Primary care practices—supported by telepsychiatry and telehealth resources—are best positioned to improve access to mental healthcare, resulting in earlier intervention and improved mental health outcomes.
Over the past few years, we’ve seen encouraging improvements in the diagnosis and treatment of mental health conditions in the United States. Notably, recent government acts have improved access to mental health services for many Americans. Despite this, however, significant issues remain that signify our patient population still isn’t accessing the timely mental healthcare they require.
Among these issues is the continued shortage of mental healthcare providers needed to treat the 1 in 5 adults suffering from mental illness in the United States (as of 2015). The troubling impact of this gap between demand and specialty care availability is demonstrated by numerous critical measures. For example, as of 2017, nearly 6 in 10 Americans with a mental illness received no treatment or medication, according to the National Institute of Mental Health. Specific to the nearly 8 million children diagnosed with depression, anxiety, or attention deficit hyperactivity disorder (ADHD) in the U.S., roughly half receive no treatment.
Striving to provide “right time, right place, right provider” mental health treatment, accountable care organization (ACO) models have placed particular importance on the role of primary care. These organizations are uniquely positioned to promote innovation and efficiency in care models, and telepsychiatry technologies can provide key support in addressing the factors that impact access to mental healthcare.
While policies have made mental healthcare more accessible, additional resources are still needed to ensure the expansion of care.
To date, improvements to mental health services have resulted primarily from requirements for increased mental health insurance coverage. This is a significant step in the right direction; however, these policies do not address important access hurdles that result from the broken referral system. Patient referrals to mental health specialists often do not result in appropriate and timely care due to mental health specialist shortages, lengthy patient wait times, and the high likelihood of mental health professionals to be out-of-network for many patients. Office visits with therapists are five times more likely to be out of network—and thus, far more expensive. Amid these factors, patients are increasingly ending up in emergency departments in search of mental health services. We need to find a better solution to delivering mental healthcare earlier in order to support already overburdened emergency departments (EDs), which often lack the psychiatric services and mental health resources to appropriately care for these patients.
Telehealth provides an alternative for PCPs to increase access to mental healthcare for patients in the most appropriate setting.
Telehealth solutions that enable primary care physicians (PCPs) to consult with psychiatrists outside of the traditional referral system, using either video or eConsults, can improve access to mental healthcare, reduce the burden on EDs, and improve health outcomes for patients. These services are increasingly covered and reimbursed, resulting in higher use in PCP clinics across the country.
Using telehealth solutions, PCPs are able to consult with qualified psychiatrists without requiring patients to make separate appointments. This increases access to necessary care for those patients for whom visiting an out-of-network therapist would be an undue burden. Furthermore, telepsychiatry and other telehealth solutions are introducing new and innovative ways for this patient population to access the mental healthcare they need—from virtually anywhere. Making telepsychiatry and other telehealth solutions readily available will significantly increase access to specialists, reducing mounting patient wait times and improving outcomes.
A spotlight on eConsults.
An example of a telehealth solution providing patients with timely access to mental health through their primary care provider is eConsult platforms. A common need for psychiatry referral is medication regimen introduction and adjustment. Many such cases can be managed within the primary care setting with the support of specialty insight via eConsults. The ability to receive necessary mental healthcare treatments within the primary care setting positively impacts outcomes and financial bottom lines for payors and health systems alike by maximizing healthcare resources. This frees queues for mental health providers to see higher acuity patients in need of face-to-face appointments and provides lower acuity patients the necessary care within the comfort of their primary care office.
The status of mental health treatment within the United States has improved over the years, but there is still much further to go in improving outcomes for those suffering from mental illnesses.
While access has been improved—particularly through insurance coverage—more innovative models must be explored if timely, appropriately placed mental healthcare is to become a reality. Primary care providers play a critical role in improving outcomes for mental health patients, and the benefits of telehealth solutions such as eConsults provide a clear avenue toward creating a brighter future for those in need of treatment for mental health conditions.
About Dr. Cladera
Dr. Ed Cladera, Medical Director of AristaMD, brings years of experience in healthcare and currently practices Hospitalist Medicine as a board-certified Internal Medicine physician. He is privileged at two of the top five hospitals in the San Diego area and has received multiple recognitions from thankful patients and families. AristaMD develops solutions to improve patient outcomes through efficiency in healthcare. The company’s Smart Care Platform empowers primary care providers with clinical work-up checklists and the ability to conduct electronic consults.