Tag Archives: telepsychiatry

A Better Approach to Crisis Behavioral Health

Original article published on Becker’s Health IT & CIO Review

Mark Alter, M.D., InSight Associate Medical Director of On-Demand Services

By: Mark Alter, M.D.

Today’s hospital emergency departments (EDs) are facing a perfect storm of behavioral health challenges. A combination of professional shortages and rapid growth in need for behavioral health services is creating significant supply and demand issues across U.S. communities. The overwhelming reality is that 42.5 million Americans struggle with mental health conditions, and professional shortages exist in all 50 U.S. states.

For many communities, the hospital ED has become one of the primary entry points for behavioral health access. Yet, few EDs are equipped with the expertise to handle the scope and complexities of this evolving challenge, leading to lengthy wait times and overcrowding, especially for patients in needs of psychiatric care.

To improve the outlook, hospitals are increasingly turning to the promise of on-demand telepsychiatry—an approach to care providing psychiatric evaluation or consult as needed via videoconferencing. These forward-looking care delivery models not only improve response times and access to services, but they also positively impact patient satisfaction and the bottom line.

The ED Behavioral Health Challenge: A Deeper Look
Current estimates suggest that one in eight ED visits involves a mental health condition, yet patients in need of evaluation often wait much longer than those in need of general medical care. One report found that 23 percent of psychiatric patients had emergency visits that were longer than six hours and 7 percent waited longer than 12 hours—that’s compared to 10 percent and 2.3 percent of other medical patients respectively. In addition, almost 21 percent of patients in need of an inpatient psychiatric bed wait between two and five days.

In terms of adequate staffing for psychiatric issues, today’s hospitals face the same supply and demand issues as consumers in need of services, especially in rural communities, where the existence of even one qualified psychiatrist is often lacking. EDs typically have limited or non-existent in-house hospital expertise available to them, and patients must wait until an appropriate professional is available. These present-day realities lead to crowded ED waiting areas, protracted waits, and the common practice of “boarding” individuals in need of psychiatric evaluation.

The Growing Influence of ED Telepsychiatry Models
Overall, hospital executives are prioritizing telemedicine models to prepare for value-based care. The “2017 U.S. Telemedicine Industry Benchmark Survey” revealed that 51 percent of executives rank deployment and adoption of telemedicine high strategically.

On-demand telepsychiatry models are certainly gaining traction as hospital EDs look to more effectively deliver behavioral health care and address the growing need for services. Provided via video-conference, telepsychiatry providers offer on-call professionals that can be accessed based on need. This framework enables telepsychiatrists to deliver care remotely to numerous organizations at once, increasing efficiency and workflows for all stakeholders.

Credentialed telepsychiatrists first collaborate with ED physicians, nurses and social workers, and review a patient’s medical record. An evaluation is then conducted with a patient in a private area through a computer, tablet or other mobile device. Ultimately, the goal of these one-time encounters is to ensure timely recommendations and triage of patients to the most appropriate level of care. On-demand providers provide valuable consultation services to ED staff and can also prescribe medications directly.

Benefits of on-demand telepsychiatry in the ED include:

Early stabilization and better outcomes
Timely psychiatric treatment initiated in the ED promotes earlier stabilization of conditions and improves patient safety—for both those facing a psychiatric crisis and other patients in the ED. It also ensures patients are triaged to the appropriate level of care or community service.

For instance, it is not uncommon for police officers in some states to bring individuals behaving erratically directly to the ED for psychiatric evaluation. Many of these patients do not require inpatient psychiatric hospitalizations, which can be often be avoided by having timely access to psychiatric professionals who can determine the appropriate level of care.

Many telepsychiatrists also report that patients in crisis situations, particularly those who are agitated or paranoid, can feel less intimidated by video conferencing as opposed to in-person evaluation.

Increased patient throughput
When evaluations are conducted in a timely manner, ED providers can help get patients to appropriate levels of care, opening needed beds to other patients and improving wait room crowding.

Greater patient satisfaction
A combination of timely evaluation and the right expertise ensures a better overall experience for any patients in crisis, including those with behavioral health concerns. When patients are forced to wait for hours or days to see a behavioral health professional, frustration is understandable.

Lower costs
Timely access to care lends to greater efficiencies in the ED and positive bottom-line impacts. In addition, telepsychiatry reduces the need for full-time emergency psychiatrists and ongoing recruitment costs and challenges.

Many hospitals—especially those in rural areas—simply lack the financial resources needed to hire specialized behavioral health professionals to provide services the ED. Additionally, hospitals benefit from the on-demand model by paying for usage as opposed to a full-time equivalent. EDs also reduce liabilities with timely access to on-demand telepsychiatry services, minimizing the potential for litigation that might otherwise occur if conditions escalate and difficult situations arise.

Reduced provider burnout
This approach to care also takes the burden off in-person psychiatric providers who are on call or responsible for covering night-shifts. Telepsychiatrists can work these shifts remotely from another location, even in different time zones, offering added flexibility and an enhanced work/life balance—critical components in addressing provider burnout.

Providing a telepsychiatry resource can also reduce stress on ED directors and other ED providers who do not have the specialty training in psychiatry, but are often faced with treating psychiatric patients.

Future Crisis Behavioral Health Models
While the current outlook on behavioral health professional shortages is grim, the good news is that telepsychiatry holds great promise for filling needed gaps, especially in critical environments such as EDs. Hospitals can realize notable gains by leveraging on-demand telepsychiatry services to improve outcomes, patient and provider satisfaction and the bottom line.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

Delaware Takes Its ACT to the Next Level

A Delaware ACT team conducts a weekly briefing with its telepsychiatrist.

Delaware is known as the “First State” since it was the first colony to ratify the United States Constitution, but that motto can also apply to another bold step undertaken in the state more recently. A few years back, Delaware became the first state to merge telepsychiatry with assertive community treatment (ACT).

Two teams managed by the nonprofit Resources for Human Development (RHD) have been using telepsychiatry since 2014. The teams are known as RHD Kent ACT2 and RHD New Castle ACT2 and are based in Dover and Wilmington, respectively.

For some, it may seem an odd pairing. A core aspect of ACT—a proven therapy for severe mental illness such as schizophrenia—is the idea of face-to-face contact. Multidisciplinary ACT teams meet with patients both in clinics and in their communities (at home, at work while on lunch break, or at another similar location in the community) to help patients recover and reintegrate into society.

Could this model still work if the ACT psychiatrist was present via an iPad or similar device?

“I had some concerns about telepsychiatry coming in, since I thought many clients wouldn’t want to talk to a television, but it has not been a problem at all,” said Shelley Sellinger, M.D., a New York–based psychiatrist and mental health consultant for the Kent ACT team. “A couple of patients had some wariness initially, but they warmed quickly. I even had one patient with television-related paranoia, but he was totally fine with the arrangement.”

Laura Marvel, director of RHD Kent ACT2, agreed. “It doesn’t matter if the psychiatrist is in person or on a screen,” she told Psychiatric News. “If we have access to a good doctor, it doesn’t matter where the doctor is.”

The incorporation of telepsychiatry was born out of necessity. In 2012, Delaware awarded ACT contracts to RHD to help provide better outpatient care to people with severe mental illness such as schizophrenia. RHD found out quickly that getting psychiatrists involved was difficult given the time commitments; in addition to traveling across the state to make scheduled or emergency house visits, ACT team members meet weekly to discuss patient progress.

Around that time, Dan Khebzou, an account executive with the telepsychiatry firm InSight, was meeting with RHD administrators in Philadelphia to discuss service options. He heard about the difficulties RHD was having in hiring psychiatrists for the newly formed ACT teams and suggested the telepsychiatry option.

“I’ve encountered resistance in using telepsychiatry for vulnerable populations from regulators; they cite issues such as licensing, technical problems, or handling civil commitments through video,” said Khebzou. “But Delaware was willing to embrace telepsychiatry, so it presented an opportunity to prove this model.”

After a successful pilot program, RHD moved full steam ahead with telepsychiatry in 2014, and the program is still going strong today, Marvel said. Besides patient acceptance, she said that other ACT team members—which include case coordinators, nurses, and social workers—are on board with the technology. They have not seen Sellinger’s participation via video during their weekly team meetings as hindering the team dynamic.

If anything, Sellinger said, the remote aspect can help build some relationships with the team. “I can conduct most assessments remotely as well as in person, but there are elements that are difficult, such as testing AIMS (Abnormal Involuntary Movement Scale) or rigidity,” she said. “In these cases, the on-site nurses are my eyes and ears, and we communicate about what’s going on. In addition, they will let me know about hygiene if it’s pertinent, so they also are my nose.”

There are occasional technical glitches as well, but Marvel said the teams have established back-up plans to reach Sellinger in case of some malfunction with the video monitor used in the clinic or the iPad used on the road. “I’ve found Dr. Sellinger is as accessible to me or the team as an on-site person would be,” she said. “Sometimes even more so; maybe there is a sense of overcompensating since she can’t be physically present.”

“ACT is a wonderful way to provide care to persistently ill folks who might not be able to get care otherwise,” Sellinger said. “However, it is a demanding job to go into communities every day and work with these individuals, and it can lead to psychiatrist burnout. This telepsychiatry model has allowed me to continue to practice and give care longer than I might have otherwise.”

Original article published on Psychiatric Times

Crisis Behavioral Health Readiness

Behavioral health emergencies affecting whole communities can arise suddenly and can be as unpredictable as the weather. Recent natural disasters such as Hurricanes Harvey, Irma and Maria serve as reminders that all communities are vulnerable to the kind of crisis exposure that turns lives upside down and results in extensive emotional turmoil.

In such situations, the overall readiness of a healthcare provider organization is determined by its ability to respond not only to medical needs but also to psychiatric trauma within its community, with a solid plan of action in place. Implementation and deployment of mobile crisis teams are essential in addressing behavioral health needs at any time, but especially when a disaster strikes. By leveraging telepsychiatry and telebehavioral health within these care models, forward-thinking health systems can help ensure rapid response to mental health needs and the best outcomes.

Community Mental Health Response

To be able to respond quickly to community needs in a disaster, health systems should have dedicated mental health teams in place composed of specially trained professionals who know how to respond to specific mental health issues that develop as a result of a disaster or other community trauma, such as severe destruction or loss of life.

Another way health systems can act to support mental health response in a disaster is through the use of mental health mobile crisis teams. The purpose of such teams should be to intervene with individuals who may be experiencing or are about to experience a mental health crisis in the community by offering real-time support and determining the best course of action for these individuals.

All U.S. states are currently experiencing professional behavioral health shortages, however, making access to needed services and providers a challenge, especially in times of crisis when many people may need help quickly. An effective model for addressing this challenge is the use of telepsychiatry to improve access to care. Such a model also can provide support not only when a disaster hits, but also on an ongoing basis.

Telepsychiatry Advantage

Telepsychiatry allows sessions to be conducted from the anywhere in the community, including individuals’ homes, shelters, and other locations where privacy is possible. Crisis response teams who are deployed in the community can set up consultations with remote telepsychiatry providers on an iPad or other mobile device, allowing individuals in need of immediate evaluation to speak with remote providers on the spot.

Access Services, a not-for-profit organization in Pennsylvania that delivers support services for individuals with special needs, offers an example of how one mental health crisis team is improving its ability to respond to a mental health crisis. In 2014, the organization launched one of the nation’s first models of remote crisis behavioral health care.

According to Brenda Boorse, vice president of digital operations and communications at Access Services, the program reduces the time consumers spend awaiting care and lessens the strain on the psychiatric resources of area hospitals.

“Mobile crisis intervention paired with telehealth is a more immediate support for people,” Boorse says. “It helps resolve the immediate crisis in many cases without unnecessary and costly hospitalization.”

Telepsychiatry can empower local provider resources and elevate readiness strategies by complementing provided services through disaster relief organizations. Although critical to any response strategy, many national disaster relief organizations require a lengthy vetting processes for local behavioral health providers to volunteer their time, which can delay access. Leveraging telepsychiatry provides an effective means of ensuring behavioral healthcare providers will be available in the immediate aftermath of an emergency.

Getting Started

Hospitals or health systems considering a telepsychiatry response program can get started by working with local government officials to conduct a community needs assessment to identify current gaps and opportunities. An organization should look at its existing technological capabilities, define the profile of its population, evaluate the capacity of its existing provider network, make volume projections, identify funding sources, and create action plans around the potential disasters or crises their community may face.

Crisis situations are inevitable across any community, and effective response and remediation often hinges on readiness. Telepsychiatry offers a key resource for addressing the behavioral healthcare needs in emergency situations, and healthcare organizations should consider how to leverage the advantages of this emerging model to meet the mental health needs of their communities.


Geoffrey Boyce is executive director of InSight Telepsychiatry, Marlton, NJ.

Original article published on Healthcare Financial Management Association.

Stewart Memorial Community Hospital Launches Telepsychiatry Program

Lake City, IA – Stewart Memorial Community Hospital, a general medical and surgical hospital with 25 beds, launched a telepsychiatry program this week to increase access to psychiatric care. Located in Calhoun County, Lake City is a rural area with a shortage of mental health professionals, as designated by the Rural Health Clinics Program and the Federal Office of Rural Health.[1]

Telepsychiatry is the delivery of psychiatry through real time videoconferencing. It is proven to be an effective form of care delivery and a great way to expand the psychiatric support at a hospital, especially during difficult to staff hours like nights and weekends.

In a primarily rural state such as Iowa, patients often have limited or no access to timely, affordable and quality care. This is especially prevalent in regards to psychiatric care. With telepsychiatry, emergency departments can efficiently address each patient that comes in, reduce admissions and decrease patient wait times.  Having access to telepsychiatry can also help reduce psychiatric boarding and help make sure that those admitted to psychiatric beds actually need them. This is particularly useful in Iowa which, according to the Treatment Advocacy Center, ranks second worst in the country for number of inpatient psychiatric beds with just 64 in the entire state.[2]

The telepsychiatry program is launched in partnership with InSight, a national telepsychiatry service provider organization. Telepsychiatry services are provided in the emergency department to help ensure patients struggling with mental health issues are properly treated. This gives room for other patients that come into the emergency department that may have potentially life threatening illnesses.

“Partners like Stewart Memorial Community Hospital exemplify the great impact telepsychiatry can have at a community level. Telepsychiatry has been shown to increase access to mental health care in rural areas and we’re pleased to expand that within communities like Lake City,” said InSight’s Operations Director Dena Ferrell.

“Stewart Memorial is always looking to incorporate innovative new programs that help our patients achieve a healthy mind and body. Our partnership with InSight will help better address the behavioral health needs in our community,” said Cindy Carsten, CEO of Stewart Memorial.

Stewart Memorial is served by 13 InSight telepsychiatry providers. All InSight telepsychiatry providers are licensed in Iowa and trained to provide care to Stewart Memorial patients in the same way as all onsite providers. Stewart Memorial’s partnership with InSight will help transform care in the emergency department and increase efficiency so that all patients are able to receive the care they need.

About InSight Telepsychiatry
InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. More information can be found at www.InSightTelepsychiatry.com.

About Stewart Memorial Community Hospital
Stewart Memorial is committed to quality health and wellness for you and your family. Our goal is to transform our communities by providing coordinated care and exceptional experiences.

[1] Rural Health. (n.d.). Retrieved August 07, 2017, from https://www.ruralhealthinfo.org/am-i-rural/report?lat=42.26715&lng=-94.74603&addr=1301 W Main St%2C Lake City%2C IA 51449&exact=1

[2] Fuller, D. A., Sinclair, E., Geller, J., Quanbeck, C., & Snook, J. (n.d.). Going, Going, Gone TRENDS AND CONSEQUENCES OF ELIMINATING STATE PSYCHIATRIC BEDS, 2016. Retrieved August 8, 2017, from http://www.treatmentadvocacycenter.org/storage/documents/going-going-gone.pdf

 

Telepsychiatry: Advancing Connected Community Models

By Dr. James Varrell

The concept of “connected community” holds great potential for elevating and improving behavioral health outcomes for all patients. Connected communities proactively address a patient’s whole health—both physical and mental—and benefit from a comprehensive, multi-faceted behavioral health strategy.

Health care leaders recognize the potential of these models to positively impact clinical outcomes and reduce the need for higher-cost interventions by improving access to care at various points along the continuum. Yet, today’s communities often struggle to achieve this framework amid a severe shortage of psychiatric providers.

The reality is 96 percent of U.S. counties have unmet needs for mental and behavioral health services at a time when demand is soaring.1 Current shortages leave those needing care with less-than-optimal choices. People often turn to primary care doctors, or alternatively, opt for no treatment at all—leading to further deterioration or crisis situations that result in costly interventions.

The good news is that direct-to-consumer (D2C) telepsychiatry can help fill these gaps and improve the outlook on connected community models. While D2C is a relatively new concept, other settings across the care continuum have leveraged telepsychiatry for the past two decades, including hospitals, inpatient units, community-based case centers and correctional facilities.

Leveraged through easy-to-use videoconferencing technology, D2C offerings are opening new doors to psychiatric providers for evaluation, consultation and treatment.

D2C Telepsychiatry: Expanding Access And Referral Options

Growth of D2C telepsychiatry in recent years has expanded as patients become more empowered and seek out convenient ways of managing their care. Patients increasingly prefer “anywhere, anytime” options like the D2C model because it enables access to care from the comfort of home—or other private locations—on their own schedule.

This type of care allows providers to be more proactive and address issues before conditions reach what Mental Health America (MHA) refers to as a “stage four” level of severity. In effect, better patient engagement can trigger greater follow-through with care plans and minimize the potential for symptoms and issues to escalate.

Telepsychiatry often gives providers greater insights into their patients’ environments. For instance, a colleague of mine is a therapist in New Jersey, and she’s been treating one of her patients for years in person. When my colleague started using D2C Telepsychiatry, she was able to see her patient online through real-time video calls rather than in person, and noticed right away that her patient was hoarding her belongings. My colleague was able to learn about her patient’s living condition and other factors that influenced her treatment plans. Further, her patient reported feeling more comfortable and at-ease during their appointments.

D2C telepsychiatry also provides more referral options, enabling earlier interventions and greater access to services. While frequently sought out as a mental health alternative, many primary care providers are uncomfortable prescribing psychotropic medications or lack psychiatry expertise.

By providing a reliable behavioral health referral option, D2C telepsychiatry takes the pressure off of primary care providers. Moreover, collaboration and information exchange between the referring physician and D2C provider can allow for more comprehensive care.

Outside of primary care, D2C expands referral options for discharge planning from acute and inpatient settings. The current mental health provider shortage can slow down referral processes, leading to disjointed transitions where patients must “settle” on whatever is available in the nearby area instead of what is best.

Closing The Loop To A Connected Community

Even as health care leaders increasingly embrace telepsychiatry models, most are currently used in siloes across community settings. However, there’s opportunity to leverage existing resources and establish community-wide telepsychiatry networks to connect all appropriate care settings.

This connected community model improves both information sharing between providers and continuity of care for patients. Patients can use telepsychiatry to see the same provider or same network of providers across different care settings or from home with D2C care. In tandem, primary care doctors, community organizations and telepsychiatry providers can better collaborate on patient care.

Telepsychiatry networks not only improve care outcomes, but also create economies of scale. For instance, health care settings can benefit from sharing a telepsychiatry provider network. This option places less pressure on community resources to recruit and retain local behavioral health providers.

Communities can take steps to utilize a telepsychiatry network across care continuums by:

  • Bringing together payers, primary care, hospital systems, outpatient behavioral health, corrections, schools, skilled nursing and other community organizations
  • Assessing their current behavioral health resources to identify gaps and opportunities
  • Setting multiple locations up with technology to access telepsychiatry
  • Establishing a telebehavioral health network of licensed providers who are aware of community services and resources
  • Utilizing shared scheduling tools for booking psychiatric resources and appointments

Telepsychiatry helps address the gaps in behavioral health care across the continuum by proactively treating patients’ whole health through the concept of the connected community. By increasing patient access to care and referral options, this evolving model supports timely, proactive intervention, minimizing the potential need for more costly care and enabling better outcomes.

About The Author

James R. Varrell, M.D. is a child and adolescent psychiatrist who has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry. InSight’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.

Original article published on Health IT Outcomes

Telepsychiatry: Closing Care Gaps for More Connected Health Care Communities

Geoffrey Boyce, Executive Director of InSight

By: Geoffrey Boyce

Value-based care and the concept of connected health care communities go hand-in-hand. It is simply not possible to extract the full “value” of forward-looking care delivery models without a strategy that addresses patients’ whole health—both physical and behavioral—across the entire continuum. Connected community models achieve this objective through a comprehensive, sustainable and multi-faceted behavioral health strategy that improves treatment access at key entry points and across all levels of care.

Health care stakeholders increasingly recognize the power of connected community models, yet behavioral health remains significantly fragmented due to supply and demand challenges. While rapid evolution of integrated delivery networks is increasing scale and synergies on the medical side of the house, behavioral health lags behind partially due to professional shortages that exist in all U.S. states. These shortages are felt across the continuum, beginning in the most acute settings and flowing into outpatient care and referral networks.

Telepsychiatry models have emerged as one solution that holds great promise for changing this dynamic. Through video conferencing sessions that enable anytime, anywhere access, this model is opening new gateways to care and disrupting traditional approaches to behavioral health.

The Telepsychiatry Advantage

Providers and patients are embracing telepsychiatry as a viable treatment alternative for good reason: it meets the standard of traditional in-office care for diagnostic accuracy and quality, while also improving care continuity, outcomes and patient satisfaction.

Patients appreciate the convenience and privacy afforded by direct-to-consumer (D2C) telepsychiatry sessions that can be accessed at home or other comfortable locations that are private. By empowering patients with greater choice in location and time, telepsychiatry models help tear down communication barriers and reduce stigma—a key factor that keeps many from seeking treatment. Appointments are easily scheduled outside of traditional office hours where a reliable Internet connection exists. Additionally, patients can look outside of local areas to access services, expanding provider options.

In tandem with patient benefits, behavioral health providers often find telepsychiatry a good fit for work-life balance. Today’s health care communities rely heavily on existing behavioral health professionals to fill care gaps. As such, it’s not uncommon for those in the field to have upwards of three to four different jobs. Telepsychiatry relieves some of the pressure by allowing existing providers to schedule sessions in more convenient, creative ways.

In addition, many providers want to address the urgent need for services in rural communities and desire to fill care gaps. Yet, they often prefer to live in urban areas or are unable to relocate. Telepsychiatry allows them an outlet to reach those locations where the greatest need exists without moving their practice or making long commutes.

Leveraging Telepsychiatry Across the Continuum

Communities are realizing notable gains by integrating telepsychiatry across the continuum in various ways including:

Emergency departments (EDs)

Busy ED physicians often lack the psychiatric resources needed for timely evaluations of critical-need patients. As a result, patients are stuck waiting in the ED or transferred to a med/surg unit until a qualified provider is available. This scenario leads to higher costs associated with longer wait times and inappropriate admissions. Telepsychiatry relieves this pressure by ensuring timely evaluation and quick triage to the most appropriate level of care.

Other hospital-based applications

Telepsychiatry can also be used on medical floors of the hospital for psychiatric assessments of medical patients. Some hospital inpatient units utilize telepsychiatry providers to augment their in-person staff and ensure units have 24/7 psychiatric coverage.

Discharge Planning

Telepsychiatry is increasingly an important resource for discharge planners, who are tasked with helping patients access post-discharge services in a timely manner. Consider, for example, that patients are often discharged from hospitals, correctional facilities or other residential programs with a 10-day “bridge” prescription and are required to continue treatment with a community-based psychiatrist. In these instances, discharge planners can face notable challenges to securing a timely follow-up appointment as waiting lists for psychiatrists at some community clinics can reach upwards of several months.

Medication lapses are common, and if the patient misses a follow-up appointment, the situation is exacerbated, opening the door for conditions to deteriorate. Ultimately, this scenario results in a vicious cycle of patient readmissions.

Community based referrals

For under-resourced clinics, telepsychiatry provides a lifeline of support through remote providers who serve a regular caseload of new and existing patients just like an in-person psychiatrist. This enhanced provider pool increases a clinic’s psychiatric capacity and potentially shortens the long wait periods for psychiatric appointments that exist in many communities.

Provider referrals

More than half of all psychiatric drugs today are actually prescribed by non-psychiatrists due to provider shortages. Primary care doctors are increasingly sought for psychiatric care, although many are uncomfortable with or lack expertise with psychotropic drugs. Telepsychiatrists provide both an attractive referral option and consultative partnership, where knowledge and expertise can be shared.

Forward looking

While telepsychiatry is not a “magic wand,” it does provide an effective option for improving the fragmented behavioral health continuum. Communities are wise to consider effective telepsychiatry partnerships that can bolster behavioral health service lines. When these services are effectively integrated, communities achieve a more connected health care continuum that drives better outcomes and lower costs.

Geoffrey Boyce is Executive Director of InSight Telepsychiatry.

Original article from Healthcare Business Today

Family Service Launches Outpatient Telepsychiatry Program

Philadelphia, PA – Family Service Association of Bucks County launched an outpatient telepsychiatry program to increase efficiency and access to psychiatric care for adults, children and adolescents across four of their locations in Bucks County, Pennsylvania. The telepsychiatry program is launched in partnership with InSight, a national telepsychiatry service provider organization.

Telepsychiatry is the delivery of psychiatry through real time videoconferencing. It is proven to be an effective form of care delivery and a convenient, cost-effective way to safely expand the psychiatric support without the challenge of staffing an in-person psychiatry provider.family service

Prior to implementing a telepsychiatry program, Family Service staffed an onsite psychiatrist that would travel between Langhorne, Doylestown and Quakertown locations. With telepsychiatry, Family Service was able to increase efficiency and reduce costly, time consuming commutes.

“Telepsychiatry allows organizations like Family Service to reduce commute time for providers and patients. This allows for more valuable time with patients,” said InSight’s Operations Manager of Scheduled Services Nate Ortiz.

It is estimated that 1,051,490 individuals in Pennsylvania are living with serious psychological distress including major depressive disorder, bipolar disorder, panic disorder or anxiety.[1] Telepsychiatry is a great solution in Pennsylvania and in many other states across the nation where there is a shortage of psychiatry providers.

“We are thrilled to be able to offer this innovative new service to our patients. We are dedicated to increasing psychiatric access to all consumers, and this is a smart way to ensure our patients are getting the care that they need on a consistent basis,” said Audrey J. Tucker, Chief Executive Officer.

InSight’s telepsychiatry provider will offer these services to patients in Family Service outpatient behavioral health programs, namely counseling.

About InSight Telepsychiatry

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. More information can be found at www.InSightTelepsychiatry.com.

About Family Service Association of Bucks County

Family Service Association of Bucks County is a nonprofit social service organization with locations throughout Bucks County, Pennsylvania. Family Service’s mission is to listen, care and help. Every day. For more than 60 years, Family Service has been improving the lives of children and their families, doing whatever it takes to help them overcome obstacles and reach their full potential. Visit www.fsabc.org to donate, volunteer or learn more about how Family Service helped more than 27,000 children, teens and adults last year.

[1] National Institutes of Mental Health, National Survey on Drug Use and Health (NSDUH) 2015, and

NSDUH-MHSS 2008-2012.

How Telepsychiatry is Carving Out its Healthcare Niche

With a dwindling supply of psychiatrists nationwide, telepsychiatry services are starting to become more mainstream

It was nearly 20 years ago when a clinician (non-james-varrell-225x225psychiatrist) brought up the notion of telepsychiatry to James Varrell, M.D., a licensed psychiatrist himself who at the time didn’t know much about the telemedicine subsector. “This was 1999 and it was like voodoo to me,” Varrell says, adding that after that conversation he needed to do his due diligence and research.

What came from that conversation, and ensuing exploration into telepsychiatry, was a realization that there was more support for it than Varrell initially assumed. In fact, the American Psychiatric Association (APA) put out a significant paper in 1995 in support of telepsychiatry, and it was around that time when research began on its ability to facilitate access to care, overcome geographical obstacles and how it compared to in-person care. “All of the go-to organizations in the [industry] have always been supportive of it. Clinicians individually have been skeptical since they’ve never done it. But now, many [places] are incorporating into their residency programs,” Varrell says.

Indeed, folks might not be as familiar with telepsychiatry as they are with other forms of telemedicine, since behavioral health often flies under the radar compared to its physical health brethren. But according to the APA, by the 2000s, the field began to see it as effective, but slightly different, than in-person care, and research in outcome studies provided a platform for practice guidelines, via the American Telemedicine Association.

Varrell says that today’s mental health landscape is characterized by an increased need for services coupled with a dwindling supply of psychiatrists. Indeed, more than 55 percent of U.S. counties are currently without any psychiatrists, and the mental health landscape is facing shortages in more than 4,600 areas, according to Kaiser. Varrell, who has been practicing telepsychiatry for 18 years ever since it was brought up to him back in 1999, now works at telepsychiatry service provider organization InSight, a Marlton, N.J.-based company that he founded in 2008 and where he currently oversees a team of more than 200 psychiatrists and psychiatric nurse practitioners—many of whom work full-time doing telepsychiatry.

Speaking to the growth in the sector, Varrell says that his company began with telepsychiatry mostly in ERs where patients in crisis environments were prioritized. But, he notes, “The place more than anywhere where it started to develop was in rural environments, where access to basic psychiatry care would be otherwise inaccessible. That’s still growing,” he says. “Now, the new wave is that we are starting to do integrated care in medical offices, and that was a big push with Obamacare. We think the next trend is in-home services for consumers, which is telepsychiatry direct-to-patients in their homes or wherever they are [in a private space].”

The reason InSight started to provide telepsychiatry services was because it was located in a rural environment, but Varrell says beyond that, there have been valuable lessons learned since the organization’s inception: primarily that telepsychiatry works well for most people in most areas. “For people in crises, you don’t want to do an in-home visitation if they are psychotic or suicidal. You want them in more supported environments like outpatient mental centers or ERs if it’s very acute,” explains Varrell. “Over the years, we have learned that we can accommodate all types of people.”

Among these are: translations [for people who speak] different languages; the geriatric population, for which a great sound system is needed for older folks who have hearing issues; and also for those with cognitive and intellectual disabilities in which the patients’ families are present to make it easier and provide the psychiatrists with the necessary information, says Varrell.

Over the years, telepsychiatry has continued to grow both in volume and acceptance. Varrell notes how educating organizations such as the University of Virginia and Johns Hopkins University have big electives for all of their psychiatry residents who are mandated to learn telepsychiatry. And, InSight as a sole organization performed more than 100,000 encounters via telepsych in all settings last year (hospitals, clinics, treatment centers, universities), while its in-home platform, Inpathy, is still growing but has around 100 direct-to-consumer sessions in a week, according to officials.

“This is an area that used to be weird and hard, but now people are jumping into it,” says Varrell. “Doctors are calling us all of the time saying they want to work with us. That’s good since there’s a national shortage and we’re often begging doctors to work with us in person, but this is the opposite of that,” he says, noting how on one recent day alone, eight psychiatrists called looking for work.

Original article posted on Healthcare Informatics 

Digital Health Direct-to-Consumer Telehealth: The Disruptive Solution to the Behavioral Health Provider Shortage

By: Scott Baker, MBA, InSight Business Innovations Manager

The link between behavioral health and medical outcomes is well understood. Providing behavioral health services can help keep some medical conditions in check and prevent hospitalizations and readmissions. However, more than half of US counties are currently without any psychiatrists, resulting in large care gaps and wait times of up to 3 to 6 months. As a result, many patients seek mental health services from primary care providers, who often lack both time and specialized psychiatric expertise to treat such conditions. A more dire situation arises when patients are discouraged from seeking treatment altogether, which can lead to further deterioration or crisis situations.

Amid this provider shortage and growing behavioral health crisis, telepsychiatry is emerging as an effective tool to meet providers’ referral needs. In addition, direct-to-consumer (D2C) telepsychiatry is becoming a more widely utilized treatment option—one that can fill gaps in care at a time when the need for services far outpaces provider supply and address issues before they escalate.

By enabling provider-patient interaction at any time from any location, D2C telehealth helps increase access to care and promotes a more comprehensive response to patient needs, whether physical or behavioral. Making care more convenient often leads to earlier interventions that help ensure patient needs are addressed before issues escalate and require higher-cost interventions.

D2C telepsychiatry: A natural fit for telehealth

The American Telemedicine Association defines telehealth as “the remote delivery of healthcare services and clinical information using telecommunications technology.” The more popular forms of telehealth rely on real-time videoconferencing to deliver services and address patients’ needs, emulating the kind of in-person exchange and connectivity experienced in a provider’s office setting. Continued growth of D2C telehealth underscores the attractiveness of the videoconferencing model, as patients—increasingly empowered in their own care choices—seek direct access to providers and alternative options to more conveniently manage their care.

When it comes to telehealth for behavioral health, telepsychiatry is now used for evaluation, consultation, and treatment throughout the care continuum, and it can be found in settings that range from acute inpatient settings and emergency departments (EDs) to community-based care environments and in-home referrals from primary care doctors and discharge planners.

D2C telepsychiatry takes the burden off primary care providers and expands referral options in areas lacking adequate psychiatric services. With additional providers available, patients are empowered with greater choice, rather than limited by what is within a drivable radius. Beyond primary care providers, community-based professionals such as referral coordinators, benefit managers, and discharge planners can leverage this option to help consumers access qualified behavioral health specialists in a timely manner.

Collaborative care between telepsychiatry providers and patients’ primary care and regular providers can also extend the value proposition of D2C telepsychiatry by improving coordination, increasing clinical exchanges and connecting a patient’s community of caretakers for more holistic care.

The advantages of D2C

D2C telepsychiatry delivers inherent advantages for both patients and providers, including:

Flexibility. Consumers can schedule appointments outside of traditional weekday time slots, including nights and weekends, and can often find available appointments within a few days of their request.

Convenience. Services can be accessed from any private location leading to better continuity of care. For example, consumers can continue treatment with the same psychiatric provider during life transitions, such as moving to a new city for college.

Privacy. Like in-person care, telepsychiatry protects the privacy of patients. In fact, confidentiality may be heightened since appointments are accessed from home, eliminating the potential that patients will see someone they know in a waiting room—a concern that keeps many from seeking out treatment.

High-quality care. Telepsychiatry meets the standard of traditional in-person care for diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction. Along with all major national healthcare associations, the American Psychiatric Association supports the use of this model.

Implementing telepsychiatry

Healthcare organizations interested in utilizing D2C telehealth and telepsychiatry should, of course, consider situational nuances prior to determining the best course of treatment. Conditions such as anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD align well with D2C telepsychiatry. However, it is not appropriate for patients who display suicidal, homicidal, delusional or paranoid symptoms.

In addition, providers should keep in mind that while most people have access to reliable internet connections and smart devices that can support telepsychiatry, not everyone has this luxury. Prior to making referrals, providers should assess a patient’s ability to follow through with the telepsychiatry option.

The potential of D2C telepsychiatry

D2C telehealth models, and specifically telepsychiatry, represent a disruptive care delivery movement that is laying the groundwork for a more connected community and collaborative care continuum. By improving access, these forward-thinking models of care promote early intervention, addressing issues before they escalate and require higher-cost interventions. Ultimately, it’s an optimal framework for improving outcomes and empowering consumers in their care.

Original article posted in Oliver Wyman Health.

Use of Telepsychiatry Improves Provider Links at Pennsylvania Hospital

chester county hospital

Mental Health Weekly
By: Gary Enos

As administrators of a general hospital with no specialized psychiatric unit, leaders at Chester County Hospital in eastern Pennsylvania had become accustomed to a waiting game for psychiatric consultation when a patient with clear mental health needs presented in their emergency department. As is the case at a growing number of general hospitals around the country, telepsychiatry is providing these leaders with an alternative to what can become a crisis in emergency operations — as well as for patients in need.

In partnership with national telepsychiatry company InSight Telepsychiatry, LLC, Chester County Hospital is now using video technology to enable it to receive expert consultation on cases, usually within an hour of making initial contact.

This reduces wait times for services and creates more effective referral to specialty mental health treatment services in the community, while in other cases it simply might offer a more rapid and expert confirmation that a patient with mental health needs can be safely discharged.

“In the emergency department, the availability of specialty services is always difficult,” Betty Brennan, Chester County Hospital’s director of emergency services, told MHW.

“We were finding that the availability of psychiatrists was increasingly more difficult, because of their professional load in their offices. The immediacy that we needed just wasn’t there.”

The hospital’s phone calls to other facilities to see how they were handling the issue of delays in mental health patient transfer or discharge led the organization to InSight in 2011.

Brennan said the high quality of communication between patient and remote provider via video gives her confidence that the sessions between patient and psychiatrist virtually duplicate the more common face-to-face experience. “You almost forget in today’s world that you’re talking on videoconference,” Brennan said of the telepsychiatry experience.

The hospital launched its work with telepsychiatry for evening and overnight hours but has since expanded the program in order to maintain round-the-clock coverage.

The Encounter

In a typical scenario, a patient might present with suicidal ideation and be seen immediately by an emergency physician on the hospital staff. Once an initial level-of-care evaluation takes place in the ER setting, the hospital will contact In- Sight’s Access Center and transmit a patient history.

Brennan said InSight provides a number of psychiatrists for the telepsychiatry services, and the hospital has been able to develop a rapport with these individuals over the course of the project. (The psychiatrists are required to be credentialed at the hospital facility with which they are working.)

Often the hospital staff physician will speak with the psychiatrist before the specialist conducts the patient interview. For the video interviews, the hospital uses several secure rooms that are located a fair distance from any hospital exits. A hospital employee, such as a nurse or a member of the security team, is required to be present while the patient is being assessed via video.

The interviews are highly detailed and usually last anywhere from 20 to 45 minutes, Brennan said.

The high-definition videoconferencing equipment helps to establish a process that very closely approximates what occurs in a face-to-face interview, she said.

“We’ve never had a patient refuse,” Brennan said, as the message to them becomes one of facilitating necessary services in the quickest manner possible. “The physicians are very skilled, and the patients like that it’s private.”

A written consult from the psychiatrist is faxed to the hospital upon completion of the specialist’s interview and evaluation. “We’re not waiting for a psychiatrist to come in when his office hours are over,” Brennan said.

Often it is the case that the psychiatrist’s consultation offers a rapid confirmation of a course of action that was already apparent to the hospital staff, from a referral to a specialty behavioral health facility in the community to a discharge without extensive follow-up.

Brennan added that having this service available not only helps establish more effective linkages with mental health providers outside the hospital for followup care, but also speaks to a more humane way of addressing patient needs.

“There is an increased focus now on the rights of the mental health patient, and on getting them to the right facility,” she said.

Additional Applications

Brennan believes the telepsychiatry option can work equally well for adult and adolescent patients. The secretary of the Delaware Department of Health recently said that telepsychiatry could assist in reaching underserved young people in a state that this year has seen a significant number of teen suicides related to unaddressed mental health needs.

Brennan said the telepsychiatry experience at Chester County Hospital has proven so effective that the hospital has begun to extend telehealth into other operations. It is now using similar technology for evaluations of stroke patients, she said.

Other hospitals across the country that are working with InSight technology have reported similar improvements in wait times and overall emergency operations as a result of telepsychiatry’s availability.

“On occasion, patients are taken to the hospital under the Baker Act for a behavioral issue when they’re actually under the influence of drugs or alcohol,” said Eddie Carie, behavioral health case manager at South Florida Baptist Hospital in Tampa.

“These patients used to wait days for a psychiatrist’s evaluation. Now, we’re able to have a psychiatrist evaluate the patient and make a decision within hours.”

Increasing Access to Mental Health Care with Telepsychiatry

Primary Care Doctor Referring to Telepsychiatry

By James Varrell, MD

The United States is facing a severe shortage of psychiatrists, in which 55 percent of counties nationwide currently have no psychiatrists available, according to a new report. This shortage is impacting the country’s health care system, particularly for primary-care doctors, who increasingly have to assume these roles to treat mental or behavioral health conditions.

Taking on mental health care often requires more time and resources to adequately assess and treat such conditions, which can further limit the valuable time doctors have with other patients at the point of care.

Moreover, the delivery of specialized mental healthcare can be out of the realm of expertise or comfort for many primary-care doctors. When it is, it makes sense to refer care to psychiatry providers. Yet, due to the current shortage of psychiatrists, patients may need to wait weeks—sometimes even months—to be seen by a local psychiatry provider in their community.

This is where direct-to-consumer telepsychiatry, also known as in-home telepsychiatry, can help fill the gap for primary-care doctors. Telepsychiatry is a type of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation and treatment.

Why direct-to-consumer telepsychiatry?

Telepsychiatry offers several benefits, and meets the standard of traditional in-person care. Telepsychiatry can meet patients where they are, whether at home or in a private office, eliminating time spent traveling to appointments or in waiting rooms. It also allows more flexibility with scheduling, as direct-to-consumer telepsychiatry providers usually work from home themselves and can offer appointments during non-traditional hours, including evenings and weekends.

By eliminating long wait times associated with community-based psychiatry options, direct-to-consumer telepsychiatry enables greater accessibility to psychiatry providers and supports continuity of care. It expands the reach outside the local community, so patients have access to high quality care and a variety of specialized providers. As long as a telepsychiatry provider is licensed in the state where a patient is physically located, they can deliver care. This also opens the door for patients to continue seeing their same psychiatry provider throughout many life transitions; including job changes, college, and vacations.

Just like with in-person treatment, patients meet with the same telepsychiatry provider over time, allowing the patient and his or her consented primary-care doctor to develop a rapport with the remote psychiatrist. By ensuring the mental health of a patient is appropriately addressed, primary-care doctors can better attend to the patient’s physical health.

Key considerations when referring patients

Referring patients to direct-to-consumer telepsychiatry is similar to referring to any outpatient setting. Like other referrals, the process begins with an intake of patient’s medical history and applicable screenings to determine if the patient requires specialty care.

Telepsychiatry is versatile and has been proven effective with all age groups. For patients who worry about mental or behavioral health stigmas, telepsychiatry may help them follow-up with referrals to psychiatry providers who they can see through telehealth as opposed to those they would have to see in-person.

Referral coordinators can help determine if a patient is appropriate for in-home, direct-to-consumer treatment by asking a few simple questions and considering the following:

  1. Can this condition be treated through direct-to-consumer telepsychiatry?
    Anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD are all conditions that can be successfully treated using telepsychiatry. Much like outpatient care, direct-to-consumer telepsychiatry is not appropriate for patients who currently may be suicidal, homicidal, delusional or paranoid.
  2. Does the patient have the technology needed to access telepsychiatry?
    When considering patients for telepsychiatry, referral coordinators should make sure the patient has access to a computer, tablet or smartphone with video calling abilities. Most people already have one or more of these devices and can access telepsychiatry sessions from home. As long as the patient has an email address and is moderately comfortable using technology—telepsychiatry can be an option.
  3. Does the patient have a safe space for accessing direct-to-consumer appointments?
    The patient should have consistent access to a safe and private space in their home, office or another location, such as a community center to have their telehealth sessions.

For many remote referral groups, patients have the option to choose from a list of applicable psychiatry providers based on specialty and area of expertise, and schedule an online appointment at their convenience.

Expanding your referral community

Because telepsychiatry is a newer type of referral option, a practice may want to test direct-to-consumer care on a small group of early adopters to create an easy system for referring before offering this option practice-wide. When evaluating remote referral group options, primary-care doctors should consider:

  • Whether the group is a technology company or if real people are behind the service and involved in supporting the process.
  • If there are opportunities to meet the potential providers referred beforehand, either in person or via video.
  • Whether the group accepts only certain insurance or if all patients are eligible.
  • If the telepsychiatry provider will share information periodically with the primary-care doctor, so all parts of the care team can stay involved and informed (with the patient’s consent).

After a few early adopters, a practice can gauge their comfort level with this type of referral option, generate buy-in from staff and patients and roll out the direct-to-consumer referral option practice-wide.

The impact of telepsychiatry

With direct-to-consumer telepsychiatry as a referral option, primary-care doctors don’t have to settle for the limited choices within their community or provide mental or behavioral health services themselves. Using telepsychiatry, doctors can ensure the mental health of their patients is addressed in an effective and timely fashion, which can ultimately have a direct impact on their health, wellbeing and overall quality of life.

James R. Varrell, M.D. is a child and adolescent psychiatrist who has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry. InSight’s direct-to-consumer division that currently accepts patient referrals for psychiatry and therapy is called Inpathy.

Read the full article on Physician’s Practice here.

Expanding Access to Mental Health Care

Expanding Access to Mental Health Care - NAMI

By James Varrell, M.D. | Jul. 07, 2017 – Original article on NAMI.org/Blog

Anna struggled to leave her home because of her severe anxiety and depression. Because her psychiatrist’s office was more than an hour away, the stress of commuting often made Anna’s symptoms worse. Anna needed a more practical treatment option and believed there had to be one out there. In her search, she discovered telepsychiatry.

Telepsychiatry is a growing and clinically effective way to provide mental health care via online video calls. One of telepsychiatry’s newest applications called direct-to-consumer (D2C) telepsychiatry is quickly becoming a popular solution for many struggling to find convenient and effective care. D2C telepsychiatry allows providers to deliver mental health care to individuals in their homes (or any other private space) using computers, tablets or phones.

For Anna, and the millions of people living with mental health conditions, this innovative option takes away the stress of commuting to and from an in-person office setting. Telepsychiatry sessions are also far easier to fit into busy schedules. With telepsychiatry, Anna could have her sessions at home after her children had gone to bed. Most importantly, Anna could now receive consistent treatment, empowering her to better cope with her conditions.

The Benefits of Telepsychiatry

Unfortunately, Anna is not alone. More than 55 percent of U.S. counties are currently without any psychiatrists at all. Even in areas that do have mental health professionals, there are simply not enough providers to go around. And because most psychiatrists are concentrated in cities, many people outside these areas, like Anna, endure long commutes to reach the nearest psychiatrist with available appointment times.

For those who share Anna’s experience, D2C telepsychiatry offers an alternative. Here are some of the many ways a person can benefit from telepsychiatry:

  • Convenience. Anyone can schedule appointments—even outside of traditional workweek hours—and can easily attend sessions using any computer, tablet or smartphone with a webcam in any private space with a reliable internet connection.
  • Increased access to care. Telepsychiatry expands choices for providers beyond those who are within driving distance. Any licensed provider in the individual’s state can offer services to them, allowing individuals to connect with the provider most appropriate for him/her.
  • High-quality care. With more providers to pick from, a person can choose someone who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs train their licensed providers in best practices of delivering care appropriately and effectively through telehealth. Technical support is also available for pre-session test calls.
  • Privacy. Telepsychiatry removes the fear of running into someone you know in the waiting room, while also protecting your information and following state and federal regulations. Many D2C telepsychiatry providers have annual audits to ensure their encryption systems meet HIPPA standards—this is how telepsychiatry providers differ from Skype or FaceTime.

Telepsychiatry makes it possible for people like Anna to receive care in a comfortable, familiar environment. This new form of treatment has the capacity to improve the lives of millions by increasing access to mental health care across the country.

 

James R. Varrell, M.D. is a child and adolescent psychiatrist who has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry. InSight’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.

InSight Telepsychiatry Experts Present Psychiatry Grand Rounds at Western Michigan University Homer Stryker, M.D. School of Medicine

KALAMAZOO, MI – Representatives from InSight Telepsychiatry participated in a grand rounds presentation for the Department of Psychiatry at Western Michigan University Homer Stryker, M.D. School of Medicine. This was the first time the School of Medicine held a presentation on the topic of telepsychiatry.

The presenters were Randy McCloud and Dillon Euler, M.D. McCloud has a decade of diverse healthcare experiences and extensive clinical knowledge of behavioral health, in addition to experience designing and implementing successful telepsychiatry programs. Dr. Euler has focused his career on public and community psychiatry, forensic psychiatry and administrative consulting. For the past two years, Dr. Euler has worked in emergency telepsychiatry and is very interested in improving access to and quality of psychiatric care in various communities.

In their presentation entitled, How to Make Telepsychiatry Work, McCloud and Dr. Euler discussed

  • How telepsychiatry is used
  • The benefits of utilizing these kinds of services
  • Different models of telepsychiatry
  • The best practices for organizations and providers when using telepsychiatry.

As an appropriate demonstration of telemedicine’s technological capabilities, Dr. Euler joined via videoconference and shared a clinical case study demonstrating the strengths of telepsychiatry care in practice.  Those in attendance were left with a few “Telepsychiatry Takeaways” to remember as they continue their work in the behavioral health field.

About InSight Telepsychiatry

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. Forty percent of InSight’s telepsychiatry providers are child and adolescent psychiatrists. More information can be found at www.InSightTelepsychiatry.com.

InSight Brings Telepsychiatry Services to the Yellowstone County Detention Facility

BILLINGS, MT – Located in south central Montana, Yellowstone County is Montana’s most populous with an estimated 144,797 residents in 2009, according to the Montana Department of Commerce. The Yellowstone County Detention Facility brings six hours a week of InSight telepsychiatry services to their inmates from Psychiatric Nurse Practitioner, Renée Brunner Houser.

Renée Brunner Houser, PMHNP, MSN is a Montana licensed psychiatric nurse practitioner who has worked as a psychiatric nurse practitioner and registered nurse in a variety of settings such as psychiatric hospitals, inpatient/outpatient health centers, hospice facilities and public schools. InSight will provide first time evaluations, follow up care, medication management and more.

According the National Alliance on Mental Illness, at least 83% of jail inmates with a mental illness did not have access to needed treatment. In addition, telepsychiatry is found to improve access to mental health services for inmates and save correctional facilities from $12,000 to more than $1 million [1]. InSight brings years of experience in correctional facility psychiatric care to serve Yellowstone’s inmates and increase access to care when they need it the most.


[1] Deslich, S. (2013). Telepsychiatry in Correctional Facilities: Using Technology to Improve Access and Decrease Costs of Mental Health Care in Underserved Populations. The Permanente Journal,17(3), 80-86. doi:10.7812/tpp/12-123

The Psychiatrist Shortage in Virginia

By James Varrell, MD

HOW TELEPSYCHIATRY CAN HELP

Due to trends in mental health advocacy and growing clinical evidence, people are increasingly recognizing the benefits of psychiatry and behavioral health care. For example, a 2012 study published in Contingencies measured the cost of a single employee’s depression over a two-year period prior to that employee receiving depression treatment and found the cost to the business to be as high as $3,386 per affected employee.

Unfortunately, even with a cultural shift towards addressing mental illness in Lynchburg, employers and families are struggling to get convenient and timely access to care due to a significant shortage of psychiatrists. According to the National Alliance on Mental Illness, there are over a million Virginians who experience mental illness and about 300,000 of those illnesses are classified as serious. Even with 930 psychiatrists licensed in Virginia, there simply aren’t enough providers to go around. As a psychiatrist, the demands for services can be overwhelming.

Moreover, because most psychiatrists are concentrated in Virginia’s urban pockets (Northern Virginia, the Richmond metropolitan area and Hampton Roads) many individuals outside of these areas endure long commutes to reach the nearest psychiatrist who has available appointment times. Oftentimes, getting care for oneself or a family member can be off-putting and stressful.

How Telepsychiatry Can Help
Telepsychiatry is a growing and clinically effective way to provide psychiatry, mental and behavioral health care to individuals through online video calls. Telepsychiatry can be used to provide psychiatric evaluations, consultations and treatment to individuals in various settings including outpatient offices, correctional facilities, hospitals, emergency departments, crisis centers or even in homes.

Facility-based telepsychiatry has a decent foothold in the healthcare industry. Today one of telepsychiatry’s newer applications, direct-to-consumer (D2C) telepsychiatry, is quickly becoming popular. D2C telepsychiatry allows providers to give psychiatry, mental and behavioral health care to people directly in their homes or any other private space. This takes away the stress of commuting to and from in-person offices. It also means that the time individuals and their families spend getting care is shortened to only the duration of the session, making it easier to fit into a busy schedule.

An Individual’s Experience with D2C Telepsychiatry
For example, one of my patients, whom I will call Anna, suffers from severe anxiety and depression. As a result of her disorder, Anna struggled to leave her home, and her husband, Rick, often had to take time off of work to accompany her to appointments with her psychiatrist whose office was 50 minutes away.

The stress of her appointments made Anna’s symptoms worse, negatively impacted Rick’s work and put additional strain on their family life.

It was in their search for a better care solution that Anna started to receive psychiatric medication management from me and therapy from one of my colleagues all through telepsychiatry. Anna started to access her sessions from home in the evenings after her children had gone to bed. Using telepsychiatry allowed her to receive treatment independently and the reduced stress of receiving care has empowered her and helped her to better cope with her disorder.

The Benefits of D2C Telepsychiatry

Anna’s experience is one that is shared by many Virginians who struggle to find a convenient psychiatry or behavioral health solution for themselves or their loved ones. Here are some of the many ways people can benefit from D2C telepsychiatry:
• Convenience. People can schedule appointments outside of traditional weekday hours and can easily attend sessions using any computer, tablet or smartphone in any private space with a reliable internet connection.

• Increased access to care. Telepsychiatry expands choices for providers and specialists beyond those who are within driving distance. Any provider nationwide who is licensed in the individual’s state can offer services to them. Practicing online means providers can spend more time treating people instead of traveling between offices.

• High-quality care. With more providers to pick from, people can choose the one who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs will have their providers trained to deliver telehealth appropriately and effectively.

• Privacy. Telepsychiatry is safe and secure. Some individuals prefer seeking care from the privacy of home without the fear of running into a nosy neighbor in the waiting room.

Not only does this type of treatment make it possible for people like Anna to receive care in a comfortable environment, but it also removes stress from their work and personal relationships. Telepsychiatry improves lives and is an excellent tool for increasing access to psychiatry and behavioral health care in Virginia communities.

Original story posted in Lynchburg Business Magazine.

Telepsychiatry Long-Term Partnership a Continued Success

InSight Telepsychiaty and NewPoint Behavioral Healthcare Continue to Reduce Emergency Department Wait Times with Telepsychiatry for 15 Years

MARLTON, NJ — After 15 years of service, InSight Telepsychiatry and NewPoint Behavioral Healthcare continue to provide successful telepsychiatry services to individuals requiring emergency behavioral healthcare.

Winona InSight

As a New Jersey designated screening center, NewPoint Behavioral Healthcare provides behavioral health services such as emergency assessments, crisis intervention and referrals to inpatient psychiatric organizations.

The services offered by NewPoint Behavioral Healthcare combine traditional treatment options with telepsychiatry. When an individual enters a screening center during a psychiatric crisis, an on-site behavioral health screener conducts an initial assessment. The screener then meets with an InSight provider through phone or videoconference to determine diagnosis and treatment options. This could include admission, prescribing of medication or referral to follow-up care.

“NewPoint Behavioral Healthcare screeners truly develop a strong rapport with InSight’s providers,” says InSight’s Director of Operations Dena Ferrell, who worked as a behavioral health screener for the organization prior to joining InSight in 2007. “InSight providers really enjoy a friendly and productive working relationship that adds value to this partnership,” she added.

The partnerships success is exemplified through conducting over 200 telepsychiatry sessions in 2015 alone. “We use telepsychiatry 24/7 and most feel just as satisfied as they are with face-to-face psychiatrist sessions,” said Vikki McFadden, NewPoint Behavioral Healthcare’s Clinical Coordinator of Psychiatric Emergency Screening. “Before we were able to utilize telepsychiatry clients in other emergency room settings would sometimes wait days to be sent to the screening host,” McFadden added.

“The technology has gotten better,” says Jennifer Plews, NewPoint Behavioral Healthcare’s Director of Psychiatric Emergency, describing how telepsychiatry used to be delivered on a heavy cart with a monitor versus a cart that can now be easily pushed with one hand.

As one of InSight’s longest partnerships, NewPoint Behavioral Healthcare has seen firsthand how telepsychiatry has evolved. With a mission to provide a spectrum of quality services to maximize individual potential through education and empowerment, NewPoint Behavioral Healthcare has served communities in New Jersey for nearly 60 years through more than 16 outpatient behavioral health programs offering effective, affordable psychiatric screenings.

About InSight Telepsychiatry

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. Forty percent of InSight’s telepsychiatry providers are child and adolescent psychiatrists. More information can be found at www.InSightTelepsychiatry.com.

About NewPoint Behavioral Healthcare

The mission of NewPoint Behavioral Healthcare is to provide a spectrum of quality services to maximize individual potential through education and empowerment. NewPoint Behavioral Healthcare is committed to be the leader of quality mental health services in the region.

Telepsychiatry Helps Businesses Realize Better Outcomes For All

By Barry Doan, MSW

In today’s busy, on-demand world, more employers are offering online or telemedicine services to employees to give them the ability to speak with a psychiatrist or nurse practitioner remotely. Telemedicine is not only convenient for employees who don’t have to take time off work for an appointment, but also helps employers reduce the cost of hospitalizations. While two-thirds of employers currently offer employees access to telemedicine services, that number is expected to increase to 90 percent by 2018.

One popular form of telemedicine is telepsychiatry, a clinical model that uses videoconferencing to provide psychiatry and mental health services, such as evaluations, consultations and ongoing treatment. It allows employees to receive mental health care through live, interactive communication with a licensed provider in a private setting, whether that’s at work, at home or in a healthcare facility. Telepsychiatry is particularly useful given the severe shortage of psychiatrists, which limits access to critical care and results in long wait times.

Impact of mental illness on employers

Mental illness is the leading cause of disability, accounting for one-third of new disability claims in 2015. Depression is among the top workplace challenges for employee assistance programs, along with family crisis and stress. While most employers provide coverage for mental health care, benefits and services aimed at preventing or reducing depression are often underutilized by employees for a variety of reasons. For example, they may have difficulty finding an in-network psychiatry provider in their area, trouble making an appointment that fits around their work schedule or employees may feel stigmatized or embarrassed by their condition.

Untreated mental health issues are costly to employers. The total economic burden of major depression, for example, is estimated to be $210.5 billion per year — nearly half of which is attributed to the workplace, including missed work days and reduced output. Further cost implications can also be attributed to treating medical conditions that often coexist with depression. Employees who suffer depression frequently have other medical conditions that occur at the same time, including diabetes, asthma, COPD, heart disease, chronic pain and insomnia. Treating these coexisting problems can significantly drive up costs. For example, researchers found that for every dollar spent treating depression, $1.55 was spend on depression workplace costs, while $2.13 was spent on treating coexisting disorders.

Advantages of offering a telepsychiatry benefit to employees

Investing in the mental wellbeing of employees creates measurable returns. Research by the American Psychiatric Foundation found that after only three weeks of mental health treatment, the number of work-impaired employees with behavioral health conditions was reduced by half, and after a little more than four months of treatment, two-thirds were no longer work-impaired.

Telepsychiatry can help employers improve productivity and profitability. Here are five reason why:

  1. Convenient

Providing convenient access to psychiatric and mental health care via telepsychiatry can help reduce absenteeism, tardiness and anger issues by allowing employees access to easy and convenient treatments thus enabling more consistent work attendance. Online appointments allow busy professionals to easily access specialty behavioral health services in a private and comfortable setting. Employees can also schedule appointments outside of traditional weekday time slots, such as weekends or in the evening, which reduces travel time and time away from work. By providing enhanced access to care, employees are more likely to engage in services more proactively and routinely.

  1. Prompt

When behavioral health issues are left untreated, they tend to get progressively worse. With telepsychiatry, employees have prompt access to routine care that reduces the chance of the condition becoming urgent or emergent. In light of the dramatic shortage of mental health providers, resources are scarce, driving up wait times to be seen in person. Telepsychiatry meets employees where they are, offering them faster access to care. Accessing telepsychiatry through online platforms not only allows for real-time diagnosis and treatment, but also provides more opportunities for communication between the employee and their mental health provider between sessions.

  1. Increased well-being

Employees who suffer from behavioral health issues cost employers $44 billion per year in lost productivity, mostly in the form of presenteeism — when employees are physically but not mentally present or working at full capacity. Offering mental health care not only reduces employee stress but improves morale. One study found employees who completed just one session with a mental health provider experienced significant improvement in work performance. Employers reported increased productivity and substantial improvement in overall mental health.

  1. Private

Telepsychiatry protects employee privacy and confidentiality just as in-person care does. Moreover, many find that not being in the same room as the provider actually enhances feelings of safety for many. Accessing appointments online also eliminates the possibility of running into co-workers in waiting rooms and/or psychiatry providers’ offices, which can be uncomfortable and contribute to anxiety.

  1. Quality care

Telepsychiatry is has been clinically proven to deliver high quality care that meets the standard of traditional in-person care for diagnostic accuracy, treatment, effectiveness, quality of care and patient satisfaction. Telepsychiatry offers enhanced access to care, which improves an employee’s ability to use services proactively and routinely, and providers can diagnose and prescribe medicine in the same way an in-person psychiatrist can.

Through telepsychiatry, employees and employers can experience better outcomes across the board.

Barry Doan has more than 30 years of behavioral health industry experience and now works for Inpathy, a division of the leading national telepsychiatry service provider organization that delivers telepsychiatry directly to employees and other individuals online.

Original story published on BenefitsPro.com on 4/24/17.

InSight Telepsychiatry to Present at the American Telemedicine Association Annual Conference

InSight Telepsychiatry representatives are presenting at the American Telemedicine Association’s Annual Conference and Trade Show in Orlando. Their presentations, will address innovative telebehavioral health programs in a variety of settings, drawing on InSight’s experience as the leading national telepsychiatry provider organization.

ORLANDO, FL – InSight Telepsychiatry, the leading national telepsychiatry provider organization with a mission to increase access to behavioral health care, today announced thought leaders from the company, along with CFG Health Network and InSight partner, Access Services, will give presentations on a variety of telepsychiatry topics during the American Telemedicine Association’s (ATA) Annual Conference and Trade Show, taking place in Orlando, FL from April 23 to 25. ATA is the industry’s leading event for insights into the latest telemedicine and mobile health trends.

On Monday, April 24, representatives from InSight, CFG and Access Services will present during the session called The Use of Consumer-Based Telemental Health for Acute and Long-Term Needs. This session will feature “Bringing Help Home: The Use of Telepsychiatry in a Mobile Crisis Program” presented by Dan Khebzou and Jessica Fenchel, and “Getting Ahead of the Curve: Layering Home-Based Telehealth into an Existing Outpatient Mental Health Clinic” presented by Joel Freidman, PhD, that discusses the use of Inpathy, InSight’s direct-to-consumer division.

Dan Khebzou, a regional account executive for InSight, and Jess Fenchel, the senior director for adult behavioral health and crisis at Access Services, will give details on the partnership that facilitated the nation’s first mobile crisis program to utilize telepsychiatry.

Access Services and InSight work together to connect individuals in crisis and crisis team members with a remote telepsychiatry provider who is able to rapidly meet the person where they are – all through telehealth. This case study will review the implementation steps the partners went through to develop and roll out a successful program including designing workflows, selecting providers, overcoming hurdles, informing payers, choosing their technology and educating their teams. In addition, they will discuss lessons learned.
In the second presentation, Joel Friedman, PhD., the clinical director of CFG Health Network, will give details on how Center for Family Guidance, an outpatient mental health organization with three offices, is utilizing Inpathy, in order to meet the increasing needs of consumers.

Additionally, InSight Executive Director Geoffrey Boyce will present the e-poster, “Do You Know Ryan Haight?” on April 23. This poster will break down the confusing elements of the Ryan Haight Act into digestible and applicable pieces.

Visit booth 1506 for more information and to connect with InSight. To schedule a time for a meeting, contact Olivia Boyce at oboyce@in-sight.net or 770.713.4161.

InSight Telepsychiatry is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through innovative applications of technology.

St. Joseph’s Villa Receives Telehealth Innovation Award

Telehealth Innovation Award from the Mid-Atlantic Telehealth Resource Center recognizes effective use of telepyschiatry in the Villa’s Crisis Stabilization Unit.

RICHMOND, VA — St. Joseph’s Villa (SJV) of Richmond, VA received the prestigious Telehealth Innovation Award from the Mid-Atlantic Telehealth Resource Center (MATRC). The award recipients were announced on April 3, 2017 during the 2017 MATRC Telehealth Summit. The award is given to organizations that demonstrate an innovative application of telehealth and contribute to improved health outcomes and/or quality of life in the Mid-Atlantic region.

SJV partners with InSight to bring telepsychiatry to children receiving mental health services at their facility. One of SJV’s many innovative and effective programs is their Crisis Stabilization Unit (CSU), where children experiencing mental health crises can receive treatment in an environment that feels like home — all with the goal of preventing costly, unnecessary hospitalization. Since opening in 2012, the CSU has served nearly 500 children and has successfully diverted nearly 90 percent of them from hospitalization. InSight has helped the CSU work toward this goal for nearly two years with the help of telepsychiatrist Dr. Ashika Kapoor.

As one of the first crisis stabilization units for children and adolescents in Virginia, and one of the first crisis stabilization units in the country to use telepsychiatry, St. Joseph’s Villa exemplifies how combining modern technology and a personal touch can offer a meaningful and potentially life-changing service to patients and families in their time of need. The Villa is able to help children and families through a difficult time in their lives and provide them with opportunities to succeed because they have a telepsychiatry provider.

“St. Joseph’s Villa is committed to providing high quality behavioral health services to children and their families in innovative new settings. Our partnership with InSight has allowed us to expand our provider capacity,” said Kathleen Burke Barrett, CEO of St. Joseph’s Villa.  “We’re delighted that our efforts to provide care beyond the confines of an office were recognized by MATRC.”

Telepsychiatry allows children in the CSU to see psychiatry providers through videoconferencing. It has been proven an effective and cost-conscious way to bring psychiatric care to children and many other populations.[1]  With the option to utilize remote providers, telepsychiatry and other telemedicine services represent unprecedented access to specialists who are typically difficult to staff in rural and underserved areas. When the CSU opened in partnership with the Richmond Behavioral Health Authority (RBHA) Region IV, SJV found that it was challenging to locate a qualified local child psychiatrist. In terms of mental health providers, several of the counties SJV’s CSU serves are Designated Health Professional Shortage Areas, according to the U.S. Health Resources and Services Administration.  Ultimately, SJV turned to telepsychiatry as the solution for bringing psychiatric care to their facility.

“InSight prides itself on developing partnerships with innovative, like-minded organizations and works hard to find the right fit between our telepsychiatry providers and our partners,” says Geoffrey Boyce, Executive Director of InSight. “Congratulations to St. Joseph’s Villa on this accomplishment and we look forward to sustaining a productive partnership.”

About InSight Telepsychiatry

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. Forty percent of InSight’s telepsychiatry providers are child and adolescent psychiatrists. More information can be found at www.InSightTelepsychiatry.com.

About St. Joseph’s Villa

Established in 1834, St. Joseph’s Villa is the longest serving nonprofit for children in the country.  The Villa impacts 3,000 children and families each year facing homelessness, autism and developmental disabilities, mental illness, and other challenges.  Villa programs help them believe in themselves while providing them with the tools they need for long-term independence, stability, and success. For more information, visit www.NeverStopBelieving.org.

[1] Myers, K. M., Valentine, J. M., & Melzer, S. M. (2008). Child and Adolescent Telepsychiatry: Utilization and Satisfaction. Telemedicine and EHealth, 14(2), 131-137. doi: 10.1089/tmj.2007.0035

News on Telemental Health Services

(Original story published in Federal Telemedicine News — April 2, 2017)

Advancing critical telemental health services to help individuals with behavioral health issues was discussed at ATA’s Telehealth Capitol Connection (TCC) www.americantelemed.org briefing held on March 28, 2017. The use of technology enables mental healthcare to be delivered to major sectors of the population especially in rural areas in spite of the shortage of professionals.

Neal Neuberger as Senior Policy Consultant to ATA and moderator, opened the event by saying the use of technology in medicine has exploded since providers, patients, and employers see the advantages. However, as he pointed out, there are still policy matters that have to be addressed such privacy, finding eligible providers to deliver mental health care, and reimbursement issues.

Representative Tim Murphy (R-PA) https://murphy.house.gov Practicing Psychologist and Commander in the Naval Reserve reports, “Substance abuse and drug addiction is a major problem in this country, but the fact is that many people aren’t able to get adequate treatment fast enough because there are not enough professionals or facilities available to treat the affected population.

As reported, Congressman Murphy was able to secure an additional $15 billion in AHCA with a requirement that states must use the additional resources for mental health and addiction treatment. “We are continuing to build on our successful record to help families in the current mental health and addiction crisis. This additional $15 billion investment represents the largest surge in behavioral health funding in recent history.”

According to “Twelve percent of the 702,000 veterans have successfully received care using telehealth through the VA program”, according to John Peters, Deputy Director, Office of Connected Care, at the Department of Veteran’s Affairs, https://connectedcare.va.gov,

He reports, “Patient satisfaction for 304,000 veterans using store and forward telehealth is 94 percent, satisfaction for 307,000 veterans using video telehealth is 92 percent, and for 156,000 veterans using home telehealth, the patient satisfaction is 83 percent.”

He mentioned the bill “The Care Veterans Deserve Act of 2017” (H.R 1152) that was introduced on February 16, 2017. The bill amends the “Veterans Access Choice and Accountability Act” to make the VA’s Choice Program permanent and includes veterans with a 50 percent service connected disability.

Currently, a number of vital remote psychiatry services are available to community-based organizations, according to Geoffrey Boyce Executive Director, for InSight Telepsychiatry http://insighttelepsychiatry.com “Facing budget constraints, many community-based organizations are choosing to supplement their onsite psychiatric services with remote psychiatric prescriber teams.”

InSight is able to provide correctional facilities 24/7 access to psychiatric treatment within one hour after the request is submitted. InSight is able to respond to on-demand telepsychiatry services quickly to support an inpatient or a home setting crisis situation.

Deborah C. Baker, J.D., Director of Legal & Regulatory Policy in the Office of Legal and Regulatory Affairs, representing the American Psychological Association’s www.apa.org Practice Directorate, wants to see changes in licensing occur that would be specific to psychology.

As Baker explained, “The laws are confusing and a number of questions need to be clarified. To deal with jurisdiction issues, a few years ago, the “Psychology Interjurisdictional Compact” (PSYPACT) was introduced by the Association of State and Provincial Psychology Boards.

PSYPACT uses model language to discuss where a psychologist is physically related, where the psychologist is licensed to practice psychology, and where the client patient is physically located. Since PSYPACT is only model language, it would need to be passed in at least seven states to come into existence.

Lauren McGrath Vice President Public Policy for Centerstone, https://centerstone.org, a healthcare organization operating for 60 plus years, offers services for health homes, emergency follow-up services, integrated primary care, help for addiction, hospital and crisis services, intellectual and developmental disabilities services,  and also actively helps veterans suffering from PTSD and combat stress.

Today, Centerstone provides mobile and remote assessments in order to facilitate a quick referral for the coordination of care and appropriate treatments. The team is able to see how each person is doing by using a dashboard and if there is a problem, connections can be made by using a bidirectional app or be connected via telehealth.

— Carolyn Bloch of Bloch Consulting Group

Bloch has researched and reported on Federal government and legislative activities in the areas of science, R&D, defense, telemedicine, and health technology — and has worked with many scientific and technical newsletters, publishing firms, and other companies.

The author of 5 books and many articles based on Federal government activities, Federal funding programs, and university research grant opportunities. Carolyn Bloch has also taught courses in proposal writing for government contracts at a number of colleges and universities.

She is a member of the National Press Club, American Telemedicine Association, and the Healthcare Information and Management Systems Society (HIMSS) Maryland Chapter.

Live & Practice: Small Towns and Cities

(Original story published in PracticeLink Magazine—Spring 2017)

Marlton, New Jersey

Just 30 minutes from Philidelphia, 90 minutes from New York City and 2 hours from Baltimore, Marlton is popular among people who want to be near family in one of these major geographic areas while enjoying a small-town lifestyle. Marlton has strong community spirit, with several annual festivals sponsored by local government and scores of free exercise facilities, family activities and classes such as yoga and karate for residents.

Small towns and rural areas sometimes present a challenge for health care providers. That was the case when a rural southern New Jersey community first contracted with CFG Health Network, which is based in Marlton.

The community asked CFG to cover its psychiatry needs. But a week before the contract was to begin, there was a new requirement: all physicians had to be able to get to the facility within an hour of getting a call.

To continue reading, click here.

PracticeLink article

 

 

Telepsychiatry: Reaching More Patients For Better Outcomes

By Dr. Jim Varrell, Medical Director, InSight Telepsychiatry

(Originally Published 3/17/17 on Health IT Outcomes)

A 42-year-old woman with chronic anxiety and agoraphobia found herself unable to leave her apartment. She reached out to her primary care doctor who prescribed Xanax, but the medication was only making her feel worse. Unable to go out in public, she found a telepsychiatry provider who adjusted her medication and dosage, connected her with cognitive behavioral therapy, and helped her reclaim her life.

Health IT Outcomes Every year, about 42.5 million Americans struggle with mental illness — enduring stress, depression, anxiety, relationship problems, grief, mood disorders or other psychological concerns. Despite the availability of treatment most people don’t get the help they need, not necessarily due to stigma or denial, but because they can’t: it’s inconvenient or mental healthcare providers aren’t available in their area or within the time frame they need an appointment. To increase access to behavioral healthcare, people need an alternative to traditional doctor referrals, and telepsychiatry can help. Telepsychiatry is a type of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation, and treatment.

A Growing Market
A key driver of telepsychiatry is the serious shortage of psychiatry providers and other mental health professionals in the U.S. Today there are more than 4,600 mental health professional shortage areas making it difficult, if not impossible, for patients to access services. People referred to psychiatry providers by their primary care doctors face long and potentially dangerous wait times — often three to seven months or longer.

The situation is even worse for those in need of specialty providers, such as child and adolescent psychiatry providers. Currently, there are only about 8,200 practicing child and adolescent psychiatry providers nationally. To put this in perspective, New Jersey alone would need three times as many practitioners as it now has to adequately support the number of children in the state.

Telepsychiatry also offers the promise of delivering more effective mental healthcare in primary care practices. The burden of mental healthcare often falls on primary care doctors, yet many are unable to provide the most appropriate behavioral health resources. Adequately assessing and treating behavioral health issues requires more time with the patient than many doctors or nurse practitioners are able to spend. Moreover, while it is perfectly acceptable for primary care doctors to not know the ins and outs of mental healthcare, many don’t feel equipped to treat behavioral health conditions themselves because they lack specialized training. But without referral options, primary care doctors are often forced to do so. Many practices are overwhelmed with changes in how care is delivered and reimbursed, and under pressure to maximize time with patients, making it difficult for doctors to do it all.

Meeting Behavioral Healthcare Needs

Quality: Telepsychiatry is leading the way in telemedicine for delivering high quality care that meets the standard of traditional in-person care. The American Psychiatric Association supports the use of telepsychiatry as long as it is used in the best interest of the patient and complies with medical ethics and federal privacy and security regulations. It supports the patient-doctor relationship required by law to prescribe medications with documentation — a process identical to the traditional outpatient setting. For these reasons as well, it is increasingly reimbursable by insurance plans.

Continuity of care: In addition to meeting care standards, telepsychiatry positively impacts continuity of care by providing greater accessibility to psychiatry providers. It meets patients where they are. Many patient populations including children, college students, and veterans respond well to this form of treatment, especially since they can maintain the relationship with their same psychiatric provider regardless of location. Other studies have found telepsychiatry can positively impact care for seniors and nursing home residents, reducing costs for the facility as well as improving access to needed care. Age has not been found to be a barrier to acceptance and most seniors readily accept the format.

Access to care: Telepsychiatry is one of the most effective ways to increase access to care for individuals who might otherwise go without. Providing access to specialists for people in rural and remote areas is a challenge. Telepsychiatry offers a practical and cost-efficient way for psychiatry providers to reach these patients. The logistical benefits extend to those in urban centers as well. In light of the dramatic provider shortage, resources are scarce in all settings driving up wait times and commutes to be seen in-person. Telepsychiatry allows existing behavioral health providers to see more people at more flexible times. Many providers who offer telepsychiatry services do so during off-hours to meet the needs of consumers who have trouble finding time for commutes and waiting rooms, or who have trouble leaving their homes.

Cost-effective: Behavioral health issues cost $135 billion every year — almost as much as heart disease and cancer treatment combined. Telepsychiatry can help lower costs for both psychiatry providers and their patients. Studies have found telepsychiatry incurs fewer direct and indirect costs than in-person services saving on provider time, medical supplies, technology, and reimbursement, as well as costs associated with the clinical space, administrative support, travel, and time off work. Nowhere is this savings more pronounced than in the rural setting where telepsychiatry has been found to reduce costs by as much as 40 percent. For hospitals and inpatient residential programs required to provide patients with follow-up care options, telepsychiatry can help ensure a seamless care transition with proactive post-discharge outreach, reducing potential penalties for providers under value-based care.

A Solution For Better Outcomes
Telepsychiatry meets patients’ needs for convenient, flexible, and accessible mental health services, helping improve patient outcomes. The convenience of online appointments makes patients more likely to attend their behavioral health sessions than if they were seeing a provider in person — and when people are consistent in managing their behavioral health, their physical health also improves. It also gives patients more options to find the right provider for them and the care that meets their specific needs, and allows typically underserved groups to access care. This combined with less travel time, less time off work and shorter wait times for services means people get the care they need sooner, are more engaged in their health and happier with their experience of care.

About The Author
James R. Varrell, M.D. has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry.

Inpathy Gets a Makeover – New Website Makes it Easier to Get Online Psychiatry and Therapy Anytime, Anywhere

Online Therapy and Psychiatry

WASHINGTON, DC (PRWEB) FEBRUARY 20, 2017 – Inpathy has launched a new look for its website, http://www.Inpathy.com. Inpathy is dedicated to making it easy for people to get access to psychiatric, behavioral and mental health care through convenient, online video calls. Inpathy is the newest division of InSight Telepsychiatry, the leading national telepsychiatry service provider organization with nearly two decades of experience delivering online behavioral health care safely and securely.

While InSight’s other divisions bring psychiatrists and mental health providers to community-based facilities and organizations through telehealth, Inpathy uniquely brings life-changing behavioral care directly into people’s home or any other private place. While the website makes it easy for people to self-direct themselves, Inpathy also has a team of care navigators for users to call or email if they would like the extra assistance finding and connecting with a provider.

Online Sessions Make Care Convenient

“Inpathy allows me to help people who have mobility issues, anxiety around commuting or those who just don’t have the time to get to their in-person appointments,” says Jeanine Miles, a New Jersey licensed professional counselor.

There are many reasons people prefer online therapy and psychiatry services.

  • It’s convenient: Be seen when and where it works for you without the hassle of taking time off work or sitting in waiting rooms. Inpathy providers often have next-day appointments and are available evenings and weekends.
  • It provides options: Find the right provider who fits your needs and preferences — whether or not they live in your community. Access licensed counselors, therapists and psychiatry providers who are licensed in your state.
  • It’s safe and secure: Unlike Skype or FaceTime, our technology is HIPAA-compliant and protects your personal information.
  • It’s completely private: Your session on Inpathy is strictly confidential. Inpathy sessions are never recorded and you have control over whether you invite family or friends to join your online video call.
  • It’s easy to use: Inpathy works on any computer, tablet or smartphone with internet and a webcam. Plus, we offer 24/7 support for tech issues, test calls and troubleshooting.
  • It’s flexible to schedule: Weekdays a no-go? Need to do a session after the kids go to bed? No problem. Appointments are available 7 days a week from 7 a.m. to 11 p.m. — and it often only takes a few days from your request before you can meet with a provider.
  • It’s effective: Numerous studies have also shown that it is highly effective as a form of treatment and sometimes more effective than traditional in-person care.

According to Dr. Varrell, Medical Director of Inpathy and a child and adolescent psychiatrist who has been doing video sessions with people for the past 18 years, “Many people, especially children, are able to talk to me more easily through televideo than in person. Online care is more comfortable, less intimidating and it removes some of the power dynamics so people are more likely to open up more quickly than in-person care.”
Insurance companies and employers are also recognizing the advantages of online care and are starting to include services like Inpathy as a benefit.

Referring to Online Psychiatry and Therapy Saves Time and Money

In addition to convenience for individuals seeking care, Inpathy also acts as a non-traditional resource for health care providers or organizations that would like to use it as a referral option.

In a recent webinar on expanding referral options through online psychiatry, Inpathy’s Practice Liaison, Anne Marie Jones, explains its benefits: “With a network of over 300 behavioral health care providers, Inpathy can help reduce opportunity costs in terms of time, transportation and absenteeism.”

The New Inpathy Website

The Inpathy new website is a resource for people who want to connect with licensed professional therapists, counselors and psychiatry providers. It offers:

  • Online assessments
  • Information on the types of behavioral health care providers and the services they offer
  • Explanations on how to sign up, find a provider and book a session
  • A searchable directory of providers who offer online sessions
  • Access to care navigators who can answer questions and help you sign up
  • 24/7 technical support

“We wanted this new website to be helpful for people seeking care and give them hope that receiving behavioral health care doesn’t have to be a stressful ordeal every time they meet with their provider. It can be as easy as a Skype call and as private as online banking,” says Olivia Boyce, InSight’s Marketing and Communications Manager.

Inpathy services are available is most states. Inpathy has its largest provider and insurance networks in California, New York, New Jersey, Delaware, Virginia, and Missouri.

Read the original press release here.

 

InSight’s Dr. Mark Alter Airs on Wharton Business Radio as Guest Speaker

Mark AlterPhilidelphia, PA— Mark Alter, Associate Medical Director of On-Demand Services at InSight Telepsychiatry, recently appeared as a guest speaker on “The Business of Health Care” to talk about telemedicine on Business Radio Powered by The Wharton School.

The show, which originally aired on Sirius XM Channel 111, featured Dr. Alter along with fellow guests Jules Lipoff, Assistant Professor of Dermatology at the University of Pennsylvania, and George Bodenger, Health Care Law Attorney at George W. Bodenger, LLC. The show covered the rapidly growing size and potential of the telemedicine market and also explained how the various models of telemedicine work across specialties. Dr. Alter talked about the importance and opportunities of providing telemedicine and telepsychiatry, including increased access to care under current and new health care policies.

Listen to the show here.

New Jersey Awards Virtua $290,000 to Serve Veterans Via Telehealth

Trenton, NJ – The New Jersey Department of Health announced a $290,000 telehealth grant to Virtua Health on January 27 that will assist veterans who need access to primary and behavioral healthcare services but may face mobility or transportation challenges.

By coordinating care with Oaks Integrated Care, Legacy Treatment Services and InSight Telepsychiatry, Virtua will offer primary and behavioral health visits conducted via online technology starting February 1.

Stigma, negative ideas about seeking help, perceptions of the Veterans Administration (VA) and a lack of access due to geography and transportation issues make it difficult for veterans to visit a doctor in person. Some medical conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), brain injury, spinal cord injury and other psychiatric disorders further complicate the ability for travel. 

“For many veterans, travel to see a healthcare provider can be complicated and overwhelming, particularly in areas where transportation options might be limited,” Health Commissioner Cathleen Bennett said. “Telehealth can ease the burden by offering long-distance virtual care to veterans while they remain in a comfortable environment.”

Telehealth includes telepsychology, telepsychiatry, telebehavioral health, e-counseling, e-therapy, online therapy and cybercounseling. If veterans have other needs such as housing, employment or transportation, Virtua will seek to connect them to appropriate services.

One in five homeless Americans are veterans. One in three homeless men are veterans, and about 60 percent of homeless veterans are minorities. Veterans of Iraq and Afghanistan have an unemployment rate approximately 40 percent greater than the general population.

Veterans have disproportionate rates of mental illness, particularly PTSD, substance abuse disorders, depression and anxiety. Nearly half of combat veterans from Iraq report that they have suffered from PTSD, and about 40 percent of these veterans report problems with alcohol use.

Follow the New Jersey Department of Health on Twitter at twitter.com/NJDeptofHealth and on Facebook at facebook.com/NJDeptofHealth.

Billings Clinic is now Bringing After-hours Psychiatric Care to its Emergency Department and Inpatient Unit Through Partnership with InSight Telepsychiatry

Jan. 17, 2017 | Billings Clinic of Billings, Montana, has partnered with InSight Telepsychiatry to bring after-hours telepsychiatry services to their emergency department and inpatient unit, an innovative program which will ensure individuals in need of psychiatric treatment at Billings Clinic will have access to timely, quality care.

BILLINGS, MT — Billings Clinic, Montana’s largest healthcare organization, and InSight Telepsychiatry are pleased to announce a new partnership to increase inpatient and emergency psychiatric coverage.

The program is designed to lessen wait times for psychiatric evaluations, admission, and treatment decisions.  The partnership gives Billings Clinic staff access to a team of remote psychiatrists who can do psychiatric evaluations, follow-up consultations and medical consultations through telehealth using video calls. Nurses and emergency department physicians can now connect patients with a remote telepsychiatry provider in as little as an hour.

The telepsychiatry program runs from 10 p.m. to 8 a.m., 7 days per week. Since, psychiatric emergencies often happen at night or on weekends, this schedule means that individuals in crisis are able to get the care they need more quickly.

The program is a result of a partnership between Billings Clinic and InSight Telepsychiatry, the leading national telepsychiatry organization and partner of MHA Ventures, a subsidiary of the Montana Hospital Association. Montana, like many other states across the country, struggles to have sufficient psychiatric coverage in its hospitals and clinics due to a national shortage of psychiatrists.

At nearly double the national average, Montana has the highest suicide rate in the United States with more than 23 suicides per 100,000 people[1]. Additionally, over 75% of Montana’s population has inadequate access to psychiatry[2]. So with the option to utilize remote providers, telepsychiatry and other telemedicine services represent unprecedented access to specialists who are typically difficult to recruit in rural and underserved areas.

“Really, the best thing about a program like this one,” says InSight’s Medical Director Jim Varrell, MD, “is that Montanans now have access to psychiatric services where they may not have had previously.”

”This partnership is another step for Billings Clinic toward improving mental health care for people in crisis,” said Lyle Seavy, Billings Clinic Director of Psychiatry, “We are addressing those peak times when staffing is a challenge to help meet the needs of our patients, help reduce strain on our staff and help improve the experience for people in a mental health crisis.”

As a result of the partnership, the telepsychiatry program is expected to expand into additional Billings Clinic facilities.

In addition to facility-based models of telepsychiatry, InSight is also working with the Montana chapter of Mental Health America to offer telemental health care to individuals in their home or other private spaces online.

About Billings Clinic

Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, Billings Clinic is governed by a board of community members, nurses and physicians. At its core, Billings Clinic is a physician-led, integrated multispecialty group practice with a 285-bed hospital and Level II trauma center. Billings Clinic has more than 4,000 employees, including more than 400 physicians and advanced practitioners offering more than 50 specialties. More information can be found at www.billingsclinic.com.

About InSight Telepsychiatry

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. More information can be found at www.InSightTelepsychiatry.com.

 


[1] Suicide: Montana 2016 Facts and Figures. (2016). In American Foundation for Suicide Prevention. Retrieved January 12, 2017, from https://afsp.org/about-suicide/state-fact-sheets/#Montana

[2] Mental Health Care Health Professional Shortage Areas (HPSAs). (2016, September 8). In Kaiser Family Foundation. Retrieved January 12, 2017, from http://kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0

MHA Ventures Partners with InSight Telepsychiatry

Dec. 19, 2016 | MHA Ventures and InSight Telepsychiatry are partnering to help bring on-demand, scheduled and direct to consumer care to hospitals in the state of Montana. These efforts will improve access to mental health care and providers.

Helena, MT — A new partnership between MHA Ventures and InSight Telepsychiatry will improve care options throughout communities in Montana. MHA Ventures (MHAV), the for-profit subsidiary of the Montana Hospital Association, works with successful healthcare organizations to help Montana become a “Top 10 Healthy State.”  InSight has been endorsed by MHAV to help members of the association improve mental health in the communities they serve through telepsychiatry.

Telepsychiatry is psychiatric care delivered through secure videoconferencing.

Members of the Montana Hospital Association provide the full spectrum of health care services, including hospital inpatient and outpatient, skilled nursing facility, home health, hospice, physician, assisted living, senior housing and insurance services.

Mental health is an important topic to address across the state as Montana has the highest suicide rate among any state in the United States at nearly twice the national average. Approximately 54 of 56 counties in Montana are designated as mental health professional shortage areas meaning those counties do not meet the criteria of having at least one mental health professional per 10,000 people. Psychiatric providers are particularly hard to come by in Montana outside of a few cities.

“We are excited by this partnership’s ability to help bring care to Montana communities that have been struggling with acute needs for psychiatric care,” says Dr. Jim Varrell, Medical Director of InSight. “With on-demand telepsychiatry, hospitals can have access to psychiatrists who can make admission or treatment decisions within an hour on average. Other locations like clinics, primary care offices or correctional facilities can also benefit from our scheduled telepsychiatry services. With telepsychiatry, psychiatry providers can offer care to anyone, anywhere as long as there is adequate internet connectivity.”

In addition to facility-based models of telepsychiatry, InSight is also working with the Montana chapter of Mental Health America to offer telemental health care to individuals in their home or other private spaces online.

InSight is already working with the Billings Clinic in Montana to provide on-demand, after-hours telepsychiatry services in the emergency department.

Telepsychiatry is an effective, cost-conscious and proven way to bring psychiatry providers, especially those with hard-to-find specialties, into areas where there may be a shortage like Montana rural and frontier land.

For nearly 30 years, MHAV has improved consumer care and reduce operating costs by tailoring flexible programs to fit the needs of each individual hospital.

InSight, the leading national telepsychiatry service provider organization, has over 17 years of industry experience, serves over 225 organizations across 26 states and has implemented telepsychiatry programs across the spectrum of care. Together, MHAV and InSight will work to improve the mental health of communities throughout Montana.

 

InSight Telepsychiatry Presents at American Academy of Child and Adolescent Psychiatry Annual Meeting

October 28, 2016 │ InSight Telepsychiatry was proud to present on the legal, regulatory and financial realities of telepsychiatry at the American Academy of Child and Adolescent Psychiatry’s 63rd Annual Meeting.

New York, NY – InSight Telepsychiatry’s Executive Director, Geoffrey Boyce, and Medical Director, Dr. Jim Varrell, presented at the American Academy of Child and Adolescent Psychiatry’s (AACAP) 63rd Annual Meeting held in New York City. The AACAP annual meetings are a gathering place for leaders in the field of child and adolescent psychiatry, children’s mental health and other allied disciplines.

Boyce and Dr. Varrell’s presentation, entitled Legal, Regulatory and Financial Realities of Telepsychiatry, was delivered during the “Road Map to Establish and Sustain a Telepsychiatry Practice” clinical breakout session organized by Dr. Kathleen Myers and attended by over 100 child and adolescent psychiatrists. Their presentation covered topics including models of telepsychiatry, reimbursement, licensure, the provider-patient relationship and emergency protocol. Other presentations during this breakout session included Media Training to Develop and Authentic Patient-Doctor Relationship presented by Dr. David E. Roth and Competencies in Telepsychiatry: Residency Training and Maintenance of Skills presented by Dr. Daniel A. Alicata.

Additionally, Dr. Varrell presented on the entrepreneurial side of telepsychiatry during the breakout’s TED-talk style session. He discussed being a thought leader in telepsychiatry and telepsychiatry best practices. Dr. Varrell has been providing telepsychiatry services since 1999 and is one of the founding members of InSight Telepsychiatry, the national leading telepsychiatry service provider.

Boyce and Dr. Varrell also took part in the breakout session’s ‘Genius Bar.’ They hosted a “Careers in Telepsychiatry: Choose Your Own Adventure” station where attendees were encouraged to ask them questions about what a career in telepsychiatry looks like. Telepsychiatry provides a unique opportunity for psychiatric providers because it allows them to work from home, extending their hours to nights and weekends.

Geoffrey Boyce is the Executive Director of InSight Telepsychiatry and an active participant in telemedicine advocacy, education and reform initiatives.

Jim Varrell, MD is the President and Medical Director of the CFG Health Network and InSight Telepsychiatry who has been at the forefront of telepsychiatry across the nation and continues to educate the medical community regarding the benefits of telepsychiatry.

InSight Telepsychiatry is the national leading telepsychiatry provider organization with a mission to increase access to behavioral health care.

InSight Telepsychiatry Supports Creativity and Innovation During Psychiatry Innovation Lab Event

Oct. 19, 2016 | InSight Telepsychiatry was proud to support three awards during the Psychiatry Innovation Lab at IPS: The Mental Health Services Conference organized by the American Psychiatric Association.

Washington, D.C. — InSight Telepsychiatry awarded three finalists for innovative ideas in the advancement of behavioral health care during the Psychiatry Innovation Lab at IPS: The Mental Health Services Conference organized by the American Psychiatric Association.

Chaired by psychiatrist and author Dr. Nina Vasan, the Psychiatry Innovation Lab is an educational workshop that fosters the advancement of health care delivery. The lab offers the opportunity for professionals in technology, business, medicine, government and nonprofits to connect and collaborate with psychiatrists and mental health professionals.

On Oct. 8, participants pitched ideas for the advancement of behavioral health care delivery by way of entrepreneurship, policy, systems redesign, education, collaboration, technology and more. InSight awarded a total of three of the six awards presented at the event.

A team of neuropsychiatry-minded high school students was awarded Outstanding Progress for their work on AlzHelp, an augmented-reality and intelligent personal assistant app that keeps individuals living with Alzheimer’s disease safe. The app was designed by Akanksha Jain, Michelle Koh and Priscilla Siow.

Presented by mental health care entrepreneur April Koh, Spring.com was awarded the Most Promising Innovation for enabling the prediction of treatment outcomes for depression by way of machine-learning and big data.

The last award supported by InSight went to a group called Beacon led by Shrenik Jain for the Most Disruptive Innovation. Beacon is a mobile application for chat-based group therapy that has participated in a diverse selection of health care technology initiatives. A consistent group of anonymous users come together in judgement-free communities with this group therapy app.

Other winners included: The grand prize winner Joseph Insler for his “overdose recovery bracelet” and the audience choice Swathi Krishna for SPECTRUM, an app for children with autism spectrum disorder.

As the leading national telepsychiatry organization, InSight is proud to support a workshop that cultivates the advancement of behavioral health care through innovative applications of technology. InSight provides psychiatric care through innovative applications of technology by providing telepsychiatry services to hospitals, outpatient clinics and other health care organizations nationwide.

Online Behavioral Health for Mental Wellness

October 5, 2016 | Business Innovations Manager of InSight Telepsychiatry Scott Baker discusses how telebehavioral health services like Inpathy can increase access to mental and behavioral health care.

Buffalo, N.Y. – As part of Mental Health Awareness Week, InSight Telepsychiatry’s own Scott Baker was interviewed by WIVB-TV News 4 in Buffalo, NY and asked to discuss how telebehavioral health services like Inpathy can increase access to mental and behavioral health care.

Baker spoke about the convenience of online behavioral health care through Inpathy, the virtual office to over 300 behavioral health providers. Another InSight team member, Melissa Harward, provided a demonstration of the Inpathy videoconferencing platform.

WIVB-TV News 4 reporter, Angela Christoforos highlighted how being able to access care online offers many benefits to individuals and families seeking behavioral health care, including appointment availability at night or on weekends, clinical effectiveness and the convenience of using everyday technology for secure sessions with providers. This is especially helpful for individuals who have issues with scheduling, mobility, transportation and/or  local provider availability.

Inpathy providers are licensed psychiatrists, psychiatric nurse practitioners, psychologists and therapists who offer a wide variety of behavioral health services like medication management and therapy. View Inpathy providers by searching the directory here: https://portal.inpathy.com/directory-search/start

Watch and read about the interview here.

New Psychiatric Practice in New York Allows Individuals to Get Their Mental Wellness On(line)

Telebehavioral health allows individuals to attend sessions with behavioral and mental health providers online through secure videoconferencing. Inpathy is a division of InSight Telepsychiatry, the largest telebehavioral health organization in the nation.

Inpathy providers include adult and child and adolescent psychiatrists and psychiatric nurse practitioners that are available for psychiatric assessments, medication management and prescriptions when appropriate. Therapists and counselors are also available for talk therapy sessions through telehealth.

Many of the Inpathy telebehavioral health providers offer night and weekend appointments, which can be accessed through the internet from home using a smartphone, tablet or a computer with a webcamera. This makes managing behavioral health care more convenient by eliminating the need to travel to in-person appointments and sit in waiting rooms. Another benefit of telebehavioral health is that it is a more private way to access behavioral health services, which makes it a good option for individuals who are worried about a stigma on behavioral or mental health care.

Just like in an in-person office, the telebehavioral health providers who deliver services through Inpathy are fully supported by a clinical and administrative staff that handles their scheduling, billing, intake, general operations and clinical oversight.
Inpathy accepts insurance from several major insurance companies, including Aetna. For in-network telebehavioral health sessions, individuals are only charged their co-pay just like they would be for an in-person session. Inpathy providers are also available for out-of-network and cash-pay appointments.

“There is a huge shortage of psychiatrists across the nation,” says Geoffrey Boyce, executive director at InSight. “Telepsychiatry and telebehavioral health offer a unique solution for making psychiatry appointments easier to book and attend.”

Inpathy has telebehavioral health appointments available with many New York-licensed providers, including the following:

  • Doug Ikelheimer, MD- an extremely experienced telepsychiatrist with expertise in the psychopharmacologic management of mood disorders, anxiety disorders, chronic mental illness and addictions
  • Catherine Newton, LCSW – a licesnsed clinical social worker who specializes in working with individuals who have experienced trauma and is trained in Eye Movement Desensitiazation and Reprocessing (EMDR)
  • Ragy Girgis, MD – a board certified psychiatrist with an interest in the psychopharmalcologic management of schizophrenia, mood disorders, anxiety disorders and eating disorders in adults
  • Hinna Shah, MD – a board certified adult and child and adolescent psychiatrist with experience working with individuals who have depression, bipolar disorder, anxiety disorders, autism spectrum disorder and ADHD
  • Liz Espinoza, LCSW – a Spanish-speaking licensed clinical social worker who is interested in helping individuals achieve life goals and specializes in anger management, relationship, communication and life transition issues

Telehealth is a rapidly growing industry and more and more insurance companies and providers are offering this form of care. Numerous studies have shown telebehavioral health to be as effective as in-person behavioral health services in most situations.

To get started as an individual using telebehavioral health care, individuals can visit http://www.inpathy.com to search the Inpathy provider directory, sign up, select an appropriate provider and schedule a session. Inpathy has a 24-hour technical support line and care navigation team that can be reached at 1.800.442.8938.

InSight is also in the process of developing referral relationships with a number of New York organizations that could benefit from additional behavioral health services for their clients. To learn more about this or connect individuals you know to care, visit http://www.inpathy.com.

Cathy Newton

Telebehavioral Health Practice Launches in Delaware and New York

AUGUST 21, 2016 | Mental health providers, including psychiatrists are now available for assessment, therapy and medication management through a newly launched behavioral health practice in Delaware and New York called Inpathy. Inpathy is unique in that it operates entirely through telebehavioral health- a convenient, private and effective medium of care that is rapidly growing in popularity.

Telebehavioral health allows individuals to attend sessions with behavioral and mental health providers online through secure videoconferencing. Inpathy is a division of InSight Telepsychiatry, the largest telebehavioral health organization in the nation.

Inpathy providers include adult and child and adolescent psychiatrists and psychiatric nurse practitioners that are available for psychiatric assessments, medication management and prescriptions when appropriate. Therapists and counselors are also available for talk therapy sessions through telehealth.

Many of the Inpathy telebehavioral health providers offer night and weekend appointments, which can be accessed through the internet from home using a smartphone, tablet or a computer with a camera. This makes managing behavioral health care more convenient by eliminating the need to travel to in-person appointments and sit in waiting rooms. Another benefit of telebehavioral health is that it is a more private way to access behavioral health services, which makes it a good option for individuals who are worried about a stigma on behavioral or mental health care.

Just like in an in-person office, the telebehavioral health providers who deliver services through Inpathy are fully supported by a clinical and administrative staff that handles their scheduling, billing, intake, general operations and clinical oversight.

Inpathy accepts insurance from several major insurance companies, including Aetna. For in-network telebehavioral health sessions, individuals are only charged their co-pay just like they would be for an in-person session. Inpathy providers are also available for out-of-network and cash-pay appointments.

“There is a huge shortage of psychiatrists across the nation,” says Geoffrey Boyce, executive director at InSight. “Telepsychiatry and telebehavioral health offer a unique solution for making psychiatry appointments easier to book and attend.”

Inpathy has telebehavioral health appointments available with many Delaware and New York licensed providers, including the following:

  • Doug Ikelheimer, MD- an extremely experienced telepsychiatrist with expertise in the psychopharmacologic management of mood disorders, anxiety disorders, chronic mental illness and addictions
  • Lamont Josey, LCSW- a clinical social worker who offers therapy to individuals 8 years old and up and has a specialty in trauma-focused Cognitive Behavioral Therapy (CBT)
  • Humberto Quinanata, MD- a Spanish-speaking child and adolescent psychiatrist with an interest in psychopharmacology
  • Patti Rodgers, PMHNP- a board certified psychiatric nurse practitioner who serves adults and aims to educate and empower the people with whom she works
  • Catherine Newton, LCSW – a licesnsed clinical social worker who specializes in working with individuals who have experienced trauma and is trained in Eye Movement Desensitiazation and Reprocessing (EMDR)
  • Ragy Girgis, MD – a board certified psychiatrist with an interest in the psychopharmalcologic management of schizophrenia, mood disorders, anxiety disorders and eating disrders in adults
  • Hinna Shah, MD – a board certified adult and child and adolescent psychiatrist with experience working with individuals who have depression, bipolar disorder, anxiety disorders, autism spectrum disorder and ADHD
  • Liz Espinoza, LCSW – a Spanish-speaking licensed clinical social worker who is interested in helping individuals achieve life goals and specializes in anger management, relationship, communication and life transition issues

Telehealth is a rapidly growing industry and more and more insurance companies and providers are offering this form of care. Numerous studies have shown telebehavioral health to be as effective as in-person behavioral health services in most situations.

To get started as an individual using telebehavioral health care, individuals can visit www.Inpathy.com to search the Inpathy provider directory, sign up, select an appropriate provider and schedule a session. Inpathy has a 24-hour technical support line and care navigation team that can be reached at 1.800.442.8938.

InSight is also in the process of developing referral relationships with a number of Delaware and New York organizations that could benefit from additional behavioral health services for their clients. To learn more about this or connect individuals you know to care, visit www.Inpathy.com

Hawaii Teens Go Off-Island for Counseling: Any Other Options?

christian-science-monitor-logo

June 2, 2016 | A report shows Hawaii teens seeking mental health treatment often have to leave the island to find it. What are patients in other remote areas trying?

By Lucy Schouten

Scott Shimabukuro, a clinical psychologist in the Hawaii Department of Health's Child and Adolescent Mental Health Division, and Lynn Fallin, deputy director of behavioral health, pose at the Hawaii Department of Health offices in Honolulu on May 24. Dozens of mentally ill teens are sent to the mainland for treatment each year because they can’t find the proper services in the islands. (Marina Rikder/AP)

Scott Shimabukuro, a clinical psychologist in the Hawaii Department of Health’s Child and Adolescent Mental Health Division, and Lynn Fallin, deputy director of behavioral health, pose at the Hawaii Department of Health offices in Honolulu on May 24. Dozens of mentally ill teens are sent to the mainland for treatment each year because they can’t find the proper services in the islands. (Marina Rikder/AP)

Many patients in rural or remote areas of the country must travel long distances to meet with a counselor or receive mental health treatment, but some young patients face a much more burdensome trip by plane or boat.

Some Hawaii teenagers have faced such long waits for treatment that healthcare providers send them to the mainland, reports the Associated Press. This takes them away from the support of friends and family, leaving authorities looking for strategies employed by other communities.

An ongoing shortage of mental health providers, especially for those trained to work with specific populations such as adolescents or veterans, has strained public health resources in many communities throughout the United States – especially in rural areas.

Noting the lack of mental healthcare options in many remote areas, the US Department of Agriculture has invested $50 million in rural mental health access, especially for veterans, part of an overall strategy to integrate more mental health services into primary care, to which rural patients have better access.

In some communities, local leaders are being trained to recognize when someone may be in need of immediate mental health services. The Mental Health First Aid course, originally developed in Australia but adapted by the health departments of Maryland and Missouri, trains rural community and faith leaders to recognize signs that a patient is suicidal or in need of other help and to identify counseling resources.

“The course helps participants to not only gain confidence in their capacity to approach and offer assistance to others, but also to improve their personal mental health,” reported the US Department of Health and Human Services after investigating the program.

A 21st-century solution, the growing practice of telepsychiatry, enables patients in remote or underserved areas to meet with counselors over live video stream. The new practice followed telemedicine – where doctors might remotely check a patient’s heart rate – but telepsychiatry shows more promise, Kristine Crane reported for US News and World Report.

Designed for patients whose remote residency limits their access to counselors, telepsychiatry can give patients at busy community hospitals the help they need without adding to patient rolls in already overburdened emergency rooms. In South Carolina, where most therapists live in or near the capital, a 2009 pilot study turned into an ongoing practice. Psychiatrists now have about 400 remote consultations per month, saving $1,400 per episode.

Such remote counseling does have disadvantages, as counseling sessions require a secure connection because of privacy laws, and it makes a “human touch” impossible.

“A caring touch or handing a patient a tissue can never be possible,” noted Hind Benjelloun, a crisis psychiatrist based in Washington, D.C., who meets with some patients via computer, in an interview with US News and World Report. “I am unable to clearly see self-inflicted wounds or tears.”

But where face-to-face counseling isn’t possible, virtual therapy can help fill a much needed void, proponents say.

“In a more rural area, nobody has access [to psychiatric care],” Geoffrey Boyce, executive director of InSight Telepsychiatry, told US News and World Report. “[Telepsychiatry is] enormously more affordable at that point.”

 

View this story on The Christian Science Monitor.

Innovative ACT Program Utilizing Telepsychiatry to Be Highlighted at American Telemedicine Association Annual Conference

May 17, 2016 | Representatives from Resources for Human Development and InSight Telepsychiatry will discuss a first-of-its-kind program that brings telepsychiatry to individuals with severe mental illness receiving care through assertive community treatment programs in Delaware.

InSight RHD

Speakers representing Resources for Human Development (RHD) and InSight Telepsychiatry will highlight their unique use of telepsychiatry in two Delaware assertive community treatment (ACT) programs at the American Telemedicine Association Annual Conference on May 17.

InSight telepsychiatrist Shelley Sellinger, MD, and RHD’s Unit Director in Delaware Laura Marvel will present a case study detailing the organizations’ development of a telepsychiatry program for RHD’s ACT teams in Wilmington and Dover, Del., the first program of its kind in the nation. Marvel, who has spent the past 15 years working in Delaware’s mental health system, was a driving force behind the creation of the program. Dr. Sellinger provides 32 hours of scheduled telepsychiatry services per week to RHD’s Dover program from her home office in New York.

Using 4G-enabled laptops and tablets, RHD social workers can bring remote telepsychiatry providers directly to the homes of individuals with severe mental illness participating in RHD’s ACT programs. These in-home visits are used in conjunction with office visits where a telepsychiatrists is also a part of the care team.

ACT programs bring together counselors, psychiatrists, registered nurses, case managers and vocational specialists to help individuals whose mental health conditions cause them significant challenges in working, maintaining social relationships, living independently and managing their health. These providers work with individuals to identify what is preventing them from living a successful life and facilitate independence. The ACT model of care was developed in the early 1970s and was widely adopted in communities across the countries by the end of the decade.

In 2012, Delaware awarded ACT contracts in Dover and Wilmington to RHD, a national human services nonprofit organization, with the goal of discharging consumers from inpatient units and providing them with intensive, 24/7 outpatient care. However, Delaware’s shortage of available psychiatry providers, which reflects national shortages, made it challenging for members RHD’s ACT provider team to come together regularly.

To address this problem, RHD took a unique approach, partnering with InSight the next year to incorporate telepsychiatry into their ACT programs.

The two organizations created a telepsychiatry pilot with two groups of 100 individuals, who were transported to RHD’s two ACT offices to meet with a psychiatrist via videoconference. By using telepsychiatry, RHD maintains a team approach to care, and psychiatry providers maximize the number of individuals they see, since they no longer have to spend time traveling from site to site.

Once RHD and InSight established the efficacy and acceptability of telepsychiatry with individuals in the office-based pilot program, they expanded the program to be able to meet individuals in the community. Instead of bringing individuals to see a telepsychiatrist in their offices, RHD could bring the telepsychiatrist to individuals in their homes or other community spaces using 4G-enabled laptops and tablets.

Today, RHD’s Delaware ACT programs use telepsychiatry both in and outside of their offices. Dr. Sellinger sees individuals in their homes a few times a week via telepsychiatry. She says that iPads have helped increase the volume of in-home telepsychiatry encounters and that individuals love it when she comes to them via the devices.

Seeing individuals in their home environments helps more accurately assess their needs, says Dr. Sellinger. “When you see them in their home, you see if it’s clean or messy, and their family is there,” Dr. Sellinger says. “You really get a sense of what’s going on with them.”

Dr. Sellinger can then use these environmental and social cues as clinical indicators to help her prescribe the best possible treatment for that particular individual.

“Despite the fact that individuals and Dr. Sellinger do not meet in the same location, both parties tend to forget that they’re seeing each other through screens,” says Kathleen Gainey, a registered nurse at RHD’s ACT office in Dover who works with Dr. Sellinger. “It’s as if she’s there in person,” she says of Dr. Sellinger and her ability to connect with individuals.

In-home telepsychiatry from InSight isn’t limited to ACT programs. InSight’s Inpathy network makes it possible for consumers to connect with behavioral health professionals, including many psychiatrists from home.

InSight and RHD’s ATA presentation will take place on May 17 at 4:15 p.m. in room 205A.

InSight will also have two booths at ATA, booth 1909 and booth 515.

For more information, to connect with InSight at ATA, or to schedule a time for a meeting with an InSight representative, contact Olivia Boyce at oboyce(at)in-sight(dot)net or 770.713.4161.

InSight Telepsychiatry to Present at American Telemedicine Association Annual Conference

May 15, 2016 | InSight Telepsychiatry leaders, providers and partners are presenting this week at the American Telemedicine Association’s Annual Conference and Trade Show in Minneapolis. Their presentations, which will address practicing telebehavioral health in a variety of settings and marketing telebehavioral health to consumers, will draw on InSight’s experience as the leading national telepsychiatry service provider organization.

MINNEAPOLIS — Representatives from InSight Telepsychiatry will give presentations on a variety of telepsychiatry topics during the American Telemedicine Association’s (ATA) Annual Conference and Trade Show May 15 to 17.

On May 17, two InSight providers will present during one of ATA’s 75+ peer-reviewed sessions. The session, called How-To Telemental Health in Non-Institutional Settings, will feature “Fast-Paced Work from the Comfort of Home: Clinical Considerations for Crisis Telepsychiatry,” presented by Doug Ikelheimer, MD and “ACT Now for Innovation: Develop a Telemental Health Program for ACT Teams,” presented by Shelley Sellinger, MD.

Dr. Ikelheimer, a board-certified psychiatrist, will draw on his experience as an InSight on-demand telepsychiatry provider to discuss the benefits of challenges of working in an emergency department (ED) from home.

On-demand telepsychiatry providers offer much-needed psychiatric expertise that can reduce the amount of time consumers in crisis wait for proper care. Dr. Ikelheimer’s presentation will review the steps that need to be taken to establish a successful emergency telepsychiatry program and examine case studies in which individuals were able to receive timely, appropriate care through telepsychiatry in emergency departments.

Dr. Sellinger, also a board-certified psychiatrist, will present a case study that details InSight’s partnership with Resources for Human Development (RHD) to establish a telepsychiatry program with mobile capabilities for two assertive community treatment (ACT) teams in Delaware. The program is the first in the nation to use telepsychiatry in an ACT program and serves as a model for implementing telepsychiatry into ACT programs nationwide.

The program brings a combination of on-site and in-home telepsychiatry services to individuals whose mental health conditions prevent them from working or living independently. With 4G-enabled tablets and laptops, RHD social workers to travel to individuals’ homes or other community spaces to connect them with a remote psychiatry provider.

Laura Marvel, the Unit Director for RHD’s Delaware assertive community treatment teams, will present alongside Dr. Sellinger.

InSight Marketing and Communications Manager Olivia Boyce will present the e-poster, “Telemarketing: It’s Not What You Think — A How-To Guide for Promoting Direct-to-Consumer Telehealth,” on May 15.

Additionally, InSight Business Innovations Manager Scott Baker will moderate the session, “Effectiveness of Automated Speech Recognition Apps,” on May 17. The session will focus on the use of speech recognition apps in behavioral health services, including telepsychiatry.

ATA 2016 is the industry’s leading event for insights into the latest telemedicine and mobile health trends.

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through innovative applications of technology.

For more information and to connect with InSight at ATA, visit booth 1909 or booth 515, where InSight will exhibit alongside Carenection, a telehealth marketplace that offers a scalable, unified telemedicine solution for organizations and systems implementing telehealth. To schedule a time for a meeting, contact Olivia Boyce at oboyce@in-sight.net or 770.713.4161.

Hospital to Decline Inpatient Psychiatric Unit Grant

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April 27, 2016 | By Allison Arthur

Jefferson Healthcare may return a $1.5 million grant it was awarded to build a seven-bed inpatient psychiatric facility and instead, head in a less costly direction that involves two safe rooms and telepsychiatric consulting services.

Jefferson Healthcare CEO Mike Glenn told hospital commissioners April 20 that the cost of building a seven-bed unit would be $2 million–$2.5 million on top of the $1.5 million grant and result in annual income losses of $2 million.

After receiving the grant last year from the state Department of Commerce, hospital officials had lobbied for an additional $1 million in capital funding. The hospital was notified recently that its request wasn’t in the state’s budget.

Hospital Commissioners Jill Buhler, Matt Ready and Kees Kolff thanked Glenn for trying to find a “way to yes,” as Glenn had phrased his hope for the project in early March.

A formal vote on Glenn’s recommendation to return the funding is expected at the May 18 board of commissioners meeting. If the board votes to decline the funding in mid-May, Glenn said, it would go back into a fund earmarked for mental health programs, and some other organization could apply. If the board were to wait longer, Glenn said, the money would go into the state’s general fund.

Instead of moving forward on the inpatient facility, Glenn proposed construction of a two-bed crisis and stabilization unit, which would include the development of programming and a policy and procedure manual as well as continued partnership with Jefferson Mental Health Services.

DISAPPOINTMENT

Commissioner Buhler said Glenn and others had done a “noble and exhaustive” effort and that hospital officials fought for it, too.

Glenn wondered aloud about the merit of “dangling a $1.5 million grant” in front of small hospitals to build a $4 million inpatient facility that would then result in annual losses of $2 million.

That’s when Ready spoke up, saying he, too, applauded the work of hospital officials for “slaving away” to try to make things work. He said the way health care is funded is essentially “criminal.”

As Glenn had explained in March, a concern is Jefferson Healthcare’s status as a critical access hospital (CAH). It’s a designation that helps keep the rural hospital afloat, bringing in more revenue for care than other hospitals might get. But not so with an inpatient psychiatric unit, officials learned.

And although the state had provided money for startup costs of an inpatient unit, the hospital would have had to spend more than the state gave it not only to design and build the unit, but to pay for staff and maintenance. And with the unit, the hospital wouldn’t have received the same level of reimbursement from Medicare as it does now for other services it provides, officials said.

Glenn called it a “penalty,” and said it was unlikely the funding challenges of a critical access hospital would change soon.

He also said that while the state has seen increased funding for mental health projects in the past few years, the state faces a $2 billion–$3 billion shortfall for funding education and so the revenue stream for mental health programs might start to dwindle.

Currently, there are no hospitals in the state with the CAH designation that have inpatient psychiatric units; Jefferson Healthcare would have been the first.

AN OPTION, TELEPSYCH

Seeming to sense earlier this year that “getting to yes” was going to be difficult, Glenn and former Chief Nursing Officer Joyce Cardinal visited Olympic Medical Center in Port Angeles, which has two “safe” rooms, which are used for temporary inpatient psychiatric care.

A mental health task force has already started to work on guidelines for the safe rooms as well as a design for converting two existing acute-care units into safe rooms.

The task force includes registered nurses and others on the Jefferson Healthcare staff, but not Dr. Sue Ehrlich, a psychiatrist. Ehrlich divides her time between Jefferson Healthcare and Jefferson Mental Health Services. Officials said she had been consulted, although she hadn’t been named to the task force; she could not be reached for comment by Leader press time.

No one from Jefferson Mental Health Services spoke out at the meeting. Glenn said the two entities are continuing to collaborate and may be hiring more help together.

The in-hospital task force also has started to look at telepsychiatric consulting services, including one operated by Swedish Medical Center from 7 a.m. to 7 p.m., and one called InSight Telepsychiatry.

Current Chief Nursing Officer Jackie Mossakowski said that telepsychiatric programs have worked elsewhere.

She said that nurses and staff at Jefferson Healthcare have had concerns about safety and such issues as using restraints to protect patients. A safe room where someone could sit and watch a patient going through a mental health crisis is needed, she said.

Mossakowski said goals for the safe rooms would be: increased resources for staff and patient; consistent care; better treatment options, including using less restraint; and increased consultation to improve medication management and help patients through their crisis.

She said it often takes 24-48 hours to stabilize someone in a crisis.

BOARDING QUESTION

To bolster the idea of moving from a seven-bed inpatient facility to a unit with two safe rooms, Glenn also noted that the number of acute psychiatric care (APC) clients in Jefferson County has dropped in the past few years and that roughly 1.5-2 patients a day in Jefferson County seek inpatient care.

Steve Workman, an advocate for people with mental health issues, noted that the state was trying to get away from “boarding” people in hospitals and he said that the two safe rooms seemed like “psychiatric boarding enhanced.”

“The enhancements are particularly profound,” responded Glenn, noting that having a psychiatrist available to consult with staff would be an improvement over what the hospital staff has now, which is a shared psychiatrist.

Glenn also said Jefferson Healthcare has been improving its access to care for people in crisis.

In 2012, according to market-share statistics Glenn presented, St. Joseph Hospital in Bellingham, Fairfax Hospital in Kirkland and MultiCare Auburn Medical Center saw 50 percent of patients from Jefferson County who needed inpatient psychiatric care.

In 2014, those hospitals had 22 percent of the patients, and Jefferson Healthcare’s “market share” had more than doubled to 22 percent as well, up from the 8 percent the hospital had had two years earlier.

After the meeting, Glenn said that the health care system spent roughly $2,500 to assist in the grant application and spent another $3,000-$5,000 to assist developing the grant and a feasibility study. It is unlikely that money can be recouped.

Glenn also said he expects the room revisions to cost less than $100,000. Glenn said he knew going in that it would be difficult to develop a seven-bed facility, but there was hope it could be pulled off. He said that he, too, was disappointed he couldn’t “get to yes.”

See the original article at ptleader.com.

Telepsychiatry and Mental Health

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April 20, 2016 | By Joshua Kendall

See the original article at Undark.org.

Patients who cannot access mental health services — or who are not comfortable seeking help — increasingly do so remotely.

In the wake of the Gulf oil spill in 2010, many rural Louisiana residents became emotionally distressed. With few mental health clinicians practicing in the area, psychiatrists at Louisiana State University decided to try something novel. They set up a video connection between their New Orleans office and small primary care clinics in towns like Hackberry, which sits over 200 miles away and has a population of just over 1,000.

“I treated several crabbers and shrimpers from Hackberry who couldn’t work, were falling into debt and were very depressed,” said Dr. Shih Tan Gipson, a psychiatrist at Boston Children’s Hospital who recently completed her residency at LSU. “With regular therapy sessions, along with medication, I was able to help them get their lives back on track.”

This approach, known as telepsychiatry, has been around for more than a half a century; in 1959, the State of Nebraska used two-way closed-circuit television between the Nebraska Psychiatric Institute and the state mental hospital to aid in the teaching of first-year medical students. Advances in technology over the last 20 years have made telepsychiatry systems much easier to set up and it is now starting to be widely adopted.

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Telepsychiatry allows patients who cannot access mental health services or are not comfortable seeking help to consult with clinicians via videoconferencing.

The U.S. Department of Veterans Affairs, which began experimenting with ‘telemental health’ in 1995, has been a pioneer in using this method. The VA has already administered over 2 million video mental health sessions with patients and the pace continues to pick up every year. In 2015, 380,000 sessions were conducted using video. At present, about 8 percent of all mental health patients at the VA use telemental health. The VA is now beginning to expand beyond its hub model — in which therapists treat patients at hundreds of community-based clinics across the country — to using phones and tablets.

“We treat patients with every type of DSM-5 diagnosis,” said Dr. Linda Godleski, a professor of psychiatry at Yale and director of the VA’s National Telemental Health Center.

Surveys show that patient satisfaction with this method is about 95 percent. In addition to being able to reach patients in underserved areas and provide easy access to national experts, telemental health has other advantages as well.

“Patients with severe disorders such as schizophrenia often feel more relaxed and are more likely to open up,” Godleski said.

Telemental health has also proved to cut health care costs. In a 2012 survey published in the journal Psychiatric Services, Godleski showed that access to telemental health service reduced hospitalization admissions of VA patients by about 25 percent.

Not everyone embraces the idea that mediated interactions between clinicians and patients are always beneficial, or that they function similarly to in-person therapy. In her 2015 book “Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy,” British psychotherapist and psychoanalyst Gillian Isaacs Russell, PhD., for example, raised questions about the loss of certain non-verbal cues, and pointed to the lack of research comparing the various pros and cons of both in-person and screen-mediated therapy.

Still, most clinicians believe that the technology is now good enough to enable them to spot many standard non-verbal cues, and some states, including New York, have begun to establish formal telepsychiatry standards and guidelines.

While the private sector has been much slower to take advantage of this new technology, the industry leader, Insight Telepsychiatry, which has been in operation since 1999, reports steady growth. In 2015, it had 150,000 patient encounters — a 50 percent increase over 2014. The company now offers services to hospitals and community mental health clinics in 26 states, compared to the nine states it operated in just three years ago.

This year, the American Psychiatric Association set up a telepsychiatry committee, which works to break down two major obstacles to broadening its scope. One involves licensure: Clinicians must be eligible to practice in the same state in which their patients reside. The other involves reimbursement, given that in some states, insurance companies provide little or no coverage. The APA is currently working with doctors in various other fields to make it easier for clinicians to obtain licenses in multiple states. To date, 12 states have signed on to the Federal State Medical Board Interstate Licensure Compact which provides an expedited pathway to licensure and another 14 have introduced similar legislation.

“In 10 years, telepsychiatry may well become a core component of psychiatric care,” said Dr. Peter Yellowlees, a member of the APA committee who teaches psychiatry at the University of California, Davis. “For people under 40, connecting with therapists on screens seems both reasonable and normal.”

See the original article at Undark.org.

St. Joseph’s Villa and InSight Telepsychiatry Bring Psychiatric Care to Children in Crisis Stabilization Unit

April 19, 2016 | St. Joseph’s Villa of Richmond, Va. works with InSight Telepsychiatry to bring telepsychiatry services to their Crisis Stabilization Unit, an innovative program in a unique setting that diverts children in mental health crisis from unnecessary hospitalization.

RICHMOND, Va. — St. Joseph’s Villa is collaborating with InSight Telepsychiatry to bring telepsychiatry to children receiving mental health services at their facility. St. Joseph’s Villa (SJV) provides children and their families with a variety of social services. One of SJV’s many innovative and effective programs is their Crisis Stabilization Unit (CSU), where children experiencing mental health crises can go to receive treatment in an environment that feels like home — all with the goal of preventing costly, unnecessary hospitalization. Since opening in 2012, the CSU has served nearly 500 children and has successfully diverted nearly 90 percent of them from hospitalization. InSight has helped the CSU work toward this goal for nearly two years.

Located in a repurposed cottage with spacious bedrooms and recreation areas, SJV’s CSU’s six-bed facility acts as a hybrid between a residential home and a hospital. This hybrid model allows SJV to offer clinical services, including telepsychiatry, while giving children in crisis a less restrictive environment than that of traditional residential treatment centers.

A first-of-its-kind facility in central Virginia, the CSU was a runner up in the Innovative Practices Award presented by the Council on Accreditation to spotlight organizations that bring lasting change to the lives of vulnerable individuals through unique, forward-thinking initiatives.

Telepsychiatry allows children in the CSU to see psychiatry providers through videoconferencing. With the option to utilize remote providers, telepsychiatry and other telemedicine services represent unprecedented access to specialists who are typically difficult to staff in rural and underserved areas. When the CSU opened in partnership with the Richmond Behavioral Health Authority (RBHA) Region IV, SJV found that it was challenging to locate a qualified local child psychiatrist. In terms of mental health providers, several of the counties SJV’s CSU serves are Designated Health Professional Shortage Areas, according to the U.S. Health Resources and Services Administration.1 Ultimately, SJV turned to telepsychiatry as the solution for bringing psychiatric care to their facility.

Telepsychiatry isn’t just a means of bringing access to care. The telepsychiatry medium is able to help these children express themselves better, says Craig Hedley, SJV’s Director of Community Partnerships. “Kids are used to Skyping, but they can be intimidated by adults. Children can relate to them better through a TV screen, which provides them a layer of safety and protection,” he says.

The CSU collaborates with an InSight telepsychiatrist for about 15 hours a week of regularly scheduled services. The telepsychiatrist, Dr. Ashika Kapoor, helps onsite providers assess children’s symptoms and manage their medications.

“There are unique challenges to working at a crisis stabilization unit, but I really enjoy being a part of a team approach,” Dr. Kapoor says. “The staff at St. Joseph’s Villa are a wonderful group of individuals who do amazing work together as a team.”

According to Hedley, Dr. Kapoor is a flexible asset to this team-oriented approach and goes out of her way to help the team help the children for which they care.

“Dr. Kapoor is extremely invested in our program,” Hedley says. “Her responsiveness is incredible.”

The relationship between the InSight telepsychiatry provider and onsite staff is vital to the success of SJV’s CSU program.

“InSight believes in the importance of partnering with innovative, like-minded organizations and working hard to find the right fit between our psychiatrists and our partners,” says Geoffrey Boyce, Executive Director of InSight. “Integrating Dr. Kapoor onto the St. Joseph’s Villa CSU team has been a wonderful success.”

InSight Telepsychiatry is the leading national telepsychiatry service provider with a mission to increase access to appropriate behavioral health care. Telepsychiatry has been proven an effective and cost-conscious way to bring psychiatric care to children.2 Forty percent of InSight’s telepsychiatry providers are child and adolescent psychiatrists.

“The partnership between InSight and St. Joseph’s Villa shows how we can combine modern technology and personal touch to offer a meaningful and potentially life changing service to patients and families in their time of need,” says Dr. Kapoor. “Together we are able to help children and families through a difficult time in their lives and provide them with opportunities to succeed.”

 

[1] http://datawarehouse.hrsa.gov/tools/analyzers/HpsaFind.aspx

[2] Myers, K. M., Valentine, J. M., & Melzer, S. M. (2008). Child and Adolescent Telepsychiatry: Utilization and Satisfaction. Telemedicine and EHealth, 14(2), 131-137. doi: 10.1089/tmj.2007.0035

Spectrum Health & Wellness Partners with InSight Telepsychiatry to Increase Access to Psychiatric Care in Franklin County

December 18, 2016 | Spectrum Health and Wellness of Chambersburg, PA has launched a new program to enhance their existing psychiatric services with telepsychiatry providers from InSight Telepsychiatry. This innovative program will ensure that individuals seeking psychiatric treatment at Spectrum Health & Wellness have access to the quality psychiatric care they need.

Chambersburg, PA— Spectrum Health & Wellness is pleased to announce that they now have increased psychiatric coverage in their outpatient behavioral health services. Spectrum Health & Wellness, LTD offers a range of psychiatric and behavioral health services including psychiatric evaluations and psychotherapy in a community setting.

The new scheduled telepsychiatry services allow coverage for psychiatric evaluations, follow-up consultations and medication monitoring for Franklin County residents.

The program is a result of a collaboration between Spectrum Health & Wellness and InSight Telepsychiatry. When an individual comes to Spectrum Health & Wellness requiring psychiatric care, the onsite staff can now connect them with a remote telepsychiatry provider from InSight for regularly scheduled services. InSight’s telepsychiatry provider will be available in regularly scheduled blocks of time to meet with healthcare consumers for services or with onsite staff for consultation.

The relationship between the InSight telepsychiatry provider and onsite staff is vital to the success of this program. Since June 2015, telepsychiatry provider Melanie Pointer, MD has been working with the Spectrum Health & Wellness team.

“InSight believes in the importance of integrating our services into the existing model of care and works hard to find the right fit between our psychiatrists and the partners they serve,” says Geoffrey Boyce, Executive Director of InSight. “Integrating Dr. Pointer onto the Spectrum team has been a wonderful success.”

“Dr. Pointer has been a wonderful complement to our telepsychiatry services. She quickly related to both our unique member population and our staff. Her professionalism and dedication to our agency is beyond comparison,” said Dinen Sanders, Clinical Director at Spectrum.

Because of the option to utilize remote providers, telepsychiatry and other telemedicine services represent unprecedented access to specialists who are typically difficult to staff in rural and underserved areas. A striking 96% of US counties, including Franklin County, where Spectrum Health & Wellness is located, have a shortage of psychiatric prescribers . With the new telepsychiatry program, individuals will not only have more access to high-quality care, but to care that’s appropriate for their specific needs.

Sanders says the program is focused primarily on being able to offer the same quality of care as the onsite doctor services, but with a quicker turnaround time for the patient who is willing to accept telepsychiatry services.

“We’re excited that this program will reduce the stress put on our internal team and help the people we treat get care that meets their needs. “

“Because we’re rural, our system of care has to make use of every viable option,” says Sanders. “Since implementing this program we’ve seen a definitive increase in the amount of people we are able to help.”

InSight Telepsychiatry is the leading national telepsychiatry service provider with a mission to increase access to appropriate behavioral health care.

The Value of Telepsychiatry in the ED – 6 Benefits to Cutting Psychiatric Boarding Through Telemedicine

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August 15, 2015 | By Olivia Boyce and Christopher Adams

Originally published in Telemedicine Magazine.
One solution that is helping to reduce psychiatric boarding in EDs across the country is on-demand telepsychiatry.

Hospitals throughout the nation are plagued with psychiatric patients boarding in their emergency departments (EDs). The wait times for psychiatric patients to see a psychiatrist for that evaluation can take hours or even days. A report of 300 ED directors found that 41 percent of EDs have a wait time of over two days to see a psychiatrist.[1]

One solution that is helping to reduce psychiatric boarding in EDs across the country is on-demand telepsychiatry.

“The goal of on-demand telepsychiatry evaluations is for the remote psychiatrist to decide on the most appropriate and least restrictive level of care,” says Dr. Jim Varrell, Medical Director of InSight Telepsychiatry, the largest private telepsychiatry company in the U.S.

“By having a psychiatrist available to do the assessment, on-demand telepsychiatry programs help hospital systems avoid inappropriate admissions, shorten length of stays and improve overall ED patient flow,” explains Dr. Varrell.

1. Shorten ED Wait Times

According to Dr. Varrell, with on-demand telepsychiatry, psychiatric assessments are able to occur within about an hour of a request on average. Since psychiatric patients typically spend over three times longer in the ED than medical patients,[2] telepsychiatry’s timeliness means that psychiatric patients are able to move on to the next level of care much more quickly.

This improvement results in shortened wait times for all patients within the ED, and ultimately an increase in revenue for the hospital system.

2. Increase Hospital Revenue

A study done on the impacts of psychiatric boarding found that boarders prevent an average of 2.2 bed turnovers which results in a lost opportunity cost for the hospital of $2,264 per psychiatric patient.[3] By implementing telepsychiatry and improving the rate of bed throughput, a hospital is ultimately able to increase revenue.

3. Reduce Inappropriate Commitments

Another way telepsychiatry programs are adding value to hospital systems is by reducing costly inappropriate commitments.

South Seminole Hospital in Longwood, Fla. is an Orlando health facility that implemented a telepsychiatry program in November 2014. Through videoconferencing, South Seminole’s ED staff accesses a telepsychiatrist when they have difficult cases or when they need to determine whether an individual who came in under Florida’s civil commitment law, merits psychiatric hospitalization. According to the hospital’s data, during the first six months of the program, one third of the involuntary commitments assessed by telepsychiatrists were rescinded.[4]

“Telepsychiatry allows us to make sure that the psychiatric patients in our ED move on to the most appropriate treatment, whether that is hospitalization or community-based care quickly,” says Charles Webb Manager of the ED at South Seminole Hospital. “When patients don’t have to wait as long for care, they are able to get on a path to better health sooner.”

4. Improve Compliance with Joint Commission Standards

Access to timely care means that hospitals are more likely to be able to meet standards for patient care set by regulating bodies like The Joint Commission who advocate that patient boarding times not exceed four hours.

“When hospitals are able to reduce psychiatric boarding from say 14 hours to under four, there are other financial benefits,” explains Dr. Varrell. “The average sitter for a psychiatric patient costs $15 per hour. By cutting 10 hours from the time a psychiatric patient waits for care, that’s $150 per patient saved on just sitter costs.”

5. Empower and Support Onsite Staff

At a more operational level, the implementation of a telepsychiatry program is reported to better empower onsite staff to handle psychiatric patients. For example, after a telepsychiatry program had been in place for several months at Chester County Hospital in Pennsylvania, the hospital saw an increase in their clearing and placing psychiatric patients without telepsychiatry because staff reported greater confidence in their abilities to assess difficult cases knowing that they had a specialist available for consult or assessment when needed.[5]

Dr. Varrell explains that this case study is an example of why collaboration between remote and onsite staff lends itself to the most effective telepsychiatry programs. “Telepsychiatrists are most effective when they establish a rapport and team-approach with the onsite staff. The remote psychiatrists benefit from onsite staff sharing difficult-to-collect information like odor or agitation in the waiting room while the onsite staff benefits from having the expertise of a team of psychiatrists who they know and trust on-call.”

 6. Expand Psychiatric Capacities Within Hospitals and Beyond

Because telepsychiatrists are able to work from remote or home offices and don’t have to be in-person at the emergency department, it is much easier to staff difficult hours like weekends, nights and holidays.

Ultimately, establishing an ED telepsychiatry program can set up a health system to more effectively manage the psychiatric needs of an entire community or population. In addition to using telepsychiatrists within EDs, many systems are also expanding programs into other settings within the hospital and beyond.

“It’s important to design a telepsychiatry system with growth in mind from the beginning,” explains Dr. Varrell.

For example, hospitals are using telepsychiatry on their med/surg floors and on their inpatient units for weekend and overnight rounding.

Within communities, telepsychiatrists commonly serve community mental health centers, outpatient clinics, correctional facilities, primary care offices and other settings where it is difficult to staff and retain onsite physicians.

More creatively, newer direct-to-consumer models of telepsychiatry are gaining popularity as a convenient way to access services and follow-up care outside of a traditional setting and potentially from home or another private space. Some health systems and insurance companies are beginning to refer psychiatric patients leaving the hospital to in-home telehealth options that make them more likely to attend their follow up appointments and less likely to end back up in the hospital.

“Telepsychiatry can be challenging to implement because it’s a change and it requires the buy-in of many parties,” says Webb. “But ultimately, the return on investment is clear.”

Sources

[1] Schumacher Group. (2010) Emergency department challenges and trends. 2010 survey of hospital emergency department administrators.

[2,3] Nicks and Manthey. “The Impact of Psychiatric Patient Boarding in Emergency Departments.” Emergency Medical International. 2012.

[4] Orlando Health Telepsychiatry Data 2014-2015.

[5] Cuyler, Robert. Chester County Hospital Emergency Psychiatry Case Study, 2012.

 

Originally published in Telemedicine Magazine.

Telepsychiatry 101 | What Healthcare Organizations Need to Know

Telepsychiatry is a proven medium for increasing psychiatric capacity at single facilities and across entire systems. Through telemedicine, your organization can access psychiatric coverage without the recruiting, logistical and financial burdens that the onsite provision of those services would require. This white paper covers everything organizations implementing telebehavioral health need to know to make the most of this exciting development in health care service delivery.

Download this white paper.

Telepsychiatry Leader Predicts Major Industry Changes

Telepsychiatry, or psychiatric care provided through real-time videoconferencing, is a widely used medium for bringing psychiatric care into locations with limited access to mental health professionals. Telepsychiatry is allowing individuals to access behavioral health services like never before.

In this white paper, telebehavioral health leader James R. Varrell, M.D. details exciting developments he foresees for the telepsychiatry industry.

Download this white paper.

InSight Telepsychiatry Launches New Telepsychiatry Resource-Driven Campaign for ACOs, Health Systems and Hospital Systems

March 27, 2015 | InSight Telepsychiatry, the leading national telepsychiatry service providers have launched a new campaign aimed at helping health systems, hospital systems and ACOs utilize telepsychiatry best practices to expand their psychiatric capacity and increase access to care.

Marlton, NJ— InSight Telepsychiatry is launching a special campaign on telepsychiatry for large healthcare systems, large hospital systems and accountable care organizations (ACOs). Telepsychiatry, or the application of technology to field of psychiatry, can help healthcare organizations increase their psychiatric capacity and increase access to care.

InSight has been working with large health systems, hospital systems and ACOs for several years and has learned a number of lessons along the way that they apply to new programs. Their experience proves that connecting an entire system through telepsychiatry results in better outcomes, reduced costs and increased consumer engagement. The InSight team has compiled many of their best practices into the resources created for this campaign.

The campaign to connect healthcare organizations with viable, usable telepsychiatry-related resources includes a live webinar series and a white paper series as well as opportunities to meet and discuss an organization’s specific needs through easily competed registration on the InSight website.

Resources will offer insight into individualized telepsychiatry program design, improving ED throughput with on-demand assessments, evaluating direct and indirect cost benefits in different settings, overcoming regulatory and protocol barriers to new programs and engaging consumers to facilitate care across a community.

For large hospital systems, registration is now open for the live webinar, “Reducing Readmissions and Improving ED Throughput with Sustainable Telepsychiatry Strategies” on April 1st at 2PM EST. Interested parties can also download a copy of a white paper, request a meeting with a telepsychiatry expert or request a complimentary ROI audit for their organization.

For large health systems, registration is now open for the live webinar, “Reducing Readmissions, Improving ED Throughput and Expanding Behavioral Health Services Across a System Using Sustainable Telepsychiatry Strategies” on April 2nd at 2PM EST. Interested parties can also download a copy of a white paperrequest a meeting with a telepsychiatry expert or request a complimentary ROI audit for their organization.

For ACOs, registration is now open for the live webinar, “Improving Behavioral Health Services Across a System Using Sustainable Telepsychiatry Strategies” on April 3rd at 2PM EST. Interested parties can also download a copy of a white paper, request a meeting with a telepsychiatry expert or request and complimentary ROI audit for their organization.

InSight is the telepsychiatry arm of the CFG Health Network, a broad based healthcare provider dedicated to increasing access to care via innovative applications of technology. Its current leaders, Dr. Jim Varrell MD, Medical Director and Les Paschall, CEO established the CFG Health Network in 1997. CFG’s first model for telepsychiatry was developed with South Jersey Hospital of southern New Jersey in 1999.

InSight is now the leading national telepsychiatry provider company with a mission to increase access to behavioral health care. InSight is currently delivering services in 23 states and rapidly expanding into new states and settings across the country. InSight employs over 200 psychiatric prescribers who serve partner organizations throughout the nation and also runs Inpathy, an online network of behavioral health providers who conduct services entirely online.

Telepsychiatry Can Help Increase Access to Psychiatric Care in Rural Illinois

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February 11, 2015 | Jim Varrell, MD 

See this article on The InSight Bulletin.

Illinois, like many other states across the country, struggles to serve the psychiatric needs of its citizens because of a huge shortage of psychiatric prescribers, particularly in rural and underserved areas.

In addressing this issue, I challenge Illinois to consider innovative solutions like telemedicine to alleviate some of the problems associated low psychiatric capacity in rural area.

Telepsychiatry, or psychiatric care provided through real-time videoconferencing, is a widely used medium for bringing psychiatric care into locations with limited access to mental health professionals. It allows for a psychiatrist or other mental health professional to see, evaluate, diagnose and treat patients without having to be in the same physical space.

Telepsychiatry is an application of telemedicine, a rapidly growing industry that incorporates technology into healthcare delivery to enable remote assessment and treatment. Scores of clinical research have shown the effectiveness of telepsychiatry in nearly all settings and populations.

Telepsychiatry is a way to increase access to Illinois-licensed providers who may live across the country. It is also a way to better leverage the time of existing Illinois-based psychiatric prescribers who could seamlessly transition between appointments at different facilities without having to physically travel, as many of them now do.

Telepsychiatry providers could be used in several ways in Illinois:

  • In hospital emergency departments: By incorporating 24-hour on-demand telepsychiatry programs, hospitals could have timely access to psychiatric providers for commitment and treatment decisions. Experienced psychiatric nurse practitioners and psychiatrists consistently assess risk with a high degree of certainty and therefore can significantly reduce unnecessary admissions, which frees up beds for those who need them and sends home those who don’t. While telepsychiatry is not able to create hospital beds, it is an advantageous way to bring psychiatric care where it is not readily available.
  • In inpatient units or psychiatric hospitals: Illinois could use telepsychiatry within inpatient units or the two state psychiatric hospitals to increase their psychiatric capacity and more quickly and appropriately treat mentally ill patients.
  • In community-based facilities: Other settings can benefit from improved access to psychiatric providers including correctional facilities, outpatient facilities, schools, primary care offices, urgent care centers and FQHCs. By increasing the psychiatric capacity of community-based programs it is less likely for a person to reach psychiatric crisis that requires hospitalization.

I urge Illinois to consider this medium of care as they work to improve their psychiatric services in rural areas.

See this article on The InSight Bulletin.

Telepsychiatry: The New Frontier in Mental Health

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January 15, 2015 | By Kristen Crane
View this story on U.S. News and World Report.
How technology is helping ‘bring’ psychiatrists to people in underserved areas.

When Hind Benjelloun, a District of Columbia–based crisis psychiatrist with InSight Telepsychiatry, works an overnight shift, there’s never a dull moment. Even when the emergency room empties out, Benjelloun still has patients waiting for her on her computer screen. Whether they’re from the inner city or rural Virginia, they have to be seen remotely, and advances in technology have made it possible for them to get the help they need at all hours of the day.Picture4

Like telemedicine, telepsychiatry relies on technology to bring clinical medicine to patients, rather than the other way around. Patients typically videoconference with doctors using computers or videoconferencing equipment. Telepsychiatric services are growing, and the advantage is that such technology opens access to care, particularly for those in remote areas where there are fewer psychiatrists.

The disadvantage, Benjelloun says, is that the human touch is missing. “A caring touch or handing a patient a tissue can never be possible,” she says, adding that this can also lead to missed cues on her part. “I am unable to clearly see self-inflicted wounds or tears.”

But many experts agree that despite the challenges of delivering care remotely, the advantages of telepsychiatry far outweigh the disadvantages.

South Carolina Transforms Psychiatric Care

In South Carolina, a steady decline of hospital beds for psychiatric patients in the 1980s and ‘90s due to downsizing at hospitals led to waiting lists in the early 2000s, says Mark Binkley, general counsel at the South Carolina Department of Mental Health.

This hit the community hospitals particularly hard. “When somebody needs a hospital bed, they usually wind up in a hospital emergency room,” Binkley says. And if you don’t have a psychiatrist on staff, he adds, “the tendency for the small ER was to hold onto the patient.” This led to prolonged hospital stays, which became a drain on already strapped hospital budgets.

In 2006, the state’s new health director, John McGill, proposed a solution: technology. With funding from The Duke Endowment, one of the nation’s largest private foundations, he was able to “deploy” psychiatrists to people living in underserved, rural areas via the Internet. This enabled psychiatrists, many of whom were (and still are) clustered in the state’s capital, Charleston, to consult with patients in real-time, irrespective of location, Binkley adds.

The results of this pilot study have been promising. Since the program started in March of 2009, there have been 21,900 total consultations, an average of about 400 per month. While only available to those admitted to emergency departments, patients at participating hospitals have experienced shorter stays, yielding $1,400 in savings per episode of care, Binkley says. Furthermore, patients who came through the program are 200 percent more likely to show up for aftercare, he adds.

Telemedicine vs. Telepsychiatry

Although telepsychiatry has developed on the heels of telemedicine, which uses technology to do things such as take patients’ vital signs and send the results remotely, studies have shown that telepsychiatry might actually benefit psychiatric patients more. That’s because their propensity to use the ER may be greater, Binkley says, so helping them avoid that visit through remote care is particularly advantageous.

Also, psychiatric patients may be more willing to open up from the comfort of their home. “Very rarely do patients have a problem talking to a psychiatrist on a big video screen,” Binkley says.

Jim Varrell, a New Jersey–based psychiatrist and medical director of Insight Telepsychiatry, which provides telepsychiatry services to clinics and private users of telepsychiatry services, adds that patients with behavioral problems are more often compliant with remote consultations. “They do better in response to this service, as opposed to being in a room with one to two adults who are pointing out what’s wrong with them,” Varrell says. “They open up more through this medium.”

The profile of patients using telepsychiatry is wide-ranging and includes everyone from children to geriatric patients; English to foreign-language speakers; and people experiencing mild depression to those in the midst of a psychotic episode. “Ultimately people are absolutely able to do it,” Varrell says. “We haven’t had any group unable to do it.”

Sound quality can be more important than picture quality, he adds, especially in older patients with hearing problems. And while the major disadvantage of remote services is the absence of personal contact, which limits a psychiatrist’s ability to use all senses when evaluating the patient, the equipment (a computer and video camera) has a number of features that can help offset that limitation. For example, it can allow the camera to zoom in on the face to visualize the dilation of eyeballs and any tics, Binkley says. There are extensive security protocols for protecting patient privacy as well, Varrell adds.

Expanding Across the Country

While South Carolina is a leader in the nation’s adoption of telepsychiatry, thousands of programs have been launched in all 50 states, says Geoffrey Boyce, executive director of InSight Telepsychiatry. More than 1 million consultations are estimated to occur in the United States this year, he adds – many of which will be in underserved populations that extend beyond just rural pockets. “When you’re talking about the weekends and after hours, that’s where it can make a lot of sense in the urban areas,” he says.

“In a more rural area, nobody has access [to psychiatric care],” he says. Telepsychiatry is “enormously more affordable at that point,” Boyce says, since people who otherwise might have had to take a whole day off work to travel to see a doctor can now be seen in the comfort of their community hospital or home.

So far, California, Texas and Colorado have been the biggest adopters of telepsychiatry, apart from South Carolina. Regulatory and insurance reimbursement issues have held other states back from wide adoption of these services, Boyce says.

Many psychiatrists have begun to embrace the concept of serving patients remotely, Varrell says.

Several, like Benjelloun, find it gratifying to reach patients who were once out of reach. “[Telepsychiatry] allows for patients to be examined by a psychiatrist within an hour, as opposed to waiting for days in an emergency room,” she says.

View this story on U.S. News and World Report.

St. Anthony Hospital Expands Its Telemedicine Program With Telepsychiatry

June 19, 2014 | St. Anthony Hospital’s newly launched telepsychiatry program provides eight rural Oklahoma hospitals with needed access to a child and adolescent psychiatrist and aims to improve psychiatric services across the state. St. Anthony’s telepsychiatry program is an expansion of their existing telemedicine program, the largest in the state, which has been used for radiology, cardiology, endocrinology, and dermatology for the past 4 years.

Telepsychiatry Delivers Help to Far-flung Patients

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October 23, 2013 | By Kay Manning, Special to the Tribune
See the original article at the Chicago Tribune.

Practice is increasingly used to serve people in rural areas, the deaf and military veterans.

The 17-year-old girl had just been released from a Streamwood hospital after threatening suicide, psychiatrist Dan Martinez remembers.

 

He asked the girl to look her caseworker in the eye and promise that she would not harm herself.

 

She did, Martinez said. But watching her on a large-screen TV in Des Plaines as the teen spoke from a youth facility about 100 miles west of there, he was unconvinced. He asked her if she really meant it and when she hesitated, he tweaked the commitment — from open-ended to not hurting herself for a week, and if she had suicidal thoughts, to reach out to him, her parents or her caseworker.

 

“I told her, we’re not mind readers,” said Martinez, who was using telepsychiatry to treat youths sent to the facility in Nachusa, Ill., for substance abuse or behavioral issues.

Portrait of psychiatrist Dr. Daniel Martinez, who runs a telepsychiatry program to serve clients in rural areas and to help alleviate waiting lists, Wednesday, October 2, 2013 in Lombard. He is in his offices at Comprehensive Clinical Services. (Chuck Berman/Chicago Tribune) B583231690Z.1 ....OUTSIDE TRIBUNE CO.- NO MAGS, NO SALES, NO INTERNET, NO TV, CHICAGO OUT, NO DIGITAL MANIPULATION...

Portrait of psychiatrist Dr. Daniel Martinez, who runs a telepsychiatry program to serve clients in rural areas and to help alleviate waiting lists

Telepsychiatry, which connects patient and doctor through technology, is poised to expand in Illinois under legislation being negotiated to mandate its coverage by private insurers.

 

 

Used for years to treat military veterans, the deaf and patients in rural areas where

psychiatrists tend to be scarce, telepsychiatry is increasingly being considered for other underserved areas — including poorer parts of cities like Chicago — as a way to provide needed mental health services and reduce medical costs.

 

It’s also used in prisons, where the number of inmates with mental health issues is steadily growing. A recent report on Illinois’ youth prisons in response to a class-action lawsuit filed by the American Civil Liberties Union found the system to be violating the constitutional rights of youths by failing to provide adequate mental health care.

 

Insurance coverage of mental health issues, including substance abuse, has been spotty, but that changes under provisions of the Affordable Care Act taking effect next year. Insurance plans offered in the new marketplaces must have a core set of services and include behavioral health treatment, counseling and psychotherapy.

 

Studies by the U.S. Department of Veterans Affairs and others have shown telepsychiatry to be as effective as face-to-face treatment and sometimes more efficient in monitoring medications and symptoms because sessions are easier to schedule and involve other doctors, parents and caregivers.

 

Private companies and nonprofits — such as Lutheran Social Services of Illinois, which operates the Nachusa facility — offer telepsychiatry. So do psychiatrists in private practice and primary care physicians, who treat the majority of mental health patients.

 

Still, telepsychiatry has been held back, say proponents, because of the expense and security of videoconferencing equipment, licensing requirements and the lack of reimbursement for patients with private insurance. Legislation proposed in Congress in late September addresses one of those hurdles. It would allow the treatment of Medicare patients via telemedicine without doctors being required to have multiple state licenses, which has been a financial and administrative burden.

 

And in Illinois, the Illinois Psychiatric Society and Blue Cross Blue Shield have drafted a bill that would mandate the coverage of telepsychiatry by private insurers. Now, doctors treating Medicaid patients can be reimbursed, but patients who pay premiums can’t choose telepsychiatry and recover the cost, said Meryl Sosa, executive director of the society.

 

“So they get less care if they have private insurance,” she said.

 

Blue Cross Blue Shield, which has about half of the private insurance market in Illinois, sees the trend toward telemedicine, said Dana Popish, director of government affairs, and “because it affects our business, we wanted to be involved. When something new is coming out, we want to make sure it’s implemented properly.”

 

The shortage of psychiatrists is well known — with an estimated 70 percent of rural counties in the state lacking any — which leads to care by nonmental health specialists or no care at all. Lutheran Services stepped in to help at the Nachusa home because no psychiatrist could be found to visit there, Martinez said.

 

“I’ve worked in rural Illinois, and often patients get less quality care and are seen less frequently,” said Martinez, who operates Comprehensive Clinical Services, based in Lombard. “To ask individuals to travel one to two hours is impractical and unreasonable.”

 

Vets Got Support

 

Geography played a big role in why veterans decades ago were offered telemedicine, which includes counseling by psychologists or social workers. The VA recognized that specialists in substance abuse and post-traumatic stress disorder tended to be at facilities in metropolitan areas while many patients sought help at smaller clinics.

 

“Telemental health services have revolutionized mental health care delivery in the U.S. Department of Veterans Affairs by expanding access to services through use of remote videoconferencing,” said a 2012 article in a psychiatric journal outlining results of a study of almost 100,000 veterans using telemedicine from 2006 to 2010.

 

The study found that psychiatric admissions to hospitals decreased by an average of 24.2 percent among patients six months after beginning remote videoconferencing compared with the six months before. In addition, the days of hospitalization dropped by an average of 26.6 percent for those who had to be admitted. The study’s authors suggested more detailed study of the cost savings and outcomes of telemedicine patients compared with those getting face-to-face care.

 

Quality and frequency of care have long been reasons why telepsychiatry is effective for the deaf and hard of hearing, said Lisa Foster, a clinical therapist at Advocate Illinois Masonic Medical Center’s behavioral health services department.

 

“Use of a videophone has really given us an option to continue to provide services to the deaf and hard of hearing who truly need mental health and psychiatric medication services, but cannot secure transportation or find services closer to home,” Foster, who is hard of hearing, wrote in an email.

 

Clients for the center’s deaf and hard of hearing program, for which she works, are in Chicago and the suburbs.

 

While the psychiatrist in the program does not use American Sign Language, a licensed ASL interpreter sits in on sessions. There are too few such interpreters, she said, and if they had to travel throughout the region for appointments, fewer people could be seen.

 

With “deafness an invisible disability that is often overlooked,” Foster said, it’s important that therapists be sensitive to issues particular to the deaf, something generally not possible in offices or facilities serving few deaf patients. Concentrating services and specialists in one place and connecting them to patients via technology is very efficient, she said.

 

Telepsychiatry takes some getting used to, said Martinez and Olivia Boyce, marketing coordinator for InSight Telepsychiatry LLC, a New Jersey-based private provider.

 

“We offer training on how virtual encounters are slightly different,” Boyce said. Doctors have to look into the camera and learn to compensate for not having the ability to see — or smell — details such as whether the patient has poor hygiene. “But we’ve found it’s as effective as face to face,” Boyce said. “Children, in particular, are very receptive; they use technology for everything.”

 

Martinez said he’s learned to pay more attention because this “”is a setting where one needs to be glued to the TV.”

 

He’s mastered the controls to allow him to observe a patient from closer up than if he maintained typical personal space in a room.

 

“This is never ideal and should never substitute for face to face,” he said. “But I’ve come to feel very comfortable and in some ways better,” because he has more information — from a nurse, case manager or parent, if the patient is a child or adolescent.

 

“I have never felt like the patient or family had qualms about inadequacy of the service,” he said.

 

Martinez believes the system he uses to communicate is secure. Yet he is dissuaded from using telepsychiatry in his private practice, where he supervises 10 psychiatrists, because of the cost of the equipment and the measures needed to ensure security.

 

He and others do see telepsychiatry evolving, especially in underserved urban settings and in hospital emergency departments where mental health patients either have to wait hours for an evaluation or are admitted without one because of uncertainty over their condition. In an era of cost containment, quicker and more precise evaluations make sense, Martinez said.

 

InSight Telepsychiatry was hired earlier this year to provide consultations 24/7 for patients in the emergency departments of hospitals in two Illinois cities — Galena and Freeport — as part of a pilot program funded by a grant channeled through the Metropolitan Chicago Healthcare Council.

 

And, according to Boyce, MCHC and InSight recently have developed a “telepsychiatry solution to support the substantial demand for services at Chicago-area hospitals.”

 

School Had Help

 

Advocate Illinois Masonic provided telepsychiatry services to Ames Middle School in Chicago’s Logan Square neighborhood for about three years until the spring, when grant funds ran out. The need was great, said Odalinda Avila, who was a counselor with Illinois Masonic at the school for five years.

 

“There were a lot of issues in these families that were struggling with limited finances,” Avila said, with students suffering attention deficit hyperactivity disorder, depression, dysfunction and the inability to handle certain situations.

 

Up to 20 percent of children and adolescents in the U.S. are said to suffer from significant mental health disorders and it’s estimated only 1 in 5 is receiving treatment, experts say.

 

A psychiatrist was brought in when the problems of an Ames student were affecting school and interrupting sleep, Avila said. If medication was advised to stabilize the situation, a parent had to be involved, but often that didn’t happen, causing treatment to be truncated.

 

“There was a lot of frustration on my part, the school’s part and the child’s part,” Avila said. “There was a real need to reach out to parents and educate them. Some were just not involved, and in some Latino families, there were myths and stereotypes on what it means to take medication.”

 

Denise Shaeffer, a clinical psychologist and coordinator of outpatient services for Illinois Masonic’s behavioral health services, said telepsychiatry at the school’s medical clinic seemed like a good answer, but in the end it was underused.

 

“Of those who used it, they overwhelmingly loved it,” Shaeffer said, but too few parents of students referred for the services followed through and there was no care in the summer.

 

Carroll Cradock, a psychologist and telemedicine consultant in Chicago, was involved early on with trying to bring telemedicine to school-based clinics.

 

“The need is growing in urban areas,” she said, because of language barriers, transportation issues and the very real fact that some children find it dangerous to cross gang boundaries to try and reach a mental health clinic. “Some kids will use school-based services because they don’t have to go somewhere else,” she said. “They think of the school clinic as their medical home.”

 

Telemedicine also helps adult patients in urban areas, she said, by integrating mental health care with medical care. She cited a new mother who may have post-delivery physical issues and postpartum depression. Her care for both can be coordinated via technology.

 

Dr. James Varrell, medical director of InSight Telepsychiatry, has been using the technology for almost 15 years and also knows the possibilities.

 

“The increased access to care from telepsychiatry makes it easier to address behavioral health concerns before they reach a level of crisis or tragedy,: he said in an email. “Telepsychiatry may seem like an innovative model of care today, but in a few years, it will be commonplace.”

 

 

See the original article at the Chicago Tribune.

North Point Behavioral Health Introduces Telepsychiatry Program To Enhance Mental Health Care In St. Clairsville and Bethesda, Ohio

June 26, 2012 | Bethesda, Ohio – North Point Behavioral Health has always been committed to providing comprehensive mental health care that improves quality of life and reduces the effects of mental illness, addiction and trauma on community members.

At the beginning of the July, North Point will launch a new telepsychiatry program that will further enhance their behavioral health services.

The Delaware Rural Health Initative (DRHI) Annual Conference Emphasized Telemedicine As a Tool for Increasing and Improving Behavioral Healthcare

June 1, 2012 | Over 140 people attended the annual conference entitled “Continuing the Journey Towards Access & Excellence in the Southern Delaware Mental Health System.” Medical, governmental, educational, and business leaders updated attendees on innovations in relevant Delaware healthcare realms. The conference served as the forum for Secretary of the Department of Health and Social Services Rita Landgraf to officially announce that Delaware will begin to reimburse for telemedicine starting July 1. In the spirit of this announcement, many of the presentations, including one from leaders at InSight Telepsychiatry, stressed technology as a tool for improving rural health care.

 

Adolescents Respond Positively to Behavioral Healthcare Delivered through Televideo Equipment

May 22, 2012 |

Three months ago, the Developmental Adolescent Residential Treatment Program (DART) at Hope Network began beaming in a remote psychiatrist to do intake evaluations and follow up medication management for their young residents. Both staff and consumers are pleased with the level of care provided via telepsychiatry from InSight Telepsychiatry; Young people find safety and amusement in seeing psychiatrists on a television screen rather than in person, while staff enjoys the efficient and consistent physician telepresence.

Other Telebehavioral Health Services

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In addition to psychiatry, InSight can offer all other levels of behavioral health services through telehealth. InSight has a large network of behavioral health providers including counselors, therapists, social workers and psychologists who we work with to service the comprehensive behavioral health needs of any organization or individual, all through telehealth. With InSight’s Inpathy division, individuals can directly access these professionals from the comfort and convenience of their own homes or other private spaces. Insurance companies, employers and EAPs can also partner with InSight to offer Inpathy behavioral health services to members or employees.

 

 

Telepsychiatry for Primary Care Centers


primary care telepsychiatry
InSight provides telepsychiatry services to primary care centers, outpatient offices and a variety of other settings across the nation. Primary care offices can utilize telepsychiatry or telebehavioral health providers for consults, treatment team meetings, regularly scheduled co-located behavioral health appointments and more. 

 

Scheduled Telepsychiatry Positions

scheduled telepsychiatry

InSight’s scheduled telepsychiatrists work regularly scheduled hours and build lasting relationships with a consistent patient base. Scheduled telepsychiatrists work with diverse consumers who often would not receive psychiatric care without telepsychiatry. Scheduled telepsychiatrists work with onsite professionals to fully integrate behavioral health into the larger system of care of the facility and the community. InSight is hiring psychiatrists and psychiatric nurse practitioners for scheduled telepsychiatry positions in multiple states.
Scheduled Telepsychiatrist Job Description

To start the process, read through our InSight Employment FAQ, then Connect with us!