“TELEPSYCHIATRY” BRINGS TREAMENT TO RURAL AREAS 

Volume 29, Issue 528                                                        November 24, 2008

Robin Richardson

States are increasingly having to develop creative solutions in order to address shortages in the health care workforce, and the mental health field is no exception. Due to the increasing availability of and decreasing costs of technology, the use of telemedicine is becoming a popular option for many states.

About a year ago, New Mexico joined the growing number of states that are using Medicaid and other programs to bring “telepsychiatry” to residents in underserved areas. As a form of telemedicine, telepsychiatry links psychiatrists and other mental health providers to patients via video, computer or phone. Patients may be in their home, a doctor’s office, or a community health center or school.

The effort grew out of a series of town hall meetings that state officials held last year on the subject of health care. “The need for more health-care providers, especially specialists, was a common theme during the public meetings,” said Human Services Department Secretary Pamela Hyde. So the state added telemedicine—including telepsychiatry—to its list of Medicaid-covered services. “Now Medicaid will pay for services via telehealth the same as if they were face-to-face services,” Hyde said.

Many rural areas lack specialists, but the supply of mental health specialists can be especially low. New Mexico has the fifth-highest suicide rate in the nation, according to the National Association for Mental Illness. And compared to other Mountain States, New Mexico has the highest percentage of uninsured citizens below the federal poverty line. "They (rural residents) have a difficult time bringing in any type of doctors, especially psychiatrists," said New Mexico Senator Carroll Leavell.

In these difficult economic times, many state legislators are anticipating the need to cut costs during their 2009 sessions. But because of its considerable potential for cost savings, telepsychiatry (and telemedicine in general) may be one of the few line items that escape the hatchet. The cost of the technology is dropping, and research shows that telepsychiatry can be not only effective but cost-effective as well.

A New Frontier
Telepsychiatry may be particularly useful in the 26 states that have frontier populations, which are areas with less than 7 persons/square mile. According to Illinois Representative Patricia Bellock, telepsychiatry "provides a fantastic opportunity for those residing in rural areas."

Some providers prefer that initial consultations and diagnoses be done face-to-face, but in an effort to save time and money, follow-up sessions (including medication management) are often performed through video-conferencing or over the phone.

Many telepsychiatry programs across the United States are created by medical schools. Advanced educational programs utilize the convenience of technology to enable faculty to oversee students' training. Students can also use telepsychiatry to gain the hours needed for licensure.

Funding Varies
States are using a variety of sources to pay for telepsychiatry. Some require private insurers to provide coverage for treatment, and more than half of all states include telepsychiatry in their Medicaid services. Revenues from cigarette taxes or lotteries are also used by states to fund telepsychiatry programs.

During the 2007-08 session, Illinois adopted S.B. 6, which requires the state's Department of Healthcare and Family Services to reimburse psychiatrists and federally qualified health centers for telepsychiatry services. Legislation co-sponsor Representative Bellock said not having access to mental health services is "the number one issue in rural health care."

Some states are providing funding to create new or expand existing telepsychiatry programs. In North Carolina, H.B. 2436 appropriates $1.65 million to pay for telepsychiatry equipment to be used by the Department of Health and Human Services.

Hawaii’s H.B. 202 of its most recent session would have expanded the University of Hawaii's existing telepsychiatry project in order to increase the number of telepsychiatry providers. Although H.B. 202 was not enacted, bill sponsor Senator Josh Green plans to introduce a comprehensive mental health bill during the upcoming session. He said he’s "looking for creative ways to get people care."

Especially Helpful for Children
Even if mental health professionals were available in every neighborhood, telepsychiatry could still improve quality of care, advocates say. Children, for example, have particular mental health needs and an increasing number of child psychiatrists (who, nationally, are in extremely short supply) use telepsychiatry to address those needs.

Dr. Avron Kriechman, a child psychiatrist at the University of New Mexico, advocates using telemedicine to connect mental health providers not only to patients, but also to parents, educators, school counselors and social workers. Kriechman develops "systemic plans" to monitor children’s medication, work with parents and communicate with the pediatrician to gain a full perspective of a child's health.

The most important factor in using telepsychiatry with children is that "families feel comfortable," says Dr. Daniel Alicata from the Department of Psychiatry at the University of Hawaii. He finds that although parents may be hesitant at first, "children are quite adaptable" and generally comfortable with the use of technology as part of their treatment.

Homeless shelters and prisons are additional examples of places where telepsychiatry is being used. Regions with dense immigrant populations are promoting the use of telepsychiatry to connect non-English speakers with mental health services. In times of natural disasters, telepsychiatry also can be used to provide victims with care.