Telepsychiatry: comprehensively addressing behavioral health across the care continuum

Today’s hospital and health system executives increasingly recognize the importance of a “connected community”—one that proactively supports the overall physical and behavioral health of patients throughout the care continuum.

These models provide the optimal framework for improving outcomes and lowering costs within evolving value-based arrangements.

A high-performing connected community engages a sustainable, multi-faceted behavioral health strategy. More specifically, it ensures that patients have access to needed services at various points of the continuum—addressing everything from least restrictive outpatient environments to more acute inpatient settings and emergent care.

Healthcare organizations, by and large, understand the critical role behavioral health plays in optimal care delivery, yet many face barriers to successfully implementing a comprehensive strategy due to the growing shortage of psychiatric professionals. For instance, 96 percent of U.S. counties have unmet needs for psychiatric services, creating barriers to providing adequate in-house services, appropriately triaging patients and providing timely referral options.

In response, forward-looking healthcare leaders are increasingly embracing telepsychiatry as an effective means of bolstering behavioral health service lines to address unmet needs. A form of telemedicine that uses videoconferencing to provide psychiatric evaluation, consultation and treatment, telepsychiatry is easily integrated into a variety of care delivery workflows.

For example, direct-to-consumer (D2C) telepsychiatry improves access to care, increases referral options for providers and removes stigma-related treatment barriers for patients in need of outpatient services. In synch with these options, telepsychiatry services provided in more acute settings like emergency departments (EDs) help providers quickly assess patients in psychiatric crisis in order to direct them to the most appropriate level of care. This improves care coordination and enables more timely access to psychiatric care.

Recognizing Opportunities for Telepsychiatry within Hospitals

Behavioral health issues are often identified or become increasingly intense in acute care settings. The provision of telepsychiatry services in these environments helps fill gaps in care and promotes optimal care delivery.

Telepsychiatry in the ED
Patients who present to the ED with psychiatric needs are best served by an immediate response. Yet, today’s EDs are often strapped to provide these needed resources. Telepsychiatry addresses this issue by ensuring patients are assessed quickly and referred out to the most appropriate level of care, whether that be an acute psychiatric inpatient setting or a direct-to-consumer telepsychiatry outpatient appointment.

Telepsychiatry on Medical/Surgical Floors of Hospitals
Many patients admitted to acute care settings for physical conditions also have behavioral health co-morbidities. For instance, one study found that 45 percent of breast cancer patients also had a psychiatric disorder. Use of telepsychiatry in med/surg environments ensures patients receive appropriate behavioral health assessments and access to services during their stay as well. While treating physical health concerns, other providers can collaborate with telepsychiatry professionals to determine the best course of comprehensive care for a patient.

Telepsychiatry for Inpatient Units
Inpatient units need around the clock psychiatric coverage which can be difficult for some facilities. As a solution, telepsychiatrists can integrate into the onsite care system to cover an inpatient unit—during weekends when resources are scarce or during weekdays and nights.

Telepsychiatry in the Community

Telepsychiatry is commonly used in community-based care environments—such as mental health centers, outpatient clinics and primary care offices—where the capacity for psychiatric services is challenging. In fact, use of telepsychiatry models is expanding out into non-traditional locations such as residential programs, correctional facilities, schools and universities. Some mobile crisis teams allow patients to access remote telepsychiatry providers through an iPad, bringing psychiatric care closer to the patient, and bolstering the expertise and scope of the team on the ground.

The convenience of the telepsychiatry model is changing the landscape of psychiatric care access and bringing additional choices and support to underserved communities. Telepsychiatry teams are equipped to follow patients throughout the continuum—whether hospital or community-based setting—to improve continuity of care.

In-home Telepsychiatry Referrals

When a person begins treatment for a behavioral health issue in a hospital or community-based setting like his or her primary care office, it is often necessary and sometimes even required that he or she be referred to a psychiatrist for continued follow up care. The scarcity of psychiatrists, however, means that it is often difficult for a person to obtain a timely and convenient appointment.

The growing realm of in-home D2C telepsychiatry provides an appropriate alternative for a wide range of patients and diagnoses.

D2C telepsychiatry delivers much-needed access to timely and qualified referral options for primary care doctors who are often the front line of defense in identifying mental illness or behavioral health conditions, and in turn, recommending specialty services. Primary care is largely impacted by the lack of specialist referral options, often requiring these providers make diagnoses and prescribe medications that exceed their comfort and training.

A key piece to the value equation for a referral partnership between a primary care practice and a D2C telepsychiatry practice is the construction of a workflow for effective communication. This ensures logistical and clinical updates are exchanged and that clinically-appropriate patient types for D2C telepsychiatry are clearly defined. These referral partnerships promote a higher level of collaboration between psychiatry providers and primary care providers who are engaged in the physical health and well-being of patients.

For non-acute care, D2C telepsychiatry becomes an easy choice. Individuals access services from any private space with an internet connection. D2C telepsychiatry providers report that patients are often more comfortable in their home settings and appreciate the convenience of evening and weekend availability as well as not traveling to and from appointments.

Telepsychiatry also expands referral options for discharge planning. Lack of community-based psychiatric services can slow down referral processes and lead to disjointed transitions where patients must “settle” on a less-than optimal choice. D2C telepsychiatry options improve discharge planning by:
• Ensuring patients do not fall through the cracks of a fragmented system during care transitions.
• Providing timely access to appointments, especially for those living in remote areas, where some gaps in professional services have reached a critical level.
• Minimizing barriers associated with stigma.
• Helping patients with busy schedules or non-traditional work hours access appointments outside of typical office hours.

Building a Connected Community

The good news is that health systems are embracing behavioral health and the importance of a connected community with more comprehensive and systematic approaches. Telepsychiatry is clinically proven to deliver high-quality care that meets the standard of traditional in-person care for diagnostic accuracy, treatment, effectiveness, quality of care and patient satisfaction. As behavioral health needs continue to soar and outpace the supply of available professionals, hospital and health systems are wise to consider telepsychiatry as part of a comprehensive approach to meet patient needs at multiple points across the care ecosystem.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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