Tag Archives: Dr. Varrell

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.

InSight Telepsychiatry Expert Presents Grand Rounds at Deborah Heart and Lung Center

BROWNS MILLS, NJ – Dr. Jim Varrell, InSight’s Medical Director spoke at the Deborah Heart and Lung Center in Brown Mills, NJ during grand rounds. Dr. Varrell gave a presentation on applications of telepsychiatry in hospital settings to an audience of doctors, residents and other behavioral health professionals.

Deborah Heart and Lung Center is a specialty hospital that sees heart and lung patients and has no emergency department. Deborah Heart and Lung Center is also a partner of InSight, where they utilize telepsychiatry on their medical floors.

Dr. Varrell’s presentation gave an in-depth outline of telepsychiatry, which included topics such as:

  • Overview of telepsychiatry
  • Telepsychiatry use in hospitals
  • How to set up a telepsychiatry program
  • Technological setup
  • Clinical workflow
  • Telepsychiatry regulations
  • Clinical best practices and case studies

“Our work at InSight has given us access to all the ins and outs of delivering behavioral healthcare via telemedicine,” said Dr. Varrell. “It is an honor to impart the knowledge we’ve gained from years of experience in the field, to a new generation of healthcare professionals.”

Dr. Varrell and other InSight leadership often present during grand rounds to educate medical professionals on the importance and best practices of telemedicine and its ability to increase access to quality care.

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 Deborah Heart and Lung Center

The Deborah Vision means continuing to be the premier provider of cardiovascular and pulmonary services in the region. We will be known for excellent clinical outcomes and for supreme customer-driven service, and as the ultimate leader in patient safety and privacy. We will continue to partner with other quality providers and payers to ensure a seamless continuum of care to the patients we serve. We will continue to improve both service and quality in the most cost effective manners. This is our uncompromising standard of care.

The Psychiatrist Shortage in Virginia

By James Varrell, MD


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.

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 Selected as Industry Partner of Washington Hospital Services

February 3, 2016 | Olympia, WA — Washington Hospital Services (WHS) has recently partnered with InSight Telepsychiatry, the leading national telepsychiatry service provider organization. Washington Hospital Services exists to support hospitals and health systems through the delivery of services and products that support organization’s operations. WHS is a subsidiary of the Washington State Hospital Association and aims to help members achieve their missions and improve the health of communities across the state and region.

InSight is the leading national telepsychiatry service provider organization with over 17 years of industry experience and background implementing telepsychiatry programs across the spectrum of care. InSight also recently launched a branch of the organization dedicated to allowing consumers to select and connect with a mental health provider of their choice entirely from home, called Inpathy.

Telepsychiatry has been proven an effective and cost-conscious way to bring psychiatrists, especially those with specialties like child and adolescent, into areas where there may be a shortage. With telepsychiatry, organizations can access psychiatrists even during difficult to staff hours like nights and weekends.

WHS and InSight view telepsychiatry as a potential solution for many of Washington State’s recent struggles with high youth suicide rates and high instances of psychiatric boarding.

InSight went through a significant vetting process before being selected as a WHS Industry Partner. InSight is offering excellent pricing for WHS members and also exploring opportunities to create unique consortiums so that remote hospitals and other clinics can leverage their buying power and increase access to psychiatrists across multiple Washington locations.

“We are excited by this partnership’s ability to bring care to Washington communities that have been struggling with psychiatric boarding and inadequate psychiatric support,” 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 about an hour on average. Other locations like clinics, primary care offices or even individuals homes, can also benefit from our scheduled telepsychiatry services since so many communities have a shortage of local psychiatrists. With telepsychiatry psychiatrists can offer care to anyone, anywhere as long as there is adequate internet connectivity.”

As part of the partnership, InSight will host several webinars exclusively for WHS members, covering topics like clinical best practices for telepsychiatry, implementing successful telepsychiatry programs and understanding telepsychiatry-related regulatory and policy updates. Telepsychiatry is a hot topic across the country right now and members of the InSight team regularly speak on similar topics at the American Academy of Child and Adolescent Psychiatry, the American Telemedicine Association, NAMI and other annual conferences.

InSight and WHS will also share telepsychiatry-related resources including white papers and articles with WHS members.

“InSight offers a unique product that helps solve the complex issue of providing access to psychiatric care in a cost effective manner,” said Tom Evert, President of WHS. “We are pleased to bring Washington Hospitals a potential solution to increase access to psychiatric specialists through this partnership.”

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.