Tag Archives: veterans

Veteran Access to Mental Health Expands Under Telepsychiatry

By Geoffrey Boyce. Originally published on Managed Healthcare Executivegeoffrey boyce

A concerning gap exists between veterans who need behavioral health services and those who actually receive them. Notably, a congressionally-mandated study found that nearly half of all post-9/11 veterans with mental health conditions remain untreated today.

It’s one of many research-backed statistics that point to growing and unmet behavioral health needs within the veteran population. Although quality care exists, the reality is that veterans are often unable to access services or do not seek them out. The congressional study uncovered numerous challenges that contribute to this current state of affairs, including stigma, self-shame, lack of understanding about treatment options, long wait times and logistical problems, such as transportation.

In response, the U.S. government is investing notable resources into programs aimed at improving this outlook. Evidence shows the positive impact of telepsychiatry models as an effective and preferred solution for closing care gaps and improving veteran utilization of services. In fact, one study of over 98,000 users suggested that telehealth has “revolutionized mental healthcare delivery” within the VA and improved mental health outcomes by close to 25%.

Telepsychiatry: improving access and outcomes

More than 700,000 veterans accessed care via telehealth in 2017, expanding adoption of this delivery model and underscoring both its effectiveness and necessity in addressing common barriers to care.

Telepsychiatry has been proven successful for treating post-traumatic stress disorder (PTSD)—the most prevalent mental health diagnosis among veterans, impacting nearly 20%. A recent study published in Behaviour Research and Therapy found that PTSD treatment delivered via in-home telehealth has the same level of effectiveness as in-person therapy.

In addition, a 2015 clinical trial found that telehealth-based collaborative care can successfully engage veteran populations in even the most extreme circumstances. Rural veterans who comprised the study sample were characterized as resistant to treatment and having high levels of PTSD severity, numerous comorbidities and poor health-related quality of life. Those who received telehealth services had significantly larger decreases in Posttraumatic Diagnostic Scale scores than those receiving care via traditional approaches.

Depression is another prevalent condition in veterans where telehealth has shown notable promise as an effective treatment alternative—and one potential solution for decreasing suicide risk rates that currently surpasses civilian rates by 22%. Across elderly veteran populations in particular, one studyfound that outcomes and patient satisfaction were equal to that of in-person care with the convenience factor of telehealth being the differentiator. The lead author of the study said telehealth “is a highly relevant option to address the needs of rural patients or those living in remote locations, while providing patient satisfaction and quality of life similar to that provided by in-person treatment delivered at clinics.”

Telepsychiatry empowers veterans and their caregivers to seek out convenient ways of receiving care for these and other common conditions—such as substance use and traumatic brain injury—and addresses many existing challenges. With direct-to-consumer models of telepsychiatry, veterans and behavioral health providers are able to connect across geographies and outside the confines of traditional office hours via videoconferencing sessions, allowing patients to stay in the safety net of home or other private locations. This framework promotes trust and a greater willingness to open up, as well as provides telepsychiatry providers with greater visibility and insights into an individual’s home environment and living conditions.

Telehealth-friendly policies: an evolving dynamic

There is good news for today’s veterans as the VA prioritized the improvement of veterans’ overall wellness as one of its top goals through 2020—behavioral health being a key part of that strategy. In 2017, VA telehealth options were significantly expanded as the U.S. government continues to acknowledge the importance of these resources.

The expansion—made possible through the Veterans E-Health and Telemedicine Support (VETS) Act of 2017—authorized VA providers using telehealth technologies to serve veterans from any location in the U.S. Previously, telehealth services could only be delivered by providers in a VA facility, limiting provider choice and access, especially in rural areas where resources are limited. This new “Anywhere to Anywhere VA Health Care” initiative empowers the VA to bring more telepsychiatry providers into the network. Those telepsychiatry providers can then be connected with veterans living in remote areas that lack sufficient provider services. The act also enabled the expansion of the VA Community Care, which allows veterans access to care options outside of a VA facility, meaning that veterans can access care from a non-VA clinic in their community that uses telepsychiatry, or access telepsychiatry from a telepsychiatry provider directly from home.

Outside of existing telehealth programs, these developments allow the VA to offer expanded care options for veterans. Forward-thinking Veterans Integrated Service Networks are exploring such opportunities by working with telepsychiatry providers outside of the VA system to expand their network of available providers.

For today’s veterans, this continued push to expanded telepsychiatry networks and access is a positive step towards better behavioral health.

 

Geoffrey Boyce is the chief executive officer of InSight Telepsychiatry, a national telepsychiatry organization with a mission to transform access to care.

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.

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.