Telemental health: Who, what, when, where, why you should use it
Eleanor Feldman Barbera, Ph.D.
Since I now Skype regularly with my 94-year old father-in-law and his wife, the concept of telemental health doesn't seem as futuristic to me as it used to seem. I was shocked to discover, however, that the American Telemedicine Association (ATA) was established 20 years ago, with the first applications of telemedicine occurring over 40 years ago. Apparently, I've been behind the times.
According to the ATA, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”
Telemental health, or telepsychology, as the American Psychological Association refers to it, is simply “the provision of psychological services using telecommunication technologies.” I turned to psychologist Dean Paret, PhD, senior vice president of clinical operations of Brighter Day Health, a provider of telemental health services in long-term care, to answer some of my questions about telemental health.
How telemental health works
According to Dr. Paret, telemental health includes not only psychiatric evaluations and medication management sessions, but psychotherapy as well. Providers use a two-way video system over a secure line to “visit” with LTC residents.
The equipment used includes a camera and a video screen that allows the clinician to see the resident and vice versa. The service is similar to Skype or Facetime, but it involves a secure, encrypted network that leaves nothing on the computer and is HIPAA-compliant. Brighter Day Health works with its facilities to set up the proper equipment. “The big challenge is the Internet speed,” Paret stated, “and the ATA has information on funding sources to upgrade rural systems.”
What facilities need to provide
Location: In order to make use of telemental health services, facilities need to have a room or a mobile station that can be brought to the resident's bedside or other private location.
Staffing: A knowledgeable staff person is needed to assist the resident either by accompanying him or her to the computer room at the designated time or by bringing the mobile station to the resident. The staff member also reviews medications, symptoms, behaviors, and medical information, especially in the case of psychiatric consultation.
Documentation: Since the provider is operating off-site, a HIPAA-compliant means of transmitting notes, such as through access to the electronic health record or even via fax, must be provided.
According to Paret, residents “adapt quickly [to telemental health services], although those with dementia might have some difficulty.” The ATA site contains a list of studies demonstrating not just the cost-effectiveness of telemental health services, but also that telemental health is as effective and helpful as in-person mental health treatment.
Since telemental health services are only reimbursable by Medicare in underserved, typically rural, areas, I'm not worried that those providers visiting facilities in person will be made obsolete. But I did wonder about certain details.
For example, I'm half Sherlock Holmes when I enter a resident's room for a psychotherapy session, noting any new photos on the wall or estimating the length of time since a family visit by the level of wilt to the fresh-cut flowers, for example. “Telemental health providers can ask to see the residents' rooms,” Paret assured me.
“And what about talking with the staff?” I wondered, thinking about the friendly exchanges of information at the nurses' station. “Providers videoconference with the team,” Paret noted, “and are able to be virtually on-site on a regular basis.”
While it's difficult for me to imagine a telemental health provider being able to observe all the details of interaction that an on-site provider can, the availability of telemental health services for those in underserved areas is a boon, especially with the recent focus on replacing antipsychotic medications with behavioral interventions.
Eleanor Feldman Barbera, PhD, the author of The Savvy Resident's Guide, is an accomplished speaker and consultant with over 16 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.