Meeting Patients Where They Are

Written by Geoffrey Boyce. Originally published on American Journal of Managed Care

The positive effect of telemedicine continues to expand as community stakeholders—both clinical and nonclinical—work to increase access and create efficiencies across a healthcare continuum plagued by provider shortages and fragmented care. Telepsychiatry sits at the forefront of these movements and is quickly carving out a permanent niche in a variety of non-traditional settings.

As a natural extension of the telehealth phenomenon, telepsychiatry represents the broader industry trend of moving care outside the walls of inperson clinical settings. When care meets individuals where they are, it not only becomes more convenient, but also ensures care is more proactive, efficient, and effective. It also has the ability to drive greater patient satisfaction as evidenced by the more than 75% of consumers demanding virtual care and telemedicine access from their providers.

To address growing behavioral health needs, community-based care settings are adopting telepsychiatry to provide an effective alternative to costly, unnecessary emergency department (ED) admissions. Telepsychiatry is also now used in a variety of nonclinical settings, such as schools, universities, and correctional institutions. And that’s just the tip of the iceberg as communities find creative ways of using telepsychiatry to meet individuals where they are, and ultimately deliver “whole person” care that promotes greater wellness.

Filling Behavioral Health Gaps for Employers and Schools
More than ever, employers must proactively address employee health to align with the goals of value-based care—better outcomes and lower costs. That’s why many organizations like the Employee Assistance Program (EAP) for Bon Secours Health System based in Richmond, Virginia, are looking to direct-to-consumer (D2C) telepsychiatry models to help bolster behavioral healthcare options.

Bon Secours offers an active and well-established EAP to its 9000 employees to improve behavioral health conditions such as depression, anxiety, substance use, and post-traumatic stress disorder. The program supports a variety of population health initiatives and helps employees find appropriate resources following an initial visit provided through the EAP.

While rural areas currently suffer from substantial psychiatric resource shortages, larger cities like Richmond are not immune. Prior to referring to telepsychiatry, staff working within Bon Secours’ EAP faced challenges connecting employees to appropriate mental and behavioral health resources in a timely manner. Wait times for appointments reached up to 2 months in some cases, leading to the potential for higher-cost interventions when employee symptoms would continue to exacerbate.

D2C telepsychiatry, offered in the comfort of an employee’s home or other Wi-Fi–enabled private location, proved to be an effective option for filling such gaps. Through the EAP, employees can access online appointments in a matter of days with a licensed telepsychiatry provider, ensuring timelier response and tailored care delivery. Past scenarios often resulted in employees turning to primary care providers (PCPs) for behavioral health assessment or treatment, despite the fact that PCPs often lack specific expertise on such conditions or psychotropic medications.

Since starting to refer employees to telepsychiatry, Bon Secours has received positive feedback from young and more mature employees alike. The staff has found that all age groups appreciate the convenience and privacy of telepsychiatry and are not intimidated technology. Many employees have stated they prefer the flexibility of scheduling appointments outside of traditional office hours and are more comfortable seeking out behavioral health services from the comfort of their home to avoid stigma.

In addition to telepsychiatry offerings available through EAP programs or employer benefits, schools and universities are also finding success leveraging telepsychiatry for many of the same reasons. Notably, a 2013 study determined that telepsychiatry may be more effective than inperson care for younger age groups “because of the novelty of the interaction, direction of the technology, the psychological and physical distance and the authenticity of the family interaction.”

At a time when behavioral health needs in younger populations are rapidly growing, telepsychiatry models enable staff to connect students with timely and proactive access to mental and behavioral health resources directly on campus and during times that align with students’ schedules. For instance, The Lincoln Center, an alternative school in Pennsylvania, is leading by example through its telepsychiatry program, which provides mental and behavioral health services to students on a regular, ongoing basis.

Minimizing Crisis Situations 
The benefits of telepsychiatry are far reaching, and 1 of the most significant impacts of these models is their ability to provide real-time support and assessment when individuals are in higher acuity or crisis situations. In line with the strong push across the industry to meet people where they are, telepsychiatry helps circumvent the need for ED visits by providing real-time assessment via videoconferencing.

St. Joseph’s Villa, a nonprofit organization in Richmond, Virginia, that serves children with special needs and their families, is making major strides to address the inadequate access to psychiatric care in the area. By leveraging telepsychiatry to provide crisis stabilization services for vulnerable child and adolescent populations, the program aims to divert individuals in need from costly, unnecessary hospitalization. Since implementing telepsychiatry in 2014, the program has served nearly 500 children in their crisis stabilization unit, diverting nearly 90% from the ED.

Many communities are also turning to telepsychiatry in efforts to enhance existing crisis management services and better serve individuals in psychiatric crisis in their own homes. By arming mobile crisis teams with videoconferencing technology during inhome assessments, individuals in need can be connected to mental health providers to receive specialized care in real-time via iPad or other similar technology. These models are rapidly expanding across the country as communities aim to more effectively utilize local resources and avoid high-cost hospitalizations.

One of the nation’s first models of remote crisis behavioral health care, launched by Access Services—a nonprofit organization that specializes in improving the quality of life for people with special needs—in 2014, has seen success with the program as an effective approach in addressing the growing behavioral health provider shortage impacting the area.

Similarly, some innovative communities have started equipping first responders and police officers with telepsychiatry to virtually “bring” psychiatrists or mental health screeners with them via iPad to assess and manage the situation in real-time. The ultimate goal is to determine the best course of action and direct individuals in crisis to the appropriate type of care from wherever they are, potentially preventing adverse outcomes for the individual and the community as a whole.

As communities embrace this reality, consumers will benefit from a less fragmented healthcare system that delivers care directly to where they are. Nonclinical settings are wise to consider telepsychiatry as an effective means to bolster behavioral health access and drive better care outcomes across the board.