Tag Archives: American Psychiatric Association

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

Telepsychiatry: Raising the Bar on Access to Mental Health Care

By Dr. James Varrell, Telepsychiatrist and Medical Director of InSight

As May—Mental Health Awareness Month—rolls around each year, health care stakeholders are reminded to reflect on the notable achievements and strides made in mental health treatment. The industry continues to forge new paths in terms of technological advancement, research, discovery and awareness, leading to a more holistic approach to care delivery and improved health outcomes across U.S. communities.

In terms of improving access to care, one advancement in particular carries significant weight for expanding care options and lowering costs for patients, providers and communities: telepsychiatry. Telepsychiatry is a form of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation and treatment. A growing segment of telepsychiatry is direct-to-consumer care, which is working to tear down stigma-related barriers to treatment and open doors to expanded referral options and more timely care. In fact, industry stakeholders increasingly recognize direct-to-consumer telepsychiatry as a primary solution for filling mental health care gaps at a time when the need is soaring.

In tandem with the goals of value-based care, today’s patients and providers are no longer willing to settle for limited mental health treatment choices within their community. Similarly, communities should no longer view the long waits traditionally associated with accessing psychiatric care as acceptable, especially when telepsychiatry lays the foundation for more optimal, timely care delivery.

Recognizing the Need for Greater Access

Today’s mental health landscape is characterized by an increased need for services coupled with a dwindling supply of psychiatrists. The reality is that 42.5 million Americans struggle with mental health conditions including stress, depression, anxiety, relationship problems, grief, mood disorders and other psychological concerns. Unfortunately, accessing effective treatment is not easily attainable given the following statistics:

  • More than 55 percent of U.S. counties are currently without any psychiatrists.
  • The mental health landscape is facing shortages in more than 4,600 areas.

In addition, referrals to community-based psychiatrists often have an average 3-6 month wait time—a fact that is especially true for specialty psychiatrists, such as those who have expertise in complex child conditions. To put this need into perspective, the number of child and adolescent psychiatrists in New Jersey would need to triple to adequately support the need in that state alone.

Primary care doctors are often sought out as a resource for filling these service gaps created by growing demand. Yet, many may be uncomfortable prescribing medication for mental health disorders or lack specific expertise on psychotropic medications.

Consider the following scenario:

A 53-year-old female has a history of refractory depression and has tried numerous antidepressant options through her primary care doctor, who is at a loss as to the correct formula for the patient’s needs. The patient’s history reveals that she has had discrete hypomanic episodes, characterized by sudden displays of energy, productivity and noticeably more creativity. These 1-2 week episodes were followed by a decline back to her usual depression. Looking for a second opinion regarding her care, her primary care doctor referred the patient to a telepsychiatrist.

When the telepsychiatrist reviewed her symptoms he made the conclusion that the patient has type two bipolar disorder and needed an appropriate medication regiment.

Fortunately, in this example, the patient suffering from type two bipolar disorder accessed the needed psychiatry expertise in a timely manner by using direct-to-consumer telepsychiatry. After an accurate diagnosis and subsequent follow-up visits with the telepsychiatrist, the patient’s medications were further adjusted, resulting in effective management of the disorder and a satisfied patient.

The Telepsychiatry Advantage

Direct-to-consumer telepsychiatry introduces notable opportunities to improve access to care. Through live, interactive communication with a licensed psychiatrist in a private setting of the patient’s choice, this treatment model diminishes many of the existing challenges to reaching patients in need.

For instance, patients who live in remote areas where mental health services are lacking have access to psychiatry expertise within a few days rather than several weeks or months. Also, stigma becomes less of an issue as patients are able to experience more privacy, and care is more conveniently accessed in the home or a private location.

Appointment scheduling options outside of traditional office hours address the roadblocks of busy lifestyles that are often a deterrent to consistent follow-up and treatment. In tandem, mental health providers can see more patients with this increased flexibility. Direct-to-consumer telepsychiatry can also support greater continuity of care. For instance, some patient populations, like teens and college students, are more willing to continue treatment if a relationship is maintained with the same psychiatric provider during life transitions like moving to a new city for college.

Telepsychiatry is 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. Along with the majority of medical associations, 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. For these reasons, telepsychiatry is increasingly becoming reimbursable by a number of insurance plans.

Forward Looking

Going forward, the industry must embrace the promise of direct-to-consumer telepsychiatry as a critical strategic component to improving access to care. Telepsychiatry is a viable option and an alternative to traditional in-person care for mental health issues that has the potential to better serve communities and improve population health.

Original story published in HIT Leaders & News.

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.

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.

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.