Telepsychiatry | News | Array Behavioral Care

By: Geoffrey Boyce

Value-based care and the concept of connected health care communities go hand-in-hand. It is simply not possible to extract the full “value” of forward-looking care delivery models without a strategy that addresses patients’ whole health—both physical and behavioral—across the entire continuum. Connected community models achieve this objective through a comprehensive, sustainable and multi-faceted behavioral health strategy that improves treatment access at key entry points and across all levels of care.

Health care stakeholders increasingly recognize the power of connected community models, yet behavioral health remains significantly fragmented due to supply and demand challenges. While rapid evolution of integrated delivery networks is increasing scale and synergies on the medical side of the house, behavioral health lags behind partially due to professional shortages that exist in all U.S. states. These shortages are felt across the continuum, beginning in the most acute settings and flowing into outpatient care and referral networks.

Telepsychiatry models have emerged as one solution that holds great promise for changing this dynamic. Through video conferencing sessions that enable anytime, anywhere access, this model is opening new gateways to care and disrupting traditional approaches to behavioral health.

The Telepsychiatry Advantage

Providers and patients are embracing telepsychiatry as a viable treatment alternative for good reason: it meets the standard of traditional in-office care for diagnostic accuracy and quality, while also improving care continuity, outcomes and patient satisfaction.

Patients appreciate the convenience and privacy afforded by direct-to-consumer (D2C) telepsychiatry sessions that can be accessed at home or other comfortable locations that are private. By empowering patients with greater choice in location and time, telepsychiatry models help tear down communication barriers and reduce stigma—a key factor that keeps many from seeking treatment. Appointments are easily scheduled outside of traditional office hours where a reliable Internet connection exists. Additionally, patients can look outside of local areas to access services, expanding provider options.

In tandem with patient benefits, behavioral health providers often find telepsychiatry a good fit for work-life balance. Today’s health care communities rely heavily on existing behavioral health professionals to fill care gaps. As such, it’s not uncommon for those in the field to have upwards of three to four different jobs. Telepsychiatry relieves some of the pressure by allowing existing providers to schedule sessions in more convenient, creative ways.

In addition, many providers want to address the urgent need for services in rural communities and desire to fill care gaps. Yet, they often prefer to live in urban areas or are unable to relocate. Telepsychiatry allows them an outlet to reach those locations where the greatest need exists without moving their practice or making long commutes.

Leveraging Telepsychiatry Across the Continuum

Communities are realizing notable gains by integrating telepsychiatry across the continuum in various ways including:

Emergency departments (EDs)

Busy ED physicians often lack the psychiatric resources needed for timely evaluations of critical-need patients. As a result, patients are stuck waiting in the ED or transferred to a med/surg unit until a qualified provider is available. This scenario leads to higher costs associated with longer wait times and inappropriate admissions. Telepsychiatry relieves this pressure by ensuring timely evaluation and quick triage to the most appropriate level of care.

Other hospital-based applications

Telepsychiatry can also be used on medical floors of the hospital for psychiatric assessments of medical patients. Some hospital inpatient units utilize telepsychiatry providers to augment their in-person staff and ensure units have 24/7 psychiatric coverage.

Discharge Planning

Telepsychiatry is increasingly an important resource for discharge planners, who are tasked with helping patients access post-discharge services in a timely manner. Consider, for example, that patients are often discharged from hospitals, correctional facilities or other residential programs with a 10-day “bridge” prescription and are required to continue treatment with a community-based psychiatrist. In these instances, discharge planners can face notable challenges to securing a timely follow-up appointment as waiting lists for psychiatrists at some community clinics can reach upwards of several months.

Medication lapses are common, and if the patient misses a follow-up appointment, the situation is exacerbated, opening the door for conditions to deteriorate. Ultimately, this scenario results in a vicious cycle of patient readmissions.

Community-based referrals

For under-resourced clinics, telepsychiatry provides a lifeline of support through remote providers who serve a regular caseload of new and existing patients just like an in-person psychiatrist. This enhanced provider pool increases a clinic’s psychiatric capacity and potentially shortens the long wait periods for psychiatric appointments that exist in many communities.

Provider referrals

More than half of all psychiatric drugs today are actually prescribed by non-psychiatrists due to provider shortages. Primary care doctors are increasingly sought for psychiatric care, although many are uncomfortable with or lack expertise with psychotropic drugs. Telepsychiatrists provide both an attractive referral option and consultative partnership, where knowledge and expertise can be shared.

Forward-looking

While telepsychiatry is not a “magic wand,” it does provide an effective option for improving the fragmented behavioral health continuum. Communities are wise to consider effective telepsychiatry partnerships that can bolster behavioral health service lines. When these services are effectively integrated, communities achieve a more connected health care continuum that drives better outcomes and lower costs.

Geoffrey Boyce is Executive Director of InSight Telepsychiatry.

Original article from Healthcare Business Today

Philadelphia, PA – Family Service Association of Bucks County launched an outpatient telepsychiatry program to increase efficiency and access to psychiatric care for adults, children and adolescents across four of their locations in Bucks County, Pennsylvania. The telepsychiatry program is launched in partnership with InSight, a national telepsychiatry service provider organization.

Telepsychiatry is the delivery of psychiatry through real time videoconferencing. It is proven to be an effective form of care delivery and a convenient, cost-effective way to safely expand the psychiatric support without the challenge of staffing an in-person psychiatry provider.

Prior to implementing a telepsychiatry program, Family Service staffed an onsite psychiatrist that would travel between Langhorne, Doylestown and Quakertown locations. With telepsychiatry, Family Service was able to increase efficiency and reduce costly, time-consuming commutes.

Outpatient Telepsychiatry Program

“Telepsychiatry allows organizations like Family Service to reduce commute time for providers and patients. This allows for more valuable time with patients,” said InSight’s Operations Manager of Scheduled Services Nate Ortiz.

It is estimated that 1,051,490 individuals in Pennsylvania are living with serious psychological distress including major depressive disorder, bipolar disorder, panic disorder or anxiety.[1] Telepsychiatry is a great solution in Pennsylvania and in many other states across the nation where there is a shortage of psychiatry providers.

“We are thrilled to be able to offer this innovative new service to our patients. We are dedicated to increasing psychiatric access to all consumers, and this is a smart way to ensure our patients are getting the care that they need on a consistent basis,” said Audrey J. Tucker, Chief Executive Officer.

InSight’s telepsychiatry provider will offer these services to patients in Family Service outpatient behavioral health programs, namely counseling.

About InSight + Regroup

InSight + Regroup (now Array Behavioral Care) is the leading and largest telepsychiatry service provider in the US with a mission to transform access to quality behavioral health care. InSight + Regroup serves hundreds of organizations and individuals in various settings across the continuum of care with its on-demand, scheduled services and direct-to-consumer (Inpathy) divisions. Given its size, diversity of services and extensive experience and expertise, InSight + Regroup is uniquely positioned to enable scalable telepsychiatry programs across the care continuum. As an industry thought leader, InSight + Regroup has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.

About Family Service Association of Bucks County

Family Service Association of Bucks County is a nonprofit social service organization with locations throughout Bucks County, Pennsylvania. Family Service’s mission is to listen, care and help. Every day. For more than 60 years, Family Service has been improving the lives of children and their families, doing whatever it takes to help them overcome obstacles and reach their full potential. Visit www.fsabc.org to donate, volunteer or learn more about how Family Service helped more than 27,000 children, teens and adults last year.

[1] National Institutes of Mental Health, National Survey on Drug Use and Health (NSDUH) 2015, and

NSDUH-MHSS 2008-2012.

It was nearly 20 years ago when a clinician (non-psychiatrist) brought up the notion of telepsychiatry to James Varrell, M.D., a licensed psychiatrist himself who at the time didn’t know much about the telemedicine subsector. “This was 1999 and it was like voodoo to me,” Varrell says, adding that after that conversation he needed to do his due diligence and research.

What came from that conversation, and ensuing exploration into telepsychiatry, was a realization that there was more support for it than Varrell initially assumed. In fact, the American Psychiatric Association (APA) put out a significant paper in 1995 in support of telepsychiatry, and it was around that time when research began on its ability to facilitate access to care, overcome geographical obstacles and how it compared to in-person care. “All of the go-to organizations in the [industry] have always been supportive of it. Clinicians individually have been skeptical since they’ve never done it. But now, many [places] are incorporating into their residency programs,” Varrell says.

With a dwindling supply of psychiatrists nationwide, telepsychiatry services are starting to become more mainstream

Indeed, folks might not be as familiar with telepsychiatry as they are with other forms of telemedicine, since behavioral health often flies under the radar compared to its physical health brethren. But according to the APA, by the 2000s, the field began to see it as effective, but slightly different, than in-person care, and research in outcome studies provided a platform for practice guidelines, via the American Telemedicine Association.

Varrell says that today’s mental health landscape is characterized by an increased need for services coupled with a dwindling supply of psychiatrists. Indeed, more than 55 percent of U.S. counties are currently without any psychiatrists, and the mental health landscape is facing shortages in more than 4,600 areas, according to Kaiser. Varrell, who has been practicing telepsychiatry for 18 years ever since it was brought up to him back in 1999, now works at telepsychiatry service provider organization InSight, a Marlton, N.J.-based company that he founded in 2008 and where he currently oversees a team of more than 200 psychiatrists and psychiatric nurse practitioners—many of whom work full-time doing telepsychiatry.

Speaking to the growth in the sector, Varrell says that his company began with telepsychiatry mostly in ERs where patients in crisis environments were prioritized. But, he notes, “The place more than anywhere where it started to develop was in rural environments, where access to basic psychiatry care would be otherwise inaccessible. That’s still growing,” he says. “Now, the new wave is that we are starting to do integrated care in medical offices, and that was a big push with Obamacare. We think the next trend is in-home services for consumers, which is telepsychiatry direct-to-patients in their homes or wherever they are [in a private space].”

The reason InSight started to provide telepsychiatry services was because it was located in a rural environment, but Varrell says beyond that, there have been valuable lessons learned since the organization’s inception: primarily that telepsychiatry works well for most people in most areas. “For people in crises, you don’t want to do an in-home visitation if they are psychotic or suicidal. You want them in more supported environments like outpatient mental centers or ERs if it’s very acute,” explains Varrell. “Over the years, we have learned that we can accommodate all types of people.”

Among these are: translations [for people who speak] different languages; the geriatric population, for which a great sound system is needed for older folks who have hearing issues; and also for those with cognitive and intellectual disabilities in which the patients’ families are present to make it easier and provide the psychiatrists with the necessary information, says Varrell.

Over the years, telepsychiatry has continued to grow both in volume and acceptance. Varrell notes how educating organizations such as the University of Virginia and Johns Hopkins University have big electives for all of their psychiatry residents who are mandated to learn telepsychiatry. And, InSight as a sole organization performed more than 100,000 encounters via telepsych in all settings last year (hospitals, clinics, treatment centers, universities), while its in-home platform, Inpathy, is still growing but has around 100 direct-to-consumer sessions in a week, according to officials.

“This is an area that used to be weird and hard, but now people are jumping into it,” says Varrell. “Doctors are calling us all of the time saying they want to work with us. That’s good since there’s a national shortage and we’re often begging doctors to work with us in person, but this is the opposite of that,” he says, noting how on one recent day alone, eight psychiatrists called looking for work.

Original article posted on Healthcare Informatics

LONG BEACH, CA – Center for Family Guidance, PC, a comprehensive behavioral health organization (stylized as CFG), will be presenting at the OPEN MINDS Management Best Practices Institute, taking place from August 15-16 in Long Beach, CA. The OPEN MINDS Management Best Practices Institute brings together executives, thought leaders, industry experts and program innovators to focus on management best practices and clinical treatment tools.

On Wednesday, April 15, the clinical director of CFG will present during the session called Using Technology to Improve Consumer Engagement: A Look at Successful Models for Engagement. This session will feature “Getting Ahead of the Curve: Layering Home-Based Telehealth into an Existing Outpatient Mental Health Clinic” presented by Joel Freidman, PhD.

CFG recently implemented home-based telehealth into an existing outpatient mental health clinic in order to keep up with the national provider shortage, address consumer demand and stay competitive in an ever-changing healthcare landscape.

Telehealth Program

The program utilizes telehealth in two ways: providers are set up with access to a secure, web-based telehealth platform and are able to offer night and weekend appointments to new and existing consumers; consumers can be referred to CFG’s telehealth partner, Inpathy, if the individual is unable to make an in-person appointment or if CFG does not have resources available. This case study presentation will look at the design, implementation and ongoing lessons of this innovative program. Dr. Friedman will discuss challenges, advantages and important buy-in elements for the providers, consumers, administrators and intake coordinators involved.

The benefit of this program for is that it does not require travel and there are more appointment availabilities than in an in-person office setting. The benefit for providers is the convenience of seeing consumers from their own private home office. Providers can also utilize Inpathy, an online psychiatry resource, for referrals.

Other speakers in this session include Richard Louis, III, Senior Associate at OPEN MINDS, and Larry Smith, CEO of Grand Lake Mental Health Center, Inc.

CFG is a broad based healthcare provider that is dedicated to increasing access to care via innovative applications of technology like telepsychiatry and virtual environments.

WASHINGTON, DC – Geoffrey Boyce, Executive Director of InSight Telepsychiatry, spoke at the National Governors Association (NGA) Rural Health Learning Collaborative meeting on August 9 in Washington, D.C.

A renowned national thought leader in the telemedicine industry, Boyce was invited to speak of a range of topics about InSight and telepsychiatry, which included:

InSight’s telepsychiatry models and service lines
Program level barriers and opportunities for telepsychiatry
Regulatory and legislative landscape
The state’s role in advancing telepsychiatry

“I was honored to accept the invitation to speak to this group about the telepsychiatry industry,” says Boyce. “InSight prides itself on sharing industry level best practices and education for this growing field.”

InSight’s Telepsychiatry

The meeting took place at the Hall of the States on August 9 – 10. The NGA Center brought together leaders from five states: Michigan, North Carolina, North Dakota, New York and Nevada during a one-and-a-half-day meeting focused on strategies states may consider to meet behavioral health care needs in rural areas. State participants and attendees broke into teams and took part in sessions, where they met with speakers and NGA facilitators to ask questions and work on action plans. The teams presented their action plans and key takeaways at the end of the meeting.

Boyce spoke during a session called, “Using Telehealth and Telemedicine to Meet Behavioral Health Care Needs.” The session highlighted strategies to build and sustain successful telehealth models and addressed topics such as Medicaid reimbursement, the scope of practice policies and best practices and misconceptions about telehealth.

Other speakers during Boyce’s session included Latoya Thomas, Director of State and Policy Resources at the American Telemedicine Association and Brian Cooper, Telepsychiatry and Rural Health Specialist for the North Carolina Office of Rural Health, Department of Health and Human Services.

About InSight + Regroup

About the National Governors Association

The National Governors Association (NGA) is the bipartisan organization of the nation’s governors. Through NGA, governors share best practices, speak with a collective voice on national policy and develop innovative solutions that improve state government and support the principles of federalism.

By: Scott Baker, MBA, InSight Business Innovations Manager

The link between behavioral health and medical outcomes is well understood. Providing behavioral health services can help keep some medical conditions in check and prevent hospitalizations and readmissions. However, more than half of US counties are currently without any psychiatrists, resulting in large care gaps and wait times of up to 3 to 6 months. As a result, many patients seek mental health services from primary care providers, who often lack both time and specialized psychiatric expertise to treat such conditions. A more dire situation arises when patients are discouraged from seeking treatment altogether, which can lead to further deterioration or crisis situations.

Amid this provider shortage and growing behavioral health crisis, telepsychiatry is emerging as an effective tool to meet providers’ referral needs. In addition, direct-to-consumer (D2C) telepsychiatry is becoming a more widely utilized treatment option—one that can fill gaps in care at a time when the need for services far outpaces provider supply and address issues before they escalate.

By enabling provider-patient interaction at any time from any location, D2C telehealth helps increase access to care and promotes a more comprehensive response to patient needs, whether physical or behavioral. Making care more convenient often leads to earlier interventions that help ensure patient needs are addressed before issues escalate and require higher-cost interventions.

D2C telepsychiatry: A natural fit for telehealth

The American Telemedicine Association defines telehealth as “the remote delivery of healthcare services and clinical information using telecommunications technology.” The more popular forms of telehealth rely on real-time videoconferencing to deliver services and address patients’ needs, emulating the kind of in-person exchange and connectivity experienced in a provider’s office setting. Continued growth of D2C telehealth underscores the attractiveness of the videoconferencing model, as patients—increasingly empowered in their own care choices—seek direct access to providers and alternative options to more conveniently manage their care.

When it comes to telehealth for behavioral health, telepsychiatry is now used for evaluation, consultation, and treatment throughout the care continuum, and it can be found in settings that range from acute inpatient settings and emergency departments (EDs) to community-based care environments and in-home referrals from primary care doctors and discharge planners.

D2C telepsychiatry takes the burden off primary care providers and expands referral options in areas lacking adequate psychiatric services. With additional providers available, patients are empowered with greater choice, rather than limited by what is within a drivable radius. Beyond primary care providers, community-based professionals such as referral coordinators, benefit managers, and discharge planners can leverage this option to help consumers access qualified behavioral health specialists in a timely manner.

Collaborative care between telepsychiatry providers and patients’ primary care and regular providers can also extend the value proposition of D2C telepsychiatry by improving coordination, increasing clinical exchanges and connecting a patient’s community of caretakers for more holistic care.

The advantages of D2C

D2C telepsychiatry delivers inherent advantages for both patients and providers, including:

Flexibility. Consumers can schedule appointments outside of traditional weekday time slots, including nights and weekends, and can often find available appointments within a few days of their request.

Convenience. Services can be accessed from any private location leading to better continuity of care. For example, consumers can continue treatment with the same psychiatric provider during life transitions, such as moving to a new city for college.

Privacy. Like in-person care, telepsychiatry protects the privacy of patients. In fact, confidentiality may be heightened since appointments are accessed from home, eliminating the potential that patients will see someone they know in a waiting room—a concern that keeps many from seeking out treatment.

High-quality care. Telepsychiatry meets the standard of traditional in-person care for diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction. Along with all major national healthcare associations, the American Psychiatric Association supports the use of this model.

Implementing telepsychiatry

Healthcare organizations interested in utilizing D2C telehealth and telepsychiatry should, of course, consider situational nuances prior to determining the best course of treatment. Conditions such as anxiety, depression, stress, life transitions, childhood mood disorders, and ADHD align well with D2C telepsychiatry. However, it is not appropriate for patients who display suicidal, homicidal, delusional or paranoid symptoms.

In addition, providers should keep in mind that while most people have access to reliable internet connections and smart devices that can support telepsychiatry, not everyone has this luxury. Prior to making referrals, providers should assess a patient’s ability to follow through with the telepsychiatry option.

The potential of D2C telepsychiatry

D2C telehealth models, and specifically telepsychiatry, represent a disruptive care delivery movement that is laying the groundwork for a more connected community and collaborative care continuum. By improving access, these forward-thinking models of care promote early intervention, addressing issues before they escalate and require higher-cost interventions. Ultimately, it’s an optimal framework for improving outcomes and empowering consumers in their care.

Original article posted in Oliver Wyman Health.

HERSHEY, PA – Franklin Family Services, a network of outpatient behavioral health clinics in Pennsylvania, launched a telepsychiatry program this week to increase access to psychiatric care in several of their locations (Carlisle and Camp Hill).

Telepsychiatry is the delivery of psychiatry through real time videoconferencing. It is proven to be an effective form of care delivery and a great way to expand the psychiatric support at a clinic without having to staff an in-person psychiatrist.

This is a great solution in Pennsylvania and in many other states across the nation where there is a shortage of psychiatrists. Telepsychiatry allows one provider to easily serve multiple sites without having to spend time commuting between various locations.

About Outpatient Telepsychiatry Program

The telepsychiatry program is launched in partnership with InSight, a national telepsychiatry service provider organization. Telepsychiatry services provided include all the same services someone would receive in-person through their telepsychiatry provider, Dr. David Kaicher.

Dr. Kaicher is a Pennsylvania licensed, board certified adult psychiatrist. Dr. Kaicher has published research in The Journal of ECT and Urology, and completed his residency at Mt. Sinai Hospital and Saint Vincent’s Catholic Medical Center, his doctorate at Rutgers New Jersey Medical School and his Master of Arts in Psychology at New York University.

With this program, Franklin Family Services aims to treat the behavioral health needs of adults, adolescents and families so that they can achieve their potential through a balanced, healthy lifestyle. Telepsychiatry allows for unprecedented access to specialists, so that Franklin Family Services can better serve its community across its three locations.

“We’re happy to be able to leverage telepsychiatry to serve several of Franklin Family Services’ different communities. By sharing a psychiatric provider across multiple clinics everyone gets the psychiatric care they need in the most efficient way,” said InSight’s Operations Director Dena Ferrell.

“We are thrilled to be able to offer this exciting new service to our clients. We are dedicated to increasing psychiatric access to all consumers and this is a smart way to meet the community need,” said Dana M. Matheson, MA, LPC, Clinical Director, Franklin Family Services.

It is estimated that 1,051,490 individuals in Pennsylvania are living with serious psychological distress including major depressive disorder, bipolar disorder, panic disorder or anxiety.[1] The telepsychiatry program will allow Franklin Family Services to increase their ability to treat those that need care the most.

About InSight + Regroup

About Franklin Family Services

Franklin Family Services (FFS) is a private, social-service agency for youth and families. Founded in May 2003, we operate outpatient clinics from Greencastle to Hershey, PA, providing intensive home- and community-based interventions for children, adolescents, adults, and families in the child welfare, juvenile justice and mental health systems.

[1] National Institutes of Mental Health, National Survey on Drug Use and Health (NSDUH) 2015, and NSDUH-MHSS 2008-2012.

By: Joel Friedman, PhD

For more than 25, years I have had the opportunity to provide outpatient behavioral healthcare services. During that time, I have observed the tremendous benefits thousands of individuals receive through access to care. My colleagues and I have the privilege of being a part of the process in which individuals make changes that significantly improve their quality of life. In some cases, these changes have literally been life-saving. We are becoming increasingly aware of how prevalent mental health disorders are in our communities, and through that awareness, we have come to realize that for each individual who is able to access effective behavioral healthcare, there are many others who are unable to do so.

Access to behavioral healthcare has been a challenge for decades. Dating back to the Community Mental Health Act of 1963, the vision people have had for access to behavioral healthcare has not been matched by the availability of services. The good intention of the community mental health center movement to “deinstitutionalize” individuals led to an increase in the need for treatment in the community. Unfortunately, the community resources were not nearly enough to keep pace with the growing need for treatment.

Improving Resources to Health Care via Telebehavioral Health

In addition to the insufficient number of available licensed behavioral healthcare providers and the limitations on insurance coverage for behavioral healthcare, there are many other factors that can influence accessibility of effective clinical services. People who utilize behavioral healthcare services frequently require sessions with their providers several times each month. The effective provision of treatment models such as Cognitive Behavioral Therapy (CBT) often involves dynamic interactions between the clinician and the patient on a regular basis. The application of CBT includes homework assignments that need to be reviewed and analyzed to ensure that progress is being made. Additionally, many psychotropic medications need to be closely monitored for side effects as well as their effectiveness in treating presenting symptoms, especially at the onset of treatment.

For some individuals, transportation to an office or facility in which behavioral healthcare is provided is not consistently available. Thus, they may not engage in treatment at all or receive insufficient treatment if they are required to travel to the clinician’s office. Other individuals may have access to reliable transportation but have young children and do not have childcare arrangements that will allow them to attend appointments at the clinician’s office.

Mental health disorders can affect individuals in a variety of ways. Some individuals suffer from intense symptoms of anxiety or panic. For those individuals, leaving their home on a regular basis is often not possible. Other individuals may suffer from paranoid ideation to the point that sitting in a waiting room among other patients while awaiting an appointment may be more than they can tolerate. Some individuals suffer from profound symptoms of depression and may not have the energy or motivation to leave their homes and travel, even for treatment of their symptoms.

While progress has been made in reducing the stigma associated with mental health disorders, a great deal of bias still exists. Many people elect not to pursue behavioral healthcare due to concerns about how they may be perceived by others if it becomes known they have received such services. In some cases, privacy may be crucial. For example, a teacher may not be uncomfortable sitting in a waiting room with one of their students while awaiting an appointment with an optometrist. However, that same teacher may feel very uncomfortable sitting in the waiting room of a psychiatrist or therapist and have a student walk in. Privacy in behavioral healthcare belongs to the patient—if he or she wishes to maintain it, our field is required to protect it as much as possible.

The benefits of behavioral healthcare via telebehavioral health

Over the past several years, I have observed the benefits that are associated with the provision of behavioral healthcare via telebehavioral health. Improved access to care is among the most significant of those benefits. Transportation issues that often prohibit individuals from receiving care at an office can be eliminated. Individuals with young children can often negotiate their childcare needs much more easily if their appointments do not involve travel to and from an office and dealing with a crowded waiting room. At some points during treatment the condition for which an individual is seeking treatment may be the reason why they do not access services. Symptoms of anxiety and/or panic, paranoid thoughts, or depression may be debilitating at times. If care is brought to the individual in their home, they may be able to progress to the point that they will then have the option of services provided at an office as well as in-home treatment. If in-home services are not available when the person is at a particularly difficult point in their ability to function, the risk of an undesired outcome is much greater.

We are continuing to make strides in our understanding of mental health disorders and in our ability to effectively treat those conditions. Expanding access to care for individuals who need behavioral healthcare treatment is not only an option we should pursue, it is an obligation if we are to reach those who may be in the most need of care.

Original article posted in Health Management Technology.

Mental Health Weekly
By: Gary Enos

As administrators of a general hospital with no specialized psychiatric unit, leaders at Chester County Hospital in eastern Pennsylvania had become accustomed to a waiting game for psychiatric consultation when a patient with clear mental health needs presented in their emergency department. As is the case at a growing number of general hospitals around the country, telepsychiatry is providing these leaders with an alternative to what can become a crisis in emergency operations — as well as for patients in need.

In partnership with national telepsychiatry company InSight Telepsychiatry, LLC, Chester County Hospital is now using video technology to enable it to receive expert consultation on cases, usually within an hour of making initial contact.

This reduces wait times for services and creates more effective referral to specialty mental health treatment services in the community, while in other cases it simply might offer a more rapid and expert confirmation that a patient with mental health needs can be safely discharged.

“In the emergency department, the availability of specialty services is always difficult,” Betty Brennan, Chester County Hospital’s director of emergency services, told MHW.

“We were finding that the availability of psychiatrists was increasingly more difficult, because of their professional load in their offices. The immediacy that we needed just wasn’t there.”

The hospital’s phone calls to other facilities to see how they were handling the issue of delays in mental health patient transfer or discharge led the organization to InSight in 2011.

Brennan said the high quality of communication between patient and remote provider via video gives her confidence that the sessions between patient and psychiatrist virtually duplicate the more common face-to-face experience. “You almost forget in today’s world that you’re talking on videoconference,” Brennan said of the telepsychiatry experience.

The hospital launched its work with telepsychiatry for evening and overnight hours but has since expanded the program in order to maintain round-the-clock coverage.

The Encounter

In a typical scenario, a patient might present with suicidal ideation and be seen immediately by an emergency physician on the hospital staff. Once an initial level-of-care evaluation takes place in the ER setting, the hospital will contact In- Sight’s Access Center and transmit a patient history.

Brennan said InSight provides a number of psychiatrists for the telepsychiatry services, and the hospital has been able to develop a rapport with these individuals over the course of the project. (The psychiatrists are required to be credentialed at the hospital facility with which they are working.)

Often the hospital staff physician will speak with the psychiatrist before the specialist conducts the patient interview. For the video interviews, the hospital uses several secure rooms that are located a fair distance from any hospital exits. A hospital employee, such as a nurse or a member of the security team, is required to be present while the patient is being assessed via video.

The interviews are highly detailed and usually last anywhere from 20 to 45 minutes, Brennan said.

The high-definition videoconferencing equipment helps to establish a process that very closely approximates what occurs in a face-to-face interview, she said.

“We’ve never had a patient refuse,” Brennan said, as the message to them becomes one of facilitating necessary services in the quickest manner possible. “The physicians are very skilled, and the patients like that it’s private.”

A written consult from the psychiatrist is faxed to the hospital upon completion of the specialist’s interview and evaluation. “We’re not waiting for a psychiatrist to come in when his office hours are over,” Brennan said.

Often it is the case that the psychiatrist’s consultation offers a rapid confirmation of a course of action that was already apparent to the hospital staff, from a referral to a specialty behavioral health facility in the community to a discharge without extensive follow-up.

Brennan added that having this service available not only helps establish more effective linkages with mental health providers outside the hospital for followup care, but also speaks to a more humane way of addressing patient needs.

“There is an increased focus now on the rights of the mental health patient, and on getting them to the right facility,” she said.

Additional Applications

Brennan believes the telepsychiatry option can work equally well for adult and adolescent patients. The secretary of the Delaware Department of Health recently said that telepsychiatry could assist in reaching underserved young people in a state that this year has seen a significant number of teen suicides related to unaddressed mental health needs.

Brennan said the telepsychiatry experience at Chester County Hospital has proven so effective that the hospital has begun to extend telehealth into other operations. It is now using similar technology for evaluations of stroke patients, she said.

Other hospitals across the country that are working with InSight technology have reported similar improvements in wait times and overall emergency operations as a result of telepsychiatry’s availability.

“On occasion, patients are taken to the hospital under the Baker Act for a behavioral issue when they’re actually under the influence of drugs or alcohol,” said Eddie Carie, behavioral health case manager at South Florida Baptist Hospital in Tampa.

“These patients used to wait days for a psychiatrist’s evaluation. Now, we’re able to have a psychiatrist evaluate the patient and make a decision within hours.”

TRENTON, NJ – New Jersey Governor Chris Christie signed Bill No. A1464 and S291/652/1954 on July 21^st which allows for the practice and reimbursement of telemedicine and telehealth across the state. Before being signed by the governor, the telemedicine bill had bipartisan support and was passed unanimously through the New Jersey General Assembly and the Senate.

“Telehealth” as defined by the bill is the use of information and communications technologies to support clinical healthcare, and “telemedicine” is defined as the delivery of a health care service using electronic communications to bridge the gap between a health care provider and a patient. Telemedicine and telehealth are rapidly growing across the U.S. The American Telemedicine Association estimates that over half of U.S. hospitals use some form of telemedicine. Telemedicine has proven to be particularly effective for increasing access to care from specialty providers who no longer have to be physically present to deliver care.

One example of specialty care that this telemedicine law will help bring to New Jersey is access to child and adolescent psychiatry. New Jersey is estimated to need at least 3 times more child and adolescent psychiatrists in order to qualify as having a “sufficient supply” by the American Academy of Child and Adolescent Psychiatry.

While telemedicine policies vary in each state, the signing of this bill will make New Jersey one of the most innovative and patient-centered telemedicine states in the country. The state is already home to a handful of telemedicine programs, and the new law will provide the opportunity for the continued expansion of telemedicine.

“We’re enthused by the opportunities for improved access to care that this new law brings to the telemedicine industry and to New Jersey,” says Geoffrey Boyce, Executive Director of InSight Telepsychiatry, a national telepsychiatry service provider headquartered in New Jersey who helped to draft and advocate the bill. “We are thankful for the years of hard work the legislators and other advocates have put into making this come to life.”

Highlights of the new telepsychiatry legislation

They allow New Jersey to join only a handful of states that require reimbursement for telemedicine services to the same extent as for in-person treatments and consultations.

They take New Jersey from being only one of two states that lack an official definition of telemedicine to a state that defines how telemedicine can and should be safely and appropriately practiced.

They allow greater access to care for patients who were previously not covered for telemedicine services. Greater access to care is expected to result in better outcomes for patients with chronic diseases and decreased expenditures over time.

They allow patients to receive care from the comfort of their own homes when appropriate.

They remove the requirement for mental health screeners to obtain an unnecessary, special waiver for services provided through telemedicine.

They allow a large range of providers to practice telemedicine including: licensed physicians, nurses, nurse practitioners, psychologists, psychiatrists, psychoanalysts, clinical social workers, physician assistants, professional counselors, respiratory therapists, speech pathologists, audiologists and optometrists. This wide range of providers will increase the number of services that New Jersey residents can access.

They involve minimal cost to the state while providing greater access to care and better outcomes for patients.

The legislators who helped champion this bill and ensure that New Jersey residents have better access to care include: Pam Lampitt (D), Joseph Vitale (D), Herb Conaway Jr. (D), Craig Coughlin (D), Valerie Vainieri Huttle (D), Joe Lagana (D), Raj Mukherji (D), Jim Whelan (D), Diane Allen (R) and Shirley Turner (D).

The enactment of this bill is a significant step for the telehealth industry and increased access to care in the state of New Jersey.