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Hospital emergency departments (EDs) across the country are experiencing a surge in the number of patients presenting with mental health issues. This trend is due to a combination of factors, including lack of community mental health services, cost and coverage barriers, insufficient outpatient resources and inpatient treatment options and a nationwide shortage and uneven geographic distribution of psychiatrists.

Given this, patients seeking behavioral health treatment face long wait times and may have to travel significant distances for an appointment. They may also have trouble finding psychiatry practices accepting new patients or that take their insurance since many have converted to cash-only private practices. Therefore, with nowhere else to turn, these patients are increasingly relying on EDs for behavioral health care.

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It has been a year like no other and that’s particularly true for the telemental health and telepsychiatry industries.

Unfortunately, mental health need has spiked during COVID-19, which has brought on the removal, at least temporarily, of nearly every barrier that previously limited telehealth.

While telehealth advocates have preached that telehealth is health, in 2020, we saw that come to fruition, particularly within the behavioral health space. You’d be hard pressed to find a behavioral health clinician today who has not held a remote session. So, what does this mean for the future?

As we look into the year to come, here are six trends we predict to see in 2021.

  • Care for clinicians - Our health care workers, including mental health care clinicians are the heroes of the year, shouldering the burden, stress and pain of so many. This sacrifice comes at a cost. The burnout and fatigue clinicians are feeling are real and measurable. Employers are pouring resources into mental health support programs for their teams. In 2021, we predict these types of programs to finally become a permanent priority.  
  • Crisis Intervention Teams expanding their reach by leveraging telehealth - As many communities have look closely at their police programs and funding in 2020, we anticipate a rise in crisis interventions teams or mobile crisis units that can bring trained mental health experts into the community to better respond to individuals in crisis. CITs, paramedic teams or even law enforcement can have more robust in-the-field support by leveraging remote behavioral health clinicians who can help assess risks and direct individuals to the appropriate level of care and support.  
  • Collaborative Care The connection between physical and mental health is indisputable, and payers across the country are doubling down on programs that help bring mental health care clinicians into individual’s primary care treatment teams. This is most efficiently done via telehealth. We anticipate major growth in this segment in 2021.  
  • Treatment teams in crisis settings - As the strain on mental health care clinicians worsens, it is vital to make the highest and best use of all mental health resources. Accordingly, we are beginning to see modifications to crisis telepsychiatry programs that layer in different levels of remote behavioral health clinicians to help with screening, triage and care. This trend, paired with a newfound desire for behavioral health clinicians to work remotely (at least for part of their week), means we expect to see more and more remote telepsychiatry teams serving all settings of care.  
  • Focus on disparities - 2020 put an important and needed lens atop healthcare disparities. We are seeing new telehealth organizations pop up that specialize in telemental health for populations with social, economic and/or environmental disadvantages and more focus placed on these efforts from existing telemental health players. One size does not fit all when it comes to mental health care, and determining the most effective ways to reach and appropriately address the needs of underserved populations must be a priority for all in 2021 and beyond. 
  • Telehealth regulations WILL change permanently 2020 was a regulatory sandbox for telehealth. Regulators moved incredibly quickly to greenlight any and every regulation that increased access to care via telehealth – however most of this year's changes were/are temporary and dependent on the public health emergency. As the CMS administrator, Seema Verma delivered what some consider the telehealth quote of the year: “The genie's out of the bottle on this one I think it's fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there's absolutely no going back." 

We are ready for permanent action. The telepsychiatry industry predicts and respectfully calls for regulators to make it happen. Here’s the short list:  

  • Reimbursement - by CMS and by every private payer for all aspects of mental health care regardless of the modality, including audio-only encounters. It must happen and it must expand.  
  • Simplified Licensure - In late November, a group of Congressmen introduced a bill (HR 8723) that would prevent states from receiving some forms of HHS funding unless they’ve joined the interstate medical licensure compact which makes it easier for physicians to use telehealth to treat patients across state lines. This bill showcases a sentiment we expect to follow us well into 2021. Unnecessary hoops to jump through in order to serve patients must go. 
  • Appropriate Controlled Substance Prescribing via Telehealth We must enact permanent policies to ensure access to behavioral health services via telehealth in order to address the opioid epidemic and other widespread behavioral health conditions. We call for the DEA to make a permanent and long-promised option for controlled substance prescribing via telemedicine under the Ryan Haight Act.

About the Author: Olivia Boyce, MPH is the chair of the American Telemedicine Association’s Telemental Health Special Interest Group and a Vice President at Array, the leading national telepsychiatry organization and a long time telehealth advocate.

About Array

Array Behavioral Care (formerly InSight + Regroup) is the leading and largest telepsychiatry service provider in the country with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care from hospital to home with its OnDemand Care, Scheduled Care and AtHome Care divisions. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.

Healthcare systems and individual hospitals can evaluate their very own metrics against industry data to evaluate cost and revenue implications of an investment in on-demand telepsychiatry.

(October 22, 2020) – Array has launched a customized capability using a value calculator to help hospitals and healthcare systems evaluate costs associated with their current process for managing behavioral health patient demand against savings and revenue opportunities.

The unique tool responds to a long-standing need for hospital administration to quantify the expected return on investment of behavioral health coverage via on-demand telepsychiatry. This new capability comes at a critical time as the industry faces unexpected operational and financial challenges. Many facilities are seeing a rise in demand for mental health services, while a simultaneous drop in ED visits in the wake of COVID-19 is presenting financial strain.

For hospitals and healthcare systems considering on-demand telepsychiatry to meet growing patient need for mental health services, implementing a financially sustainable and scalable program is essential:

  • 25% of all emergency department visits are due to behavioral health issues
  • 3X longer emergency department boarding times for mental health admissions vs. non-mental health admissions

On-demand telepsychiatry can have a positive financial ripple effect that extends well beyond emergency departments, including reduced reliance on scarce inpatient psychiatric resources, reduced inpatient psychiatric admissions, improved emergency department throughput and increased capacity for med-surg admissions. It allows healthcare systems to allocate resources to populations with heightened need and acuity to reduce strain on clinicians and improve operational metrics.

Array's value calculator uses proprietary logic based on more than two decades of experience implementing programs and delivering telepsychiatry services within hospitals and health systems. Customizable to organizations of all sizes, the tool uses validated data, clinical research and demonstrated outcomes to help organizations determine the financial impact of on-demand telepsychiatry applied to their specific use case. It takes into account actual direct and indirect costs using current behavioral health demand within the facility in order to quantify specific areas of cost savings and highlight untapped revenue opportunities.

Using key data on current behavioral resources and gaps, such as patient length of stay, bed capacity and existing clinical coverage, hospitals and health systems can:

  • Isolate specific metrics that impact overall cost of care to understand where and how telepsychiatry can drive savings
  • Compare actual data against industry benchmarks to evaluate the broader impact of telepsychiatry on operational, financial and clinical outcomes
  • Validate where and how on-demand telepsychiatry is appropriate in a variety of applications across the health system
  • Provide a clear, customized picture of potential ROI to aid in decision-making and the development of a justifiable business case

“We understand the key role on-demand telepsychiatry can play in helping hospitals deliver financially sustainable care, but it has typically been challenging for leadership to quantify its impact at a detailed level,” says David Cohn, Chief Growth Officer at Array. “Now, this capability allows us to collaborate with healthcare organizations and give them a fresh, detailed view of their current cost exposure and expected operational outcomes and financial returns from on-demand telepsychiatry programming.”

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About Array

Array Behavioral Care (formerly InSight + Regroup) is the leading and largest telepsychiatry service provider in the country with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care from hospital to home with its OnDemand Care, Scheduled Care and AtHome Care divisions. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.

Array Behavioral Care's CEO, Geoffrey Boyce, joins the Partnership to Advance Virtual Care to share lessons learned from the pandemic and how changes to legislative and regulatory environments could support patients and providers moving forward. 

You’ve experienced the telehealth surge firsthand at the height of the public health emergency. Now, hear from Array and other leading providers on how we deployed telehealth solutions and supported patients during COVID-19, and how the healthcare industry can work together to maintain the positive momentum we’ve witnessed with telehealth implementation.


About Array

Array Behavioral Care (formerly InSight + Regroup) is the leading and largest telepsychiatry service provider in the country with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care from hospital to home with its OnDemand Care, Scheduled Care and AtHome Care divisions. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community healthcare organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations.  To learn more, visit www.arraybc.com. 

Now is the time for telebehavioral health. We’ve seen a remarkable evolution for a rapidly changing telehealth industry, and the virtualization of behavioral health interactions is exploding as the need for mental health services rises and is predicted to continue. 

Array (formerly InSight + Regroup), the industry’s most experienced telepsychiatry service organization, will share fundamental best practices for implementing hospital-based telepsychiatry and discuss Illinois’ regulatory landscape. 

The webinar will cover a variety of topics, including:  

  • Hospital and health system applications of telepsychiatry 
  • How telepsychiatry has helped in response to COVID-19 
  • Illinois regulatory changes (reimbursement, HIPAA compliance, prescribing and licensure) 
  • Operational and financial outcomes derived from on-demand telepsychiatry (ROI) 
  • Lessons learned and how they will shape the future of telehealth care delivery 

Join Scott Baker, MBA, Vice President & Senior Group Lead of Partnerships as the discusses how telepsychiatry gives hospitals the ability to achieve quick, safe throughput to ensure proper use of ED and inpatient unit resources while driving a return on the investment of telepsychiatry. 

For questions, contact webinar@arraybc.com

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Virtually Caring for Behavioral Health

Telebehavioral health has been accepted as a proven medium for increasing access to psychiatric, mental and behavioral healthcare by connecting individuals to providers through video calls. Today, in-home, mobile, outpatient and primary care models of telebehavioral health allow for community-based care that addresses behavioral health issues before they reach critical levels. On-demand models of care offer timely services to individuals in the emergency department (ED), psychiatric crisis centers or in the community through mobile crisis teams. There are more patients, employers, health systems and payers employing telehealth, as well as more providers becoming involved in telehealth work in a range of fields, like psychiatry.

The first thing to ask yourself may be, “What are my organization’s overall strategic priorities?” Example questions may include:
• What is my vision for the next [x] number of years?
• How do I evaluate progress toward that goal?
• How does telehealth already fit in or how could it?
• Who is responsible for tracking the telehealth industry within my organization?
• How do I share and apply that information across my organization?

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Treating the Whole Patient

Quality behavioral health care remains frustratingly out of reach across America. With few psychiatrists available in many parts of the country, this lack of coverage comes during a time when many of these services are needed now more than ever. Against this backdrop, the need for innovation in practicing quality mental health care is resoundingly clear

To treat the whole patient, we must first understand the key factors behind the mental health care shortage

  • A shrinking pool of providers
  • Uneven distribution of clinicians
  • Growing needs for mental health services
  • Patient barriers to care

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More clinicians are choosing to work in telehealth than ever before. As the industry matures and more competitors enter the market, clinicians have more options in where they chose to work.  What makes them choose one provider organization over another?  

Telepsychiatry is changing the way mental health services are being delivered. Telepsychiatry not only transforms access to care for patients, but it also offers clinicians unparalleled job flexibility and opportunities for growth.   

The clinician network at Array continues to grow rapidly as we regularly add new psychiatrists and other behavioral health professionals to our team. In the past 6 months, more than 200 clinicians and 18 supporting administrative members have joined our teamIn addition to these new hires, we have numerous existing clinicians who have been with our organization for many years.  

These new and seasoned clinicians alike share what initially attracted them to Array and why they chose to stay: 

Work-Life Balance 

Array prioritizes the well-being of clinicians and administrative team – the mental health of our patients starts with us. Aside from the flexibility that comes with working from home and choosing your own schedule, we’ve established a wellness committee and clinician engagement team who continuously promote healthy work-life practices and on-going education. 

Longtime Array clinician, Julie Lu, a psychiatric NP who has worked with us for several years explains why she enjoys working in telepsychiatry. 

“What I like most about practicing telepsychiatry is that it feels like I’ve found more time in the day; I no longer have to fight traffic during a long commute. That time is now better used talking to patients and my clinic staff. The technology has allowed me to reach across the distance and make connections with patients who might otherwise still be on a wait-list to be seen by a psychiatric provider.”  

Focus on Clinical Care 

Array has an unmatched internal technical and administrative infrastructure backing its clinicians. We offer around-the-clock clinical, operational and technical support designed to help clinicians with their delivery of care every step of the way. Clinicians enjoy support from a large responsive team so they can focus on what they do best – providing patient care.  

Array offers reliable support via admin staff, care navigation team and user-friendly systems. Thank you, Array for allowing me to put 100% of my energy into providing therapy.” - Kelly Wood, LCSW 

Being Part of a Team 

Collaboration is a cornerstone of our organization. Through collaboration, Array clinicians develop strong professional relationships with their partner site as well as with their telepsychiatry peers and administrative support staff. Clinicians are not providing care “on an island” by themselves; our clinicians can find reassurance in having systems in place that makes it easy to communicate with colleagues and collaborate with necessary personnel in order to deliver the highest-level care  

When community health clinics across the country had to close or temporarily suspend services during the coronavirus crisis, one of our partners, the Fauquier Free Clinic in rural Virginia, in collaboration with our clinician, Dr. Azpiri, was able to quickly convert from facility-based to home-based virtual care so their patients could continue to receive much-needed mental health services. 

“I am so grateful that patients have been so receptive to this new approach. They have been so welcoming and inviting and flexible, which is a big reason we’ve been able to pivot so quickly and successfully to in-home virtual care. Delivering care directly to patients in their homes gives me a glimpse inside their private worlds, without being overly intrusive. I can assess environmental cues such as the orderliness and cleanliness of their surroundings, appearance, food needs, etc. This allows me to really see how they are doing physically, emotionally and mentally and determine if additional support is needed.” – Alicia Azpiri, MD 

Expanding Organization 

Following the recent merger between InSight Telepsychiatry and Regroup Telehealth in December 2019, even more clinicians have inquired about clinical opportunities with our newly combined organization. The merger created a larger, more comprehensive nationwide team that allows us to grow more quickly and strategically. With a bigger footprint and opportunities in various settings across the continuum of care, we are able to offer clinicians different options for where and how they practice. Clinicians also benefit from, our collective partnerships, expertise, leadership and resources; together we are truly transforming access to care. 

Clinician Choice in Care Setting 

Array is the only telebehavioral health care organization that offers clinicians the flexibility to select among multiple models, serve multiple organizations and work with multiple patient populations. Clinicians have the opportunity to choose from a myriad of settings such as emergency departments, hospital medical/surgical floors, inpatient units, mobile crisis programs, crisis centers, residential programs, primary care clinics, community health centers,  tribal programs, correctional facilities or direct-to-consumer. Given the multitude of options available, we work with each clinician from the start to figure out the best care setting for them. We discuss their individual needs and preferences as well as the needs of the organization to ensure long-term success. We have found that uniquely matching our clinicians and partners and maintaining a strong line of communication has enhanced clinician satisfaction. 

“I have been a psychiatrist with Array for 2 years. It has been a phenomenal work experience. I enjoy rotating my days between an outpatient clinic, a correctional facility and a commercial insurance/home setting. It keeps my clinical work interesting and my skills sharp.” - Betsy O’Brien, MD  

Work for an Established Reputable Organization 

Array is the pioneering leader in telepsychiatry. For the past two decades, our mission has remained the same – to transform access to quality behavioral health care. Clinicians appreciate the stability and reassurance of working for an established and rapidly growing organization that has the technical, clinical and operational support to make them successful. Clinicians can engage with telepsychiatry peers, learn from behavioral health thought leaders and clinical experts.  

The collaboration between professionals, flexible hours, and ability to work with a company whose values and standards are in alignment with mine are some of the reasons why I continue to choose Array as an employer. I enjoy working in telehealth; it's a rewarding and humbling experience to be invited into a patient’s home once a week for online therapy and have the opportunity to observe and help them when their most vulnerable.” – Robert Cleveland, LCSW 

Array uses the Net Promoter Score (NPS) metric that assesses clinicians’ experience with our organization by asking them how likely they are to recommend us to a friend or colleague. The final aggregate NPS score can range from as low as –100 to as high as 100. With the most recent clinician NPS scores for the two organizations averaging 55, it’s clear that clinicians like working at Array.  We are committed to fostering the best clinician experience possible to ensure they can deliver the best in class care. 

What do you look for in a telebehavioral health employer? We’d love to hear from you. Visit this link to either share your ideas or to discuss the various telepsychiatry opportunities available at Array. 

Communities across the nation face a shortage of behavioral health providers. Approximately 123 million Americans live in a mental health professional shortage area[1] and 96% of counties in the U.S. have an unmet need for psychiatric prescribers.[2]

In order to address the increasing number of individuals seeking mental health care from primary care practices, many organizations turn to behavioral health integration. Behavioral health integration brings mental health specialists into the primary care setting and creates teams of mental health and primary care providers working together with individuals and their families to provide the best possible treatment.

Fifty-five percent of counties in the United States currently have no psychiatrists available, according to a new report.[3] This severe shortage is impacting the country’s health care system, particularly for primary care providers and nurse practitioners, who increasingly have to treat and/or prescribe for mental or behavioral health conditions.

Moreover, the delivery of specialized mental healthcare can be out of the realm of expertise or exceed their comfort level for many primary care providers. When the scenario arises, it makes sense to refer care to a psychiatrist or other mental health provider. Yet, due to the current shortage of psychiatrists, patients often wait weeks—sometimes even months—to be seen by a local psychiatry provider.

In the U.S., one in four primary care visits are for mental health conditions. Primary care providers write 70% of antidepressant prescriptions, which is approximately 30 million prescriptions annually.[4]

Telepsychiatry allows primary care practices to connect with remote psychiatric providers, including specialists such as child and adolescent psychiatrists, and offer mental health care to individuals in their office. InSight + Regroup has several primary care integration programs. Highlighted here is an innovative collaborative care pilot program located in a health system.

Morris Hospital & Healthcare Center

Morris Hospital and Healthcare Centers has been serving the Chicago area since 1906. Located in Morris, Illinois, their 89-bed hospital serves residents in five counties. Along with their main hospital, they have offices in 25 other locations.

In 2018, they implemented a telepsychiatry program within their emergency department to serve individuals presenting with a mental health concern. The next year, they started a collaborative care pilot program after recognizing the mental health need in the primary care setting. This program was developed in collaboration with the AIMS Center at the University of Washington. During this time, Morris Hospital and Healthcare Centers also worked closely with the Collaborative Family Healthcare Organization (CFHA). This national integrated care association advocates for behavioral health integration in the primary care setting and has served as a mentor for Morris Hospital and Healthcare Centers. Through implementation coaching and support services, the collaborative care pilot program was launched in February 2019. A licensed social worker serves as a care manager and splits their time between two offices. The program utilizes a telepsychiatry provider to serve as a consultant on mental health cases.

The aim of this program is to improve behavioral healthcare services by placing social workers and mental health professionals in primary care offices. Morris Hospital and Healthcare Centers employs 37 primary care providers and has approximately 109,000 outpatient visits per year. With the mental health professional shortage, many individuals seek mental health services from their primary care providers. However, primary care providers are not adequately equipped to treat mental health disorders.

The collaborative care team addresses mental health concerns in the primary care setting as opposed to referring off-site for those services. They track a defined patient population in a registry to ensure patients do not fall through the cracks. The care manager discusses patient cases with a consulting psychiatrist on a weekly basis and the psychiatrist makes treatment recommendations. The telepsychiatry provider meets with the treatment team of primary care doctors and clinical social workers to do chart reviews for four hours each week via video. The telepsychiatry provider does not work with patients directly, but helps to advise and support primary care providers with their cases.

Then, the care manager relays the recommendations to the primary care provider and patient. The care manager also provides the patient with psychotherapy using techniques such as behavioral activation and problem-solving therapy, both of which have been shown to be effective in the primary care setting.

To date, Morris Hospital and Healthcare Centers has seen patients in the pilot program become more engaged in their treatment plans.  In order to determine success of the program, Morris Hospital and Healthcare Centers uses a caseload tracker to track information such as PHQ-9 scores, GAD-7 scores, weeks in treatment and number of sessions to see how a patient evolves over time and how involved they are in their care. Since implementation, patients are more involved and are more likely to follow through with appointments and treatment plans.

Patients have truly embraced this model and have commented that it helps to decrease the stigma associated with mental health issues. In addition to the patients, the primary care providers have embraced the Collaborative Care model as well. By having a team member who can help address mental health concerns, primary care providers are more comfortable learning to treat mental health concerns and manage medications that were previously outside of their comfort zones.

The main goal for this program was to serve patients visiting their primary care providers with mental health concerns. Eventually, Morris Hospital and Healthcare Centers would like to see Collaborative Care services available at all primary care sites. In Illinois, there was recently an exciting development. Gov. J.B. Pritzker signed into law a Senate bill that requires private insurance companies and Medicaid to reimburse for Collaborative Care services. This is a win for integrated care and supports the Collaborative Care programs that are ensuring individuals have access to mental health services. Morris Hospital and Healthcare Centers is excited to see Collaborative Care continue to grow and impact the lives of individuals in their communities.

In order to promote this program to encourage replication, Morris Hospital and Healthcare Centers has presented on their Collaborative Care model in a variety of settings including at a special telemental health workshop during the ATA2020 virtual conference and the Caravan Health’s ACO Symposium. Additionally, Becker’s Hospital Review recently interviewed Dr. Jennifer Thomas, a family medicine physician and Doctor of Integrated Care at Morris Hospital and Healthcare Centers, to learn more about their innovative program.

[1] Peterson-Kaiser Health System Tracker. (2019). Retrieved from https://www.healthsystemtracker.org/?sfid=4356&_sft_category=access-affordability,health-well-being,spending,quality-of-care

[2] Konrad, T., Ellis, A., Thomas, K., Holzer, C., & Morrissey, J. (2009). County-Level Estimates of Need for Mental Health Professionals in the United States. Psychiatric Services, 60(10). doi:10.1176/appi.ps.60.10.1307

[3] https://www.newamericaneconomy.org/press-release/new-study-shows-60-percent-of-u-s-counties-without-a-single-psychiatrist/

[4] Barkil-Oteo, A. (2013). Collaborative Care for Depression in Primary Care: How Psychiatry Could “Troubleshoot” Current Treatments and Practices. The Yale Journal Of Biology And Medicine, 86(2), 139. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670434/

This year has seen remarkable changes across every element of the healthcare landscape. From the unforeseen curve ball thrown at a vulnerable U.S. healthcare system to the rapid, necessary adoption of telehealth across all care settings, 2020 is nothing like we’ve dealt with before.

With all this change comes a need to be introspective and understand how we can prepare for the days, weeks, months and years ahead. Array maintains partnerships with hospitals and health systems across the nation under unique circumstances to ensure access to timely psychiatric assessments.

To help give us a clearer picture of what hospitals have experienced and may continue to endure related to mental health patients, Array SVP & Medical Director, Dr. Mark Alter, gives his thoughts on the current hospital-based telepsychiatry landscape.

How has the coronavirus impacted hospital behavioral health services/programs?

The earliest phase of COVID-19 (March and April) saw a significant dip in the utilization of hospital-based behavioral health services and programs. This was in large part due to patients trying to avoid physical spaces with high risks of infection. Then, we saw a spike in mental health visits in hospitals as community-based programs where individuals typically sought treatment temporarily closed or switched to telehealth-only appointments. These types of programs are often inaccessible to the most vulnerable populations such as those experiencing homelessness and require them to end up in the emergency department.

Now, as COVID impacts lives in numerous ways, the need for behavioral health care is still present and is in fact increasing. The National Alliance on Mental Illness estimated that by 2021, 1 in 3 Americans will have a mental health or substance use issue. As an organization that works with its partners to scale and adjust services to meet these challenges, we are expanding our work into non-traditional on-demand settings and developing models to improve our ability to provide our services in areas and communities most in need.

One thing that has changed is our operational process and on-demand platform used by our hospital partners to request an assessment. When an emergency department, inpatient psych unit or medical floor requests a patient evaluation, they may denote the patient in question has tested positive for COVID-19. Doing this allows for our telepsychiatry clinician to adjust their messaging and ensure the appropriate amount sensitivity around the subject. Additionally, this makes the telepsychiatry clinician aware that onsite staff may require more time preparing PPE before setting up the virtual encounter in the presence of the patient.

What does the future of behavioral health look like for hospitals?

Prior to this pandemic, the need for telepsychiatry was fueled by a limited, poorly dispersed number of quality behavioral health clinicians across the country as well as an increasing demand for services by patients in need of care. The nature of this virus complicated those already difficult challenges. Even with available care resources or a manageable demand, this virus halted many in-person encounters and has forced us to adopt virtual interaction. Whether newly implemented programs or refining and sustaining ongoing programs, healthcare professionals are realizing the efficacy of telebehavioral health encounters and we will likely see continued use of these solutions even when in-person assessments are possible.

Has there been an increase in mental/behavioral health presentations in emergency departments or changes in disposition decisions?

While stressors such as the duration of quarantine, inadequate supplies, lack of information, frustration, boredom and fear of infection exist, these have not necessarily meant an increase in mental health-related presentations in hospitals. In response to the pandemic, hospitals and health systems have had no choice but to reallocate their resources. Changes like the need to limit inpatient psych unit rooms to just one bed did decrease overall bed availability. This did not mean that behavioral health programs they had previously implemented shut down. Our telepsychiatry clinicians continue to constantly monitor the evolving circumstances of the partner facility, adjust their processes and consider the community resources that they can leverage when making dispositions.

Though behavioral health visit volume was down initially, we have seen a steady return to pre-first spike volumes of mental health-related visits across many of our hospital partners. This could be in part due to patients in crisis or in urgent need of care feeling more comfortable utilizing hospital resources now that many have managed to safely adapt their operations in response to the virus. Stepping inside a hospital may not pose an exorbitant amount of infection risk as it may have posed just a few months ago. 81% of hospital leaders stated in recent Array poll that they believe the volume of mental health-related visits will increase over the next 6 months.

Hospitals and health systems need to continue to examine their disposition processes and adjust according to the availability of other resources in their community. If resources like intensive outpatient programs (IOP) and primary care providers (PCP) close or offer limited access, telebehavioral health may be able to bridge those gaps in many instances.

If you are in crisis, call the National Suicide Prevention Lifeline, a free, 24-hour hotline at 1.800.273.8255. If your issue is an emergency, call 911 or go to your nearest emergency room.