no beds available at the local hospital.

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South Carolina contracts with Polycom, Inc. for its telepsychiatry software platform. The state, which is unusual in that it runs its own community mental health system, uses the tool in 17 community health centers, four psychiatric hospitals, three veterans’ nursing homes, and one community nursing home.

South Carolina has psychiatrists dedicated to telepsychiatry on duty 16 hours a day, seven days a week. “It is just about impossible to recruit a psychiatrist these days, no matter what you pay them, into some of these rural areas,” Binkley said. “They just don’t want to locate out in the boondocks.”

Technology Connects Patients in Hard-to-Reach Places

Overall, about half of American communities have a shortage of mental health professionals, according to the Kaiser Family Foundation. Some states, like South Carolina and others with large rural populations, are more underserved than others. The American Psychiatric Association has endorsed telepsychiatry as a potential solution.


Dr. Iyad Alkhouri, a psychiatrist at the Robert Young Center for Community Mental Health in Moline, Illinois, said patients and staff members alike overwhelmingly approve of the technology. He said no one has reported finding it impersonal, and it has increased the percentage of patients who keep their psychiatric appointments.

Some mental health patients don’t drive, and they may have other barriers that keep them from regularly seeing the doctor. UnityPoint Health, a bi-state hospital system serving the Quad-City metropolitan area in Illinois and Iowa, has telepsychiatry in hospital emergency rooms, community mental health clinics, two school districts, and a county jail. They also contract with Polycom.

Binkley and Alkhouri say they hope doctor reimbursement for telepsychiatry visits becomes more widespread as research continues to demonstrate that it works and as patients continue to voice their approval in surveys.

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