Care for Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers in developing this post.
Matt Mishkind, PhD, Rachel Griffin, APN
In the age of the smartphone, communication is easier than ever. We have face-to-face conversations with people thousands of miles away and access information with the swipe of a finger. And this amazing technology isn’t just for playing Pokemon Go or posting to Facebook—it has the potential to change the delivery of mental health care in this country.
With Skype and other teleconferencing software available on every smartphone, tablet, and computer, telemedicine has become an important industry. By using technology to connect a patient and a provider at a geographic distance, telemedicine can expand access to care for underserved communities, make treatment more convenient for patients, and improve efficiency across our healthcare system.
For thousands of patients in need of mental health care, from veterans to elderly patients to those with disabilities, tele-behavioral health can offer a life-changing solution.
How it works
Telemedicine works just like traditional medical care, only appointments happen via a smartphone or computer screen. It’s simple, personal, and extremely effective. Patients develop a one-on-one relationship with a behavioral health provider, just like they would through traditional appointments, and if the patient isn’t comfortable with their physician or therapist, they can seek out a new one.
As far as the logistics go, a primary care provider might offer telehealth services at his or her office, so a patient can connect directly with a mental health specialist from there; or a PCP can consult with a specialist virtually for medication recommendations. Alternatively, if a patient has mobility or transportation issues, telemedicine software can be installed on a personal computer or smartphone, so a patient can connect to a mental health provider directly from home.
Obviously telehealth isn’t appropriate for every scenario. If a physician needs to physically examine a patient, for example, a Skype call won’t do the trick. But for mental health care, research shows that talking via teleconference is just as good as talking in person.
In some cases, telemedicine is even more effective than the traditional in person visit. Some folks are more willing to disclose sensitive information when they’re communicating via technology. The lack of physical presence encourages them to open up, and that’s a crucial component when it comes to getting effective treatment.
For people living in remote locations, dealing with mobility issues, facing transportation problems, or unable to get an appointment with a provider nearby, telemedicine can be their first opportunity to access much-needed care.
Imagine you’re disabled and live in a rural area. You suffer from severe depression, but have no access to a therapist or psychiatrist and no transportation. Then, your primary care doctor suggests a telemedicine option. Now, you can be connected with a therapist through your home computer. Suddenly, you have immediate access to the mental health care you need: it could literally change your life.
With a severe shortage of mental health professionals nationwide, we need to use all the tools we can to help connect patients to providers and increase efficiency of care. Telemedicine can help bridge this gap.
Telehealth in action: firsthand experience from psychiatric nurse practitioner Rachel Griffin
As a psychiatric nurse practitioner, I’ve seen firsthand how telehealth can change people’s lives. As part of my duties, I work with a primary care practice that serves rural and underserved areas. Through telehealth sessions, we’re now able to offer mental health services to people who have never had that option before.
One patient I saw, a veteran, had been dealing with PTSD symptoms for some time, but hadn’t been able to access a specialist, so his primary care practitioner facilitated a session with me. He trusted his PCP and appreciated that he didn’t have to walk into a “mental health clinic,” which can still carry a stigma, particularly in small towns.
After our session, he was in tears. He was so grateful that he’d finally gotten help, and that someone had taken his issues seriously. We started him on medication and he’s doing much better. Telehealth made a huge difference for him, as it has for so many others.
What’s standing in the way of expanded telemedicine?
The availability of telehealth services is still spotty. Not all doctors offer it, not all insurance companies cover it, and there are other barriers. Providers can face issues with licensure and state regulations, and they may not be able to treat patients in different states or jurisdictions. Medicare—as it stands today—might not cover telemedicine sessions that take place at home.
These issues are being addressed by people on the front lines and, eventually, telemedicine will find its way to everyone who needs it. As patients and providers begin to actively push for this service, access is growing.
How to get help
If you’re a patient who might benefit from telemedicine, how can you get access?
The best way to find out what’s available to you is to discuss the different options with your primary care provider and insurance carrier. They can fill you in on what’s covered, what’s accessible, and whether these services are appropriate for your situation.
In addition, you can check out the American Telemedicine Association. This organization publishes guidelines for telemedicine groups and services, so they can help guide you toward the choices that address your needs.
All in all, in a system where access to care is getting worse instead of better, telemedicine is an easy, accessible, and forward-thinking part of the solution.
Dr. Mishkind received his PhD in psychology from the University of Vermont with a focus on organizational development and behavior. The majority of his career has had two focal points: military health care, and organizational development. He began his military health career with the Deployment Health Clinical Center (DHCC) at Walter Reed Army Medical Center in Washington, DC. He also served as one of the original staff members tasked with developing the National Center for Telehealth and Technology (T2) located on Joint Base Lewis-McChord, Washington State. While at T2, Dr. Mishkind helped lead the development of several technology-based initiatives to improve behavioral health access across the Department of Defense. His particular focus was on developing telehealth programs for remote and otherwise isolated populations. Both DHCC and T2 are part of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE).
Dr Mishkind has also held positions focused on organizational development. Most recently, he served as team lead for training and human capital initiatives at the Bureau of Reclamation within the United States Department of Interior. He also has experience as a management consultant for global consulting firms Hay Group and Corporate Executive Board. Dr Mishkind began his career conducting national policy research on patient safety and other health-related programs.
Dr Mishkind has 20 publications primarily focused on improving access to behavioral health care for military populations. He is also certified as a Senior Professional in Human Resources.
Rachel Griffin, APN is a psychiatric mental health nurse practitioner and a Senior Instructor in Psychiatry at the Helen and Arthur E. Johnson Depression Center. Her clinical interests are focused on incorporating integrative and wellness therapies such as yoga, mindfulness, and nutrition into psychiatric care. She believes in taking a holistic, trauma informed, evidence based approach to treating mental illness. Ms. Griffin is also interested in improving health care delivery systems to improve access to mental health care, and in integrating mental health and primary care services. She has previously worked with underserved and at risk populations, including the homeless, the formerly incarcerated, and those who are HIV positive. Ms. Griffin received her Bachelor of Arts in Psychology at Vanderbilt University in Nashville, TN, and her Bachelor and Master of Science in Nursing at Columbia University in New York City.