VA Sets the Precedent for Telemental Health Programs

Telemental health is becoming an increasingly common component of treatment delivery in today’s healthcare system. In several of our posts, we’ve discussed the benefits of telepsychiatry for various populations (e.g., general patient populations, college students, clinics, providers, hospitals), with one of the greatest being increased access to specialized care. As a pioneer in the telehealth industry, the United States Department of Veterans Affairs (VA) earned its reputation as a leader in the field by implementing an especially well–developed and effective telemental health program.

Beginning in the early 2000s, the primary function of the VA’s telemental health program was to manage patient medication remotely. Since its inception, it has grown exponentially. From 2007 to 2012, there was a 35 percent increase in Veteran patients who received care via telemental health (1). Moreover, as of 2014 the VA delivered 1.1 million episodes of patient care to more than 700 community based outpatient clinics and almost 100,000 patients (1).

These numbers are staggering. But what about clinical outcomes?

Yale University School of Medicine psychiatrist Linda Godleski studied the VA’s program from 2009 to 2011. The study, which included an analysis of 98,069 cases of Veteran patients participating in a VA telemental health program, found that there were significant decreases in both number of hospitalizations and length hospital stay. Godleski further asserts that immediate suicide assessment without the requirement of patients having to travel to a remote facility can even have the potential to prevent hospitalizations.

These findings speak volumes about the integrity of the VA’s program, as well as the efficacy of telemental health in general. In fact, research demonstrates that telemental health is just as effective as face-to-face care (3) and in the VA’s case, even more effective than the traditional, face-to-face model of care (1).

While Godleski’s findings are certainly a testament to the efficacy of telemental healthcare, they also underscore one of the major benefits for hospitals and clinics— increased efficiency.

Immediate assessment can help determine the need for hospitalization and allow those who are not in immediate danger to be discharged with appropriate follow up. As a result, only those who necessitate hospitalization actually travel to an emergency department to be admitted, effectively decreasing patients’ wait time.

Bringing care to patients instead of the other way around is particularly advantageous for VA patients. As Jam Kemp, head of the VA’s Crisis Line for Veterans, notes, reaching out for psychological help is often associated with weakness in the military culture. As a result, there is a significant “shame factor” involved that prevents Veterans from taking the necessary steps to receive care, despite an undeniable need.

Providing individuals in the military community with a way of accessing care without having to leave their homes might help to reduce the “shame factor” barrier and increase their likelihood of reaching out for care.

Though particularly prominent in the military culture, the experience of shame and fear of judgment related to receiving mental health treatment is not exclusive to this group. Many Americans do not seek care due to the stigma associated with mental illness. As such, the option of receiving care in the privacy of one’s own home has the potential to open the door to improved lives for many.

 

 References:

1. www.va.gov/health/newsfeatures/2014/june/connecting-veterans-with-telehealth.asp

2. www.ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201100206

3. www.ncbi.nlm.nih.gov/pmc/articles/PMC4582305/