|Health Factors:||Access to Care|
|Decision Makers:||State Government Federal Government Healthcare Professionals & Advocates Public Health Professionals & Advocates|
|Population Reach:||20-49% of WI's population|
|Impact on Disparities:|
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Telemental health services are mental health care services provided over a distance via telephone or videoconference. Services can include psychotherapy, counseling, supplemental support services accompanying face to face therapy, and self-directed services such as online cognitive behavioral therapy. Patients can receive care via their home computer through services such as Skype or be hosted at clinics or hospitals where telemedicine equipment is housed. Direct real time services are generally provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners (Lambert 2013). Supplemental or self-directed services such as cognitive behavioral therapy programs may or may not involve direct interaction with a practitioner. Telemental health services can supplement or provide services to individuals in areas with limited access to mental health care professionals (e.g., rural communities or other Health Professional Shortage Areas (HPSAs).
There is some evidence that telemental health services improve mental health (Osenbach 2013, Dorstyn 2013, Sloan 2011, Hailey 2008). However, additional evidence is needed to confirm effects on access to care and identify the types of services that are most effective for each condition.
Telecounseling, psychotherapy or counseling by telephone or videoconference, appears to be as effective as face to face psychotherapy for treating depression (Osenbach 2013, Dorstyn 2013, Sloan 2011, Hailey 2008). Telehealth treatments can reduce post-traumatic stress disorder (PTSD) symptoms (Sloan 2011, Hailey 2008), but appear to be less effective than face to face interventions (Sloan 2011). Telemental health services may also positively affect conditions such as dementia, schizophrenia, panic disorder, substance abuse, and eating disorders, and may aid in suicide prevention (Hailey 2008). Participation in telecounseling can also reduce depression and anxiety, and improve quality of life among ethnic minorities such as Asians, Hispanics, and Blacks (Dorstyn 2013).
Programs and services that are comprehensive and involve some contact with a therapist for feedback and follow-up appear to be more effective than less comprehensive programs and those that do not involve therapist contact. Telemental health services may be more effective when treating mild or moderate symptoms, rather than more severe symptoms (Penate 2012).
Initial cost analysis of videoconferencing telepsychiatry appears favorable, with potential savings in time, costs, and patient travel (Pesamaa 2004). One study of telephone care management and cognitive behavioral therapy found only a modest increase in the cost of services compared to usual primary care (Simon 2009), although additional study is needed to confirm effects on cost (RAND-Brown 2015).
The University of Virginia Health System in Charlottesville uses videoconferencing to link rural patients to the University’s psychiatric fellows and residents (AHRQ HCIE-Burket). In Texas, the University of Texas Medical Branch, working with community-based partners, provides remote mental health services to students and parents in the Galveston Independent School District (AHRQ HCIE-Raimer). In South Carolina, a statewide partnership established by the Department of Mental Health, the University of South Carolina School of Medicine and 18 predominantly rural hospitals provides psychiatrists via teleconference to assess and treat patients with mental health issues in hospital emergency departments (AHRQ HCIE-Narasimhan).
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