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    Telemental Health: Improving Access to Veterans’ Mental Healthcare

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    By Brian Neese

    01_MH_Summit_Tele

    Photo Credit: Dublin VA

    Military members comprise less than 1 percent of the U.S. population, yet veterans represent 20 percent of suicides nationally, according to the National Alliance on Mental Illness. Each day, about 22 veterans die from suicide.

    An issue affecting mental healthcare for veterans is accessibility. In the spring of 2014, the U.S. Department of Veterans Affairs (VA) wait time scandal emerged when allegations surfaced of veterans dying while waiting for care at the Phoenix VA Health Care System, according to Military Times. Wait time issues and manipulated appointment scheduling highlighted a nationwide problem and resulted in several top officials resigning or retiring.

    Months later, Congress passed a $15 billion bill allowing more veterans to seek care in the private sector through the VA Choice program. Meanwhile, the VA continued focusing efforts on telemental health, or the use of telecommunications technology to provide behavioral health services, to try to improve veterans’ access to mental health services, National Psychologist reports.

    Accessibility

    Nearly one in four active duty military members show signs of a mental health condition, based on a study in JAMA Psychiatry. With 44 percent of veterans returning home from Iraq and Afghanistan to rural zip codes, accessibility becomes an important topic for veterans’ mental healthcare. This is a natural strength of telemental health services, which can include clinical assessment, individual and group therapy, educational intervention, cognitive testing and general psychiatric treatment.

    The first telemental health program funded by the VA’s Office of Rural Health is at the Portland VA Center in Oregon. Through telemental health sessions, veterans saved 826,290 miles driven and $161,126 worth of gasoline in 2013, program director Mark Ward said. Some veterans who live far from Portland and lack high-speed internet are given electronic tablets and notebooks for videoconferencing.

    Telemental health can increase veterans’ access to services and eliminate travel. Another benefit is that telemental health can help veterans overcome the perceived stigma sometimes associated with seeking mental health treatment. Veterans who might feel embarrassed or ashamed to get help in person can receive care in their home.

    The VA delivered a total of more than 650,000 telemental health sessions nationally from the program’s inception in 2004 through 2014. The VA anticipated delivering 300,000 telemental health visits for 115,000 veterans in 2014, an increase from more than 200,000 telemental health visits for 80,000 veterans the previous year. Additionally, the VA has created free smartphone apps that veterans can use to help with post-traumatic stress disorder (PTSD), such as the PTSD Coach application developed by the VA and the Department of Defense.

    Telemental health has made progress in improving accessibility for veterans’ healthcare, and it will be needed to make further ground. The Government Accountability Office found that 18 months after the wait time scandal, the VA still struggled with wait times and patients’ schedules.

    Effectiveness

    The first large-scale assessment of telemental health services was published in Psychiatric Services. This study assessed clinical outcomes of 98,609 mental health patients before and after enrollment in telemental health services of the VA between 2006 and 2010. During this time, psychiatric admissions of telemental health patients decreased by an average of about 24 percent, and patients’ hospitalization lengths decreased by an average of nearly 27 percent.

    A survey of veterans found high levels of satisfaction and perceived safety with home-based telemental health provided by the VA pilot program in Portland, according to the International Journal of Psychiatry in Medicine. Findings support the feasibility and safety of using technology in the home for the delivery of mental health services. Additionally, results suggest fewer no-show appointments in home-based telemental health compared to clinic-based telemental health.

    Currently, telemental health is regarded as appropriate for general clinical use. Yet, the VA cautions that more needs to be known about using telemental health services for conditions such as PTSD, which Jama Psychiatry says is 15 times higher for those in the military than civilians. “While preliminary research has clearly established that a variety of telemental health modalities are feasible, reliable, and satisfactory for general clinical assessments and care, less is known about the clinical application and general effectiveness of telemental health modalities employed in the assessment or treatment of PTSD,” the VA says.

    The Need for Behavioral Health Professionals

    Approaches such as telemental health can support better access to behavioral healthcare and are expected to grow as a result. Yet, more professionals are needed for rising populations of veterans, children and others in need of services.

    The online B.A. in Behavioral Health from Alvernia University enables students to meet this need. Some graduates enter fields such as addiction counseling, long-term care and child welfare, while others enter graduate studies. The program takes place in a convenient online format to accommodate students’ work and personal schedules.

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