Last month at a family support group, I met the father of a young woman with bipolar disorder who was about to move back home. He and his wife were concerned about the move, understandably torn between the impulse to take care of a daughter with a serious health condition and the desire to see her flourish independently. One strong consideration in favor of the move back home was the unavailability of adequate mental health care in the community where the daughter lived in rural New England. Had she stayed where she was, she would have faced a twelve-month wait for a psychiatrist and almost as long to get into a clinic.
On December 14, 2016, President Obama signed a bill that may help relieve the problem of this and many other families across the country. The Expanding Capacity for Health Outcomes Act (ECHO) authorizes the Department of Health and Human Services to study electronic telecommunication models that might be used to “to improve patient care and provider education.” Commonly referred to as “telehealth” or “telemedicine,” these models use electronic communication such as videoconferencing, patient portals, and remote-access technology to diagnose, monitor and care for patients at remote locations.
People with mental health disorders are one of the groups most likely to benefit from advances in telemedicine. That’s because telemedicine is especially effective at reaching marginalized and underserved populations. In the field of mental health, there is a growing body of evidence that telepsychiatry, the provision of clinical mental health services via electronic communications, is effective in maintaining quality of care across populations. On a personal level, I have witnessed the benefits of telemedicine for a loved one in college who continues to receive therapy and other forms of support from the convenience of a dorm room.
For some people with mental health needs, telemedicine may be the only option. More than half of adults with a mental health problem did not receive any care or treatment last year. Vulnerable populations such as homeless veterans, children living in poverty, people with mobility issues, prisoners and those who live in rural areas are especially at risk of not receiving the help they need. Nearly 100 million Americans live in areas with a shortage of mental health professionals. Many of the best providers in specialties such as psychiatry are concentrated in the most populated regions of the country. People with mental health problems also face social barriers to care, such as fear of being seen entering a public mental health facility. Telepsychiatry can overcome many of the barriers faced by these and other groups.
Telemedicine has its drawbacks, as does any widescale public health initiative. Providers and patients alike worry that telemedicine lacks a personal touch. However, a younger generation comfortable interacting with others through their electronic devices may not have the same concerns.
For homebound, physically immobilized, incarcerated or rural patients, there may be no alternative. Capacity and accessibility of the technology, as well as protection of patient confidentiality are valid concerns addressed by the new legislation.
In 2014, the market for telemedicine technologies, including hardware, software and services, was assessed at $17.8 billion. With the passage of the ECHO Act last month, 2017 is set to be the year that telepsychiatry goes mainstream. In keeping with the spirit of a New Year, here are my predictions of how this legislation and recent advances in telecommunications will change mental health care as we know it.
- Rural patients will be able to stay in their local communities without having to travel long distances for services.
- People with physical disabilities, mobility issues or fear of public spaces will be able to access care in their environments of choice.
- Access to mental health care for veterans will improve, as they will no longer have to travel long distances to VA medical facilities, many of which lack adequate mental health resources.
- Young people will be able to maintain continuity of treatment when they go away to college.
- Inmates in jails and prisons, more than half of whom have serious mental health symptoms, will receive greatly improved access to care.
- Supported education programs will expand their offerings and be able to assist more students in 4-year colleges and universities.
- Working people with mental health issues and their caregivers will miss less time at work due to decreased transportation and waiting time.
- New best practices that utilize electronic media will emerge for the treatment and support of people with mental health disorders.
- Mental health providers will develop electronic resources, such as workbooks and enhanced recovery plans that can be accessed online and shared among patients, clinicians, and caregivers as appropriate.
- Peer support and self-help networks will flourish over wide geographic areas.
- General practitioners, school nurses, and other non-specialists will have expanded opportunities to consult with expert clinicians on behalf of their patients with complex needs.
- People in crisis and their families will be able to consult telemobile crisis teams for emergency assessments, avoiding overcrowded emergency departments staffed by non-specialist personnel and averting potentially harmful confrontations with law enforcement.
The echo effect is a term used in media to describe a situation in which information is amplified and reinforced by repetition within a defined system, much like an echo chamber. While telemedicine technologies are far from perfect, the new ECHO Act will hopefully have an echo effect that amplifies and reinforces communication among patients, providers, and caregivers in a way that changes mental health systems for the better.
—Jay is Vice President of Laurel House, Inc., 501 (c)(3), and Editor in Chief of www.rtor.org, a mental health website for families and free service of Laurel House. He writes about his family experience of bipolar and other mental health disorders in his blog The Family Side
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Jay Boll, LMSW