One of the best uses for telemedicine is mental health care. No physical contact is necessary between provider and patient (although it may be better to see a patient’s affect in person rather than via video). Rarely does mental health require in-person testing. Taking vital data is not necessary. Overall, it’s a great fit – and it’s a success that has skyrocketed during the pandemic and beyond.
What are the prospects for telepsychiatry this year? Dr. Zoe Martinez has three predictions.
She is a member of the clinical leadership at Done, a platform that connects patients with psychiatric board-certified medical professionals for services such as online video consultations, diagnosis, care team support and prescription fulfillment. She has more than 20 years of experience working with a wide range of patients. She is certified in child and adolescent psychiatry and adult psychiatry.
She says about telepsychiatry in 2024:
1. Telehealth will continue to grow because it fills a void in mental health care by creating improved access for many people who previously did not have this access.
2. Individuals and insurance companies will see the value of telehealth as a replacement for the home visit of yesteryear, which was an important aspect of medicine.
3. Despite the end of the public health emergency, individuals and informed political leaders will continue to work with pharmacies to maintain access to essential care for individuals in need of mental health medications, because mental health is part of general health.
We sat down with Martinez to have her expand on her outlook for the year.
Q: The first of your three predictions for telepsychiatry in 2024 concerns access. You argue that telepsychiatry will continue to grow because it enables access to mental health care – which is a major challenge today.
A. Patients with mental health problems often have to wait many months before being seen by a licensed physician who can prescribe psychotropic medications. During this waiting period, they not only face negative consequences at work, school, and in personal relationships, but they also run the risk of being hospitalized, which can be traumatic and costly.
Estimates of the mental health care shortage indicate that approximately 47% of the population (or 158 million people) live in an area with a mental health care shortage.
This is especially true in rural or economically distressed areas. The lack of sufficient physicians to support these underserved communities can be alleviated through the use of telepsychiatry services that allow physicians who do not live in those areas to provide care remotely from wherever they live, provided they are licensed in the state of the region. the patient’s place of residence.
In addition to a shortage of physicians to provide care, there are often other barriers to access, including cost and transportation issues. It is known that people with untreated mental health problems are more likely to end up in lower income groups.
Telepsychiatry services are often more affordable because they do not require the investments in physical infrastructure that a traditional office environment does. In terms of transportation issues, the cost of owning a personal vehicle can be prohibitive for individuals in lower socio-economic groups – and there is often a lack of reliable public transport in rural and economically depressed areas.
Additionally, if someone needs to travel from an area with little coverage to an area with more providers, travel time can be a barrier to entry.
If patients have to wait until they deteriorate before accessing care, their symptoms are likely to be more severe, their personal losses will be greater, and they are likely to feel more excluded from the mental health system.
Telepsychiatry addresses all of these access issues and provides an affordable option that increases the availability of services without requiring significant infrastructure investments in physical locations and non-clinical staff to support those physical locations.
However, depending on the state and regulations, patients may sometimes need to be seen in person. As the public health emergency comes to an end, state rules are changing and fortunately, telepsychiatry will still exist as part of a hybrid model.
Therefore, telepsychiatry will continue to provide an important part of care because, even in states where, for example, initial appointments must be done in person, follow-up appointments can help provide care to patients more frequently and therefore increase the ability of in-person physicians to care for more patients .
Q: Your second prediction concerns acceptance. You say that payers and patients will embrace telepsychiatry more as a form of health care delivery. What does this mean for mental health care this year?
A. When COVID first saw increased demand for telepsychiatry, an estimated 4% of respondents reported using telehealth in February 2019. Two years later, during the pandemic, this percentage increased to 45%.
A 2021 AMA survey found that more physicians had “enthusiastically embraced” telehealth, with more than 85% of physicians reporting they were comfortable using telehealth and used it often. Telepsychiatry is a useful tool that is cost-effective and effective when provided by an experienced clinician.
As telepsychiatry becomes an increasingly useful model, more and more patients and physicians will gain more experience using this modality.
An additional benefit of telepsychiatry is that it can provide the benefit of old-fashioned “home visits,” which can be extremely helpful in quickly learning how a patient’s social environment affects their mental health, both positively and negatively. Seeing a patient in his or her home environment often helps build rapport because one can physically see things such as a pet, a hat collection, an art collection, etc.
This helps build rapport not only during an initial visit, but also during follow-up, as the doctor and patient can discuss any changes. Seeing a patient in their home environment can also be very helpful if the patient wants their home support network to participate in their treatment plan. This can be improvised or planned and usually also helps to improve rapport with the doctor and support for the patient.
All of these things provide patients with an easy way to share their lives and feel like a cared for individual and not just a diagnosis.
When telehealth services began to be used, there was a lot of confusion about whether services would even be billable. As telehealth in general, including telepsychiatry, becomes more widely used, there has been pressure on Medicaid, Medicare, and private insurance companies to develop standards for coding and billing for telehealth services. There are still updated guidelines to help physicians use the correct codes for billing.
Now that it’s clear that telehealth is here to stay, creating standards for the coding and billing of telehealth services is an ever-evolving field. The more both government and private insurance companies can continue to create standards, the more this legitimizes telehealth as a clinical service delivery model that is not a temporary solution to survive the public health emergency caused by COVID-19, but as a valid clinical model that will endure and expand into more areas of medicine.
Q. Your third prediction concerns medication. You suggest that organizations and informed political leaders will continue to work with pharmacies to continue telemedical access to mental health medications, because mental health is part of overall health.
A. There have been numerous stories in the media about stimulant shortages, with a particular focus on Adderall. I myself have been asked to tackle this problem for both video and written media. Telepsychiatry has been “blamed” by some entities for the shortage, with the implicit message that telepsychiatry physicians are more likely to inappropriately prescribe stimulant medications to adults, which is the reason for the increased demand for stimulant prescriptions.
As mentioned, the explanation for the increased demand for stimulant prescriptions is not inappropriate prescribing, but rather increased access to care for previously underserved individuals. There is a misconception that in-person appointments will somehow avoid the relevant issues of misdiagnosis or diversion where prescribing stimulants would be inappropriate, which in fact is not true.
The measures that in-person physicians use to prevent these problems are also available to telepsychiatry physicians. In addition to increased demand for stimulant prescriptions leading to shortages, there are other reasons for inadequate supply, including issues with production and supply quotas at pharmacies.
The media attention to the issue of drug shortages could be extremely helpful, as it provides opportunities for highly trained and experienced physicians like myself to accurately describe the actual process of assessing, diagnosing, and treating patients seen via telepsychiatry versus office visits.
This includes one of the required safeguards in both cases: reviewing PDMPs to look for potential evidence of misuse of prescription controlled substances. I have been interviewed a number of times using various platforms, some of which allow laypeople to ask questions. I think this is important because it provides opportunities for not only policymakers, but also patients, families, friends and loved ones to receive free and timely education.
I am hopeful that there will be more widely available guidelines on telepsychiatry prescribing that are acceptable to regulatory agencies such as the DEA and the FDA, so that prescribers can know in advance how to avoid sending a prescription that is not has been completed.
As mentioned, this has several reasons, some of which, such as production, are not easy to solve. However, sometimes pharmacies set limits on prescribing controlled substances due to uncertainty and because they want to err on the side of caution to avoid future problems or penalties.
Because a lack of timely access to prescription medications is not an uncommon occurrence, some of this problem could be alleviated if regulators provide clear guidance. If this happens, we as physicians will follow them to ensure quality and timely care of our patients.
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