Even though depression affects about one in 10 Americans and is a leading cause of death and disability, almost half of patients with depression don’t get treatment, researchers note in the Journal of Clinical Psychiatry. When depression goes untreated, it’s often because people can’t overcome issues with mobility, travel distance, transportation costs or time off work – all of which may be addressed by telemedicine.
How Telemedicine is Used for Mental Health Treatment
Sometimes called “telemental health,” or “telepsychiatry,” telemedicine is an alternative method of treating patients seeking treatment for depression or other psychiatric conditions. Instead of visiting the office of a treating psychiatrist, therapist, or other mental health professional, the patient connects with them remotely using dedicated video conferencing software on a mobile device or computer. This is accomplished over secure, high-definition connections to create an experience similar to an in-person encounter. The technology helps overcome many of the barriers that prevent people from seeking care. The approach is used for cognitive behavioral therapy, relationship counseling, medication management, and after hospital care.
Is Telemedicine Treatment for Depression Effective?
A new study by researchers at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center in Charleston suggest that it is. They followed 241 depressed elderly veterans, some of whom received treatment via telemedicine, while others received in-person care. At the end of one year, there was no meaningful difference in symptom relief or satisfaction between the two groups.
“Based on results of this study and prior research, telemedicine 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,” lead study author, Dr. Leonard Egede told Reuters. He continued, “In addition, this study was focused specifically on the elderly population, who have limitations in terms of mobility and transportation options that make them good candidates for depression therapy using telemedicine. Based on our analyses, there are no subpopulations based on age, race, or gender that showed worse outcomes and therefore would require in-person treatment.”
Barriers to Mental Health Care
According to The Maven Project, an organization working to provide care to underserved populations through volunteer physicians, “Studies have shown that one in five adults will deal with a mental health disorder in a given year. And yet, only 40 percent of adults and 50 percent of children and adolescents with mental illness aged 8-15 report having received mental health services in the past year. A psychiatrist shortage, stigma, insurance coverage, and cultural perceptions are all major reasons why people do not receive necessary treatment, and many of these can be at least partially addressed by telemedicine.”
“By insisting that patients come to our offices, we’re excluding potentially millions of patients who need care,” says Carolyn Turvey, PhD, a professor of psychiatry at the University of Iowa and vice chair of the American Telemedicine Association’s Telemental Health special interest group.
Telemedicine’s Advantages for Patients
Leveraging telemedicine for mental health care offers a number of benefits that may allow an otherwise reluctant patient to receive desperately needed care.
Convenience – Mental health care is often a long-term proposition. With telemedicine, patients can engage with their provider without a major disruption to their schedule. They avoid travel time and transportation costs, which can add up especially with weekly visits.
Access – As The Maven Project noted, there is a severe shortage of mental health professionals in the US. Telemedicine makes it possible for providers to see more patients in a day and to service people from a broader geographic area.
Privacy – Mental health issues are still stigmatized in our culture and some patients are unwilling to be seen entering or leaving a clinic or office that provides such services. With telemedicine, the patient does not need to leave the privacy of their own home, so there is no risk that others will learn about the treatment.
Comfort – Overcoming depression and other related disorders is difficult and uncomfortable. For some psychiatric patients, it is easier to open up in the privacy of their own home.
Consistency – One thing that has a major impact on the success of mental health treatment is consistency. By providing a venue for patients and physicians to see each other on more flexible schedules, telemedicine can help them meet more regularly and allow for more immediate renewal of necessary prescriptions.
Considerations for Providers
It is important to note there are differences in telemedicine and in-person care in psychiatry and psychology. As Ray Folen, PhD, chief of the psychology department at Tripler Army Medical Center in Honolulu noted, “You really can’t just take a provider who has been doing face-to-face work all their lives and put them in front of a camera and say, ‘go for it,’ because there are some very subtle, important things that need to be considered when you’re working with someone over an electronic connection.”
For example, when a provider looks away from a patient to take notes, during a face-to-face session, there is typically no harm. But for a client being treated remotely, a provider looking away might indicate that the provider is distracted or not interested in what the client is saying. Folen says, “We now tell our providers to explain to the person on the other end that when they look away it’s simply to make a note about something.”
Providers also need to adjust their cameras to eye level to ensure proper eye contact with the client and make sure the volume is at a good level at the start of the visit.
Telemedicine has tremendous potential to improve the lives of patients suffering from depression and other mental health issues. It can also help keep costs down, provide an increased degree of flexibility for providers, and expands access to rural and homebound patients. There are certainly precautions to take, but on the whole, the approach has great value.