Telepsychiatry, The Right Time But Not Yet In Enough Places

This week I was reading a January 2012 TRENDWATCH from the American Hospital Association entitled “Bringing Behavioral Health into the Care Continuum:  Opportunities to Improve, Costs and Outcomes.”  While I work with and around the problem every day it makes me pause whenever I see some of the numbers.

….among children mental health conditions were the 4th most common reason for admission.

….27% of Americans will suffer from a substance abuse disorder in their lifetime.

….in 2009, more than 2 million discharges from community hospitals had a primary mental health diagnosis

….in the past year, 34 million adults had comorbid mental health and medical conditions

Here is what it means:

Patients with comorbid mental health and medical conditions experience higher healthcare costs, with much of it attributable to higher medical, not mental health, expenditures. Individuals with comorbid conditions are at a heightened risk of returning to the hospital after discharge.

There is a critical shortage of behavioral healthcare treatment capacity. According to the report, 55% of US counties have no practicing psychiatrists, psychologists, or social workers. Only 27% of community hospitals have an organized inpatient psychiatric unit, while state and county hospitals are closing to financial constraints.  Emergency department visits and resulting problems like boarding are on the rise.

With health care parity for mental health, healthcare technology advances, and public and government pressure to reform and recreate healthcare delivery, telepsychiatry is quickly becoming a solution. It allows the too small pool of psychiatrists, who are not evenly geographicly distributed, to meet the growing national mental health challenges.  We see the armed forces, the Veterans Administration, rural counties, managed care and many entities using telepsychiatry to reach no, low or special needs access areas.  Specialists in substance abuse, child psychiatry, mental retardation, and geriatrics can reach dispersed patient populations in need of a higher level of specialization.

Increasingly we are seeing hospitals, who previously did not have or could not maintain sufficient on demand coverage,  identify and take advantage of the improved quality, cost, and outcomes that telepsychiatry offers.  The new questions become:

-What is the benefit to the care of the co-morbid patient when the hospitalist has a Psychiatrist to consult?

-What is the benefit to the hospital that has no mental health services but has patients whose primary diagnosis is a mental health condition being brought to the Emergency Department and admitted to the hospital?

-What is the benefit of being able to diagnose, stabilize, manage, and direct to appropriate treatment the patient who is undiagnosed, untreated, or suffering from exacerbated mental health symptoms?

-What is the benefit when a child, elderly person, substance abuser comes to the hospital with an acute mental health problem and a specialist in that field is there to help?

-What is the savings when a psychiatrist is almost instantly available to determine capacity, treat emergent and urgent cases, and provide specialized recommendations?

Increasingly, as telepsychiatry is being used in the hospital setting, outcome studies all show that with early intervention, assessment, and treatment there is reduced cost of care, LOS, readmissions, staff burden and risk; and there is increased quality, services, and satisfaction.

My work deals with the problems of how to address the mental health challenges that our hospitals and their communities are facing. Every day I show hospitals that telepsychiatry is a tool to decompress ED’s, provide needed specialty treatment, and reduce the costs hospitals bear while trying to meet the needs of the people they serve.  Can we afford not to address this growing problem?  There is still a ways to go in improving the national landscape for telepsychiatry (new prescribing laws and national licensing, reimbursement and medicare coverage, and so on…), but in your community the answer may already be here.