PERSPECTIVE

The Growing Influence of Telepsychiatry

Herbert Harman , MD

Regional Director of Acute Psychiatry

Published April 12, 2021

To create a more effective and affordable healthcare system, we need to accept that behavioral health is health.

If you’re not convinced, consider the enormous burden lifestyle-related conditions place on our system. Chronic diseases like hypertension, heart failure, and diabetes account for 75% of healthcare spending. While only a fraction of these patients meet the criteria for psychiatric diagnoses, almost all could benefit from behavioral and social support to better manage their conditions. As anyone who has lost weight, quit smoking, or started an exercise program can attest, behavior change is often our biggest barrier to healthy living.

Unfortunately, few patients have the bandwidth to travel to multiple in-person doctor visits, counseling sessions, and support groups each week. So how do we integrate behavioral health without making complex disease management a full-time job? One possible solution is to leverage telemedicine and, more specifically, telepsychiatry.

A Critical Turning Point for Psychiatric Care

In the spring of 2020, I traveled to New York City to provide medical disaster relief. While I received a relatively safe assignment to the COVID hotel (where patients who could not isolate on their own stayed during their quarantine or infectious period), some of my emergency medicine colleagues were sent to a nearby ICU. At one point, one of my peers reported that every local doctor on the unit was out with COVID-19, and two were hospitalized.

In this context, hospital-based providers nearly all turned to on-demand telepsychiatry services for consults. During the early days of the pandemic and as regions across the country experienced surges, it was safer for patients and psychiatrists to interact virtually. In fact, many psychiatrists simply refuse to work in hospitals (with 60% of psychiatrists over age 55 and therefore in a higher risk category for viral transmission, this isn’t surprising).

Beyond the context of the pandemic, virtual behavioral health is the only available option for many emergency physicians and hospitalists. Relatively few health systems have the case volume to support a psychiatric hospitalist. Meanwhile, local psychiatrists often hesitate to consult on medical cases due to reimbursement barriers.

While some psychiatrists were early adopters of virtual care, telepsychiatry exploded during the pandemic. As a result, resistance to telepsychiatry has rapidly lifted. Both patients and providers started virtual care out of necessity but quickly warmed to its convenience and effectiveness. Meanwhile, regulators eased their historically onerous restrictions on telehealth reimbursement (at least for the duration of the pandemic). And health systems and physician groups see the writing on the wall and have begun investing in telehealth infrastructure.

"By leveraging new care delivery models like telepsychiatry, health systems can make meaningful strides toward mental health parity and improve the lives of our most vulnerable patients.

Herb Harman, MDRegional Director, Acute Psychiatry

Benefits of Telehealth Expansion in Psychiatry

Before the pandemic, many experts argued that telehealth would harm the patient-provider relationship so crucial in psychiatric care. For the most part, these fears have proved unfounded. It’s true that an online encounter sacrifices a certain degree of connectivity. Telepsychiatrists can’t offer perfect eye contact. However, the trade-offs are probably worth it. Getting 90% of a visit is better than no visit. (Which, alarmingly, is what 40% of people with serious psychiatric conditions were getting in the pre-pandemic era.)

On another positive note, the telepsychiatry boom has turned the old provider-centric paradigm on its head. Patients no longer need to schedule 90 days out and drive across town for routine care. Instead, they can access check-ups, medication adjustments, and counseling from their homes and workplaces. Many people don’t have the luxury of taking a half-day off of work to drive to an appointment, sit in a waiting room, and share physical space with a doctor so a treatment plan can be continued. It’s expensive and unnecessary. Over time, this could improve healthcare equity for lower-income workers, caregivers, rural and disabled patients, and others who have difficulty making in-person visits.

Other examples of telepsychiatry helping patients:

Maintenance. Regular teletherapy sessions can help patients better manage their mental health and substance use conditions and avoid exacerbations.
Better safety net. When a crisis does occur, patients can receive expert and timely treatment in the ED. Instead of waiting hours or days for inpatient admission, many ED patients can now be discharged home.
Expanded services. Psychiatrists can virtually staff crisis stabilization units, which offer stable patients an alternative to the ED.
Better treatments for substance use disorders. Telepsychiatry improves access to evidence-based therapies for people with opioid use disorder, like Medication-Assisted Treatment (MAT).

Beyond treating individuals, stakeholders are also using telepsychiatry to improve public health. A recent example is California Law 3242, which allows patients brought to the emergency room on involuntary psychiatric holds to be evaluated virtually. When appropriate, the telepsychiatrist can release the hold without seeing the patient in person. Telemedicine is face to face, so the encounter can be used to make decisions about voluntary or involuntary status. This policy change should result in drastically shorter wait times for this population.

Health systems and providers also benefit from telepsychiatry. On the hospital side, on-demand telepsychiatry consults help to ease emergency room crowding and improve patient flow. Because patients are evaluated quickly, they are less likely to become aggressive or disruptive. Most importantly, providers report an increase in morale, knowing they can deliver compassionate care that truly helps and heals.

The Future State of Telepsychiatry

As I noted above, our current healthcare system does a poor job managing chronic conditions—psychiatric and otherwise. In my opinion, this will represent the growing edge for telepsychiatry over the next five years.

Telepsychiatry allows us to evolve toward new, more synchronous models of team-based care. Under this paradigm, psychiatrists provide less clinical care and more consultation and coordination. On a regular basis—maybe every 90 days—the team will meet virtually with the patient to share updates and next steps from the care plan. This model allows the patient to be part of decisions and take a more active role in their healing.

Carried to its full potential, telepsychiatry could eventually integrate with team-based care for all chronic conditions. For example, a patient with heart disease would benefit from behavior change support to start a healthy diet. And if there’s an underlying condition like depression that drives unhealthy eating habits, it could be treated concurrently. Such a model requires us to build cultures that treat behavioral health as health and remove the stigma associated with mental healthcare.

Granted, it will take time and advocacy to bring this new paradigm to fruition. First and foremost, we need to advocate for reimbursement structures that incentivize teamwork over fragmentation. As healthcare leaders, we must also weave teamwork into the cultural fabric of our organizations. The best way to start is to focus both providers and payers on what’s best for the patient.

While telepsychiatry has grown exponentially over the past year, we’ve barely scratched the surface of its possibilities. At Vituity, we are committed to innovating acute psychiatric care for the benefit of patients everywhere. Our integrated solutions offer many paths to healing, from intensive inpatient care to short-term stabilization and patient navigation. Our approach integrates in-person and virtual care to ensure patients’ access to treatment where and when they need it.

At Vituity, we lead the industry to a future state that accepts behavioral health as a crucial component of overall wellness. By leveraging new care delivery models, health systems can make meaningful strides toward mental health parity and improve the lives of our most vulnerable patients.

Read more about how Vituity is transforming acute behavioral healthcare through telepsychiatry solutions.

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