Telehealth especially important in areas where mental healthcare is scarce

Photo: Geber 86/Getty Images

When the nearest psychiatrist's office is dozens or even hundreds of miles away, a virtual connection may be enough to help people living with serious mental health conditions get effective care through their local primary care clinic, a new study shows.

The randomized study of just over 1,000 people with post-traumatic stress disorder, bipolar disorder or both conditions shows that most patients engaged with either of two types of telehealth. The study also gives insights into which patients might need additional support when getting such care.

Half of the patients connected directly with a far-away psychiatrist and psychologist, while the other half mostly engaged with team members at the local primary care clinic who received guidance from distant psychiatrists.

Either way, most patients responded well to medication and/or psychotherapy – sometimes called 'talk therapy' – for their condition.

One major difference emerged: Those patients who were assigned to get a form of psychotherapy from a specially trained nurse or social worker on staff at their local clinic ended up completing 60% more such sessions than those who were assigned to connect with a psychologist via video. The ongoing in-person contact with their nurses or social workers checking on their other health needs may have been a contributing factor.

WHAT'S THE IMPACT

The findings, published in the Journal of General Internal Medicine, come from the Study to Promote Innovation in Rural Integrated Telepsychiatry, or SPIRIT trial, which involved patients from 24 safety net clinics in Michigan, Washington and Arkansas.

The two approaches used in the study were Telepsychiatry Collaborative Care, in which a psychiatrist makes the initial diagnosis via video, and the local clinic team provides brief psychotherapy while the local primary care physician handles medication prescriptions with consultation from the telepsychiatrist; and Telepsychiatry/Telepsychology Enhanced Referral, in which a psychiatrist makes the initial diagnosis and handles medication prescriptions, and a psychologist provides psychotherapy by telehealth.

Last summer, another study using data from the SPIRIT trial showed that patients in both groups reported substantially and statistically significant improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life. There was no difference between the groups, and there were no differences in outcomes regarding age, gender, race or ethnicity.

The new study dives deeper into how patients' own clinical characteristics affected their experience with telehealth, and how well they stuck with the treatment course. Two-thirds of the patients in the study had incomes or disabilities that made them eligible for Medicaid, and 50% were unemployed.

The analysis showed that patients who have issues with drugs, and those experiencing manic symptoms from their bipolar disorder, may need additional support to get started on psychotherapy or to stay with it.

It also showed that those who have multiple physical health conditions may be most likely to keep pace with their mental health medications and talk therapy programs, likely because they are already coming to the primary care clinic for other types of care.

THE LARGER TREND

At least one major insurer has taken note of the potential of using telehealth for behavioral healthcare. This year, Humana entered into a partnership with Array Behavioral Care, a national telehealth practice specializing in behavioral health, with the latter slated to provide telebehavioral health services to Humana Medicare Advantage individual and group members nationwide in 2022.

Humana cited research showing that 25% of Medicare beneficiaries live with some form of mental illness.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com