Telemedicine and Rural Mental Health Services

Many rural areas lack access to mental health services, which may inadvertently exclude clients from care. Alternatives to traditional in-person therapy are needed. The utilization of telehealth, or secure video visits, seems an obvious step to increase available rural mental health services.

Virtual mental health treatment, often referred to as "telemental health" or "telepsychiatry," can help overcome obstacles to treatment, increase access to providers, and offer additional benefits for rural practices. To learn more, check out the webinar: How Telehealth Helps Improve Care Delivery and Increase Revenue.  

Telemental Health in Rural Kansas

Shawna Wright Ph.D., LP is a clinical psychologist in rural Kansas. Her desire to discover opportunities for career advancement and accessible training while remaining in the area she loved led her to telepsychology. Her private telepsychology practice, Wright Psychological Services, enables her to treat a diverse range of clientele, with the majority in skilled nursing facilities.

Dr. Wright’s telepsychology services are well received. Age is not a factor as far as a client’s willingness to embrace the use of telepsychology. One of Dr. Wright’s geriatric clients stated:

“You’re here. I don’t care that you’re on television. No one else is here to support me.” 

Education to staff and clients are key components to the successful adoption of her practice. Once everyone understands how it work, the presence of the technology fades away. In fact, Dr. Wright recounted an instance when she sneezed during a telehealth visit, and her client responded with, “You sneezed. I can’t be around you or anyone that is sick.” He had forgotten they were talking virtually.

Telepsychiatry in Rural Pennsylvania

In order to meet the mental health needs in rural Pennsylvania, The Community Guidance Center, a private, non-profit, outpatient mental health clinic, had to innovate.

“The average number of psychiatrists has flatlined with only 4% going into psychiatric residency and about 50% retiring in about five years, so there's really no choice.” —Dr. Ralph May, the Clinical Psychologist at The Community Guidance Center, on the topic of innovating.

The Community Guidance Center has used telepsychiatry for 10 years. Psychiatrists began performing client evaluations in local schools in pilot programs in 2007. The use of it expanded into their mental health clinics because there were not enough physical psychiatrists to see consumers.

It’s well received by children in the school system and consumers at the clinic, and has proved to be an effective equivalent of a face-to-face visit. For the last two years, the clients of The Community Guidance Center have predominantly received telepsychiatry from their psychiatrists in Texas and New York, with certain insurances being the only exception.

Dr. Ralph May added that “without telepsychiatry consumers would not have access to the service that they need.”

Getting Started in Telehealth

Janine Gracy is the Project Director at Heartland Telehealth Resource Center (HTRC) in Kansas. This is one of several federally funded projects that provides technical assistance and resources to organizations interested in beginning telehealth.

“Patients are demanding telehealth more than providers are providing it.” —Janine Gracy

Gracy, who assesses the technology readiness of organizations and individuals as they prepare to implement, recommends that practices consider the following questions before making the decision to do so:

1. Do you have appropriate equipment?
2. Is telehealth a good fit for your practice?  
3. Is there a need in your area to help ensure reimbursement?

Gracy usually finds it’s smooth sailing once the provider is comfortable with televideo, although she does recommend mastering only one line of service at a time. After the success of the first service line, they can consider expanding telehealth offerings with a better idea of what to expect.

“To me it’s not an either/or, it’s an and/or and it’s certainly something that client’s love. It is still medicine. It is still healthcare. It’s just a different delivery method,” says Gracy.

Tips for Implementing Telemental Health in Your Practice

Telemental health is becoming a patient driven business with a large consumer demand, but in order to expand your client’s access to mental health care with telemental health it’s important to first consider:

• Reimbursement - Address the biggest hurdle first to ensure your practice, and your clients, meet reimbursement criteria.
• Staff support - A crucial barrier to overcome in telehealth adoption is support from the staff utilizing it.
• Adequate space and staffing - A room with space, privacy and few distractions is necessary. A telepresenter will remain accessible to manage the equipment, identify the patient and start the appointment.
• Best practices - Review the latest research, understand state laws and regulations, and follow best practices to develop appropriate protocol.
• Including quality improvement - Survey staff and clients on their likes, concerns, and suggestions for improvement.
• Your backup plan - Training is key to reducing feeling helpless while providing remote therapy. Have a backup plan and ensure staff are ready to act in the event of a technological, or behavioral, crisis in order to maintain safety.
• Telepsychiatrist burnout - Structure the room to make the psychiatrist/psychologist comfortable to increase job satisfaction and reduce the risk of burnout.

Expand Your Options

Telehealth is changing the assumption that living in a rural area results in a lack of client services and potential career advancement. The accessibility of telehealth has not only increased a client’s ability to receive quality mental health care, but can also help providers increase educational and consulting opportunities.  

Sources:

• Practice-Based Versus Telehealth-Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial
• Utilization of Telehealth Among Rural Medicare Beneficiaries
• A comparison of the Efficacy of Psychotherapy via Telehealth to Traditional In-Person Therapy for Rural Veterans with PTSD

To find out how Kareo Telehealth can support your virtual mental health program: