Addressing the “Ripple Effect” through Telepsychiatry

What is the “ripple effect?” According to Katie O’Toole, reporting for WJAC TV, mental health patients in that region of Pennsylvania have limited access to adequate care, according to Cambria County hospital administrators. In 2015, Conemaugh Memorial Medical Center in Johnstown, Pennsylvania, suspended all child psychiatry admissions and capped generic admissions to ten patients after the hospital lost two psychiatrists to staff attrition.

The article acknowledges, through the hospital, that telepsychiatry is helping Conemaugh and its personnel to cope with the shortage of providers, but the larger “ripple effect” is still an issue. The closure of state hospitals in the 1950s, widely known as “de-institutionalization,” resulted in a dramatic reduction of in-patient beds in the United States. This, coupled with an increase in United States population, has exacerbated an already existing problem that is further worsened by “co-curing drug use” — a particular issue in the Johnstown area.

“They went from about 550,000 in-patient beds in the United States to now having around 100,000,” O’Toole reports, quoting a hospital administrator, “so there’s been a dramatic decrease along with a dramatic increase in the population in the United States.” O’Toole goes on to say that many local patients who need care simply care cannot get it. Factors affecting local patients are difficult to correct because much of it comes down to funding, and until more is available, the ripple effect — greater need among a greater population that has fewer resources to deal with the problem — is expected to continue.

The surest way to combat this problem is advocacy of, and removal of regulatory and bureaucratic obstacles to, telepsychiatry. With trained professionals in short supply and many individuals, couples, and families living in mental healthcare shortage areas, providers must be able to treat more people in less time and reach populations that were previously inaccessible. Using secure, regulation-compliant telemedicine and video teleconferencing is one of the few truly effective ways to do this. As the concept, the technology, and the practice becomes more accepted among the population at large, telepsychiatry will continue to help get needed care to those who require it. This will require our constant support and encouragement as figures within the industry, but it’s a goal worth fighting for. The result is nothing less than improved care for the American population, a goal that drives everything we do.

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Telemedicine’s Benefits Continuing to Win Over the Establishment

Is the success of telepsychiatry specifically, and telemedicine in general, a foregone conclusion as society advances? Anjalee Khemlani, reporting for NJBiz, seems to think so. Khemlani  explains that telemedicine is indeed beginning to play a critical role in healthcare in the United States — something that most Americans say they are entirely comfortable with, at least if the American Medical Association is correct.

“In fact, the medicine world is well past the point of trying to figure out how telehealth fits in, and is now focused on how to harness the technology,” writes Khemlani. “A recent report to Congress about telehealth revealed that 60 percent of health care institutions are currently using some form of telehealth, as are almost half of all U.S. hospitals. It is also set to continue increasing revenue generation, according to the report.”

The telehealth market, Khemlani reports, generated annual revenues of $9.6 billion in 2013. That’s a massive 60 percent growth over the preceding year. Internet connectivity and mobile devices are more common than ever before, pervasive within society and taken for granted as part of our communications and entertainment infrastructure. Technology continues to make secure teleconferencing simple, easy, and regulation-compliant (or at least potentially so). And more authorities are recognizing the benefit of telehealth and removing legal barriers to its practice. The result is a perfect storm of factors that make widespread acceptance of telemedicine generally, and telepsychiatry specifically, all but guaranteed.

As our population continues to grow and to age, and as remote technology becomes even better, we look forward to a world where our population takes telemedicine and telehealth for granted. If the technology, coupled with standards for its application and guidelines for patient care, continues to advance as it has, our children and their children will know a world very different from the one we now experience. Right now, shortages prevent those who require mental healthcare services from receiving them, or from receiving them in a timely fashion. A few years from now, and certainly a generation or two hence, we will observe a sea change in how medicine is practiced in the United States. That may well become the standard of care throughout the future world… and all of us will benefit from it.

Become a part of this growing industry and join Arcardian!


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Technology Continues to Drive Improvements in Mental Health

Technology Continues to Drive Improvements in Mental Health

It is a proven fact that prevention especially where mental illness is concerned, is more effective than treatment after the fact. If you can head off a mental health issue before it worsens, costly treatment of a mental health issue over time can be avoided. Telepsychiatry can provide primary healthcare providers with a means of integrating mental healthcare with physical wellness. The result is a more holistic treatment model that decreases the stigma of receiving mental healthcare while improving patient health overall, both mentally and physically. In other words, technology and its applications are driving improvements in mental healthcare… and that trend is continuing. It may even be accelerating.

Andie Burjek, writing in Workforce, rightly emphasizes skyrocketing treatment costs associated with mental health. “Some 7.6 percent of America’s full-time workforce is estimated to have major depressive disorder,” he writes, “and its economic costs nationally were about $210 billion annually in 2015, up from $173.3 billion annually in 2005, according to the Journal of Clinical Psychiatry. Such staggering numbers remain a primary reason why prevention is an appealing concept to employers. For example, resiliency training aims to give employees the skills to face change more positively and manage crises effectively. Its goal is to reduce the impact of stress, and potentially, anxiety or depression.”

Burjek reports that almost half of companies in the United States that have more than 500 employees offer “resiliency” or stress-management programs.  “Traditionally, companies have relied on in-house training for areas like resiliency or mindfulness,” Burjek writes, “but vendors are offering technology-based solutions as well. There isn’t much research yet about the effectiveness of these technology-based solutions, but most of the vendors rely on a proven framework like positive psychology or cognitive therapy.”

Notably, Burjek’s article acknowledges that preventive care is effective for the same reasons that treatment after the fact is less so: We tend to ignore mental health problems, society wide, until they become acute crises. The employee whose depression causes him to be apathetic toward his job costs the company money in terms of lost productivity… but his problem typically is not recognized until it becomes so bad that he stops showing up for work entirely. Preventive care could not only improve his productivity (while improving his quality of life) and thus preempt a major episode that could lead to losing that employee entirely.

It will be interesting to see the role that technology based solutions, such as telepsychiatry and self-assessment and self-care applications, play in the future of the mental healthcare landscape. As is so often the case, the future looks promising. As we continue to apply technology to mental health, we will continue to see gains across the field.

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Demand for Mental Health Services at College Continues to Surge

Demand for Mental Health Services at College Continues to Surge

Previously at this blog we have touched on the subject of mental healthcare and the need for it on college campuses. The shortage of qualified mental healthcare professionals has worsened in recent years, affecting not just remote, rural, or disadvantaged urban areas, but our nation’s college campuses as well. Telepsychiatry is one way to combat this shortage. It eliminates costly travel logistics and saves the time associated with that travel. This makes  remote mental healthcare, in the form of telemental health services, invaluable in helping care providers serve more people in less time than could be served by in-person treatment. This lowers cost, increases convenience and schedule flexibility, and even allows providers to reach areas that are too geographically remote to serve through in-person means. Telepsychiatry, in other words, amplifies mental healthcare effort. The technology of telemental  health allows care providers to do more with less, effectively addressing care shortages.

More college students than ever require mental healthcare services, underscoring the need to apply telepsychiatry solutions to college and university campuses.  Anne Geggis, writing for the Sun Sentinel, reports that college students are seeking mental healthcare in unprecedented numbers. This is causing college administrators to hurry to meet that sudden demand. “Experts say the needs are wide-ranging,” Geggis reports, “from students with eating disorders, romantic break-up problems and binge drinking too much more severe issues.” For example, in Florida alone, more than 20,000 students at the state’s universities are receiving mental health services, “reflecting a 48 percent increase between 2009 and 2014. That growth outpaces by nearly fourfold the increase in the system’s number of students.”

Florida’s state university administrators estimate that up to 14 percent of their students are receiving some form of mental healthcare. Waiting lists of weeks and months are the result — and where mental healthcare is concerned, such delays can be devastating. In some cases, they can be deadly.

Now more than ever, telepsychiatry is an appropriate solution for these increases in demand. Telemental health allows providers to meet shortages with limited resources. Hopefully we will continue to see proactive responses on college campuses around the country. Further integration of telepsychiatry,  and its mainstream acceptance in society at large, will continue to point the way towards a future in which our students — and the adults they become — receive the mental healthcare they require.

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World’s Largest Mental Health Study… On Your Phone?

World’s Largest Mental Health Study… On Your Phone?

The promise of telepsychiatry — and of telemental health in general — is one of increased access through technology. Providing mental healthcare through secure video teleconferencing allows providers to reach previously underserved markets. Remote locations that would otherwise be inaccessible are thus easily served, while costly and time-consuming travel logistics are eliminated.  This enables the same number of mental healthcare providers to serve more patients in less time. Telemental health is one of the viable means of doing more with less, and thus of addressing the serious shortage of mental healthcare providers in the United States. All of this is made possible through the use of technology… and now, technology may be able to provide mental healthcare professionals with valuable data in the fight against mental illness.

Ben Lovejoy, writing in 9to5mac.com, highlights a project called “How is the world feeling?” The venture “is aiming to use an iOS and Android app to conduct the world’s largest study of mental health over a one-week period starting on October 10 [2016]. The aim is to gather data from ordinary people to identify patterns in emotions, then to open-source anonymized data to mental health professionals in a bid to devise approaches to reducing suicide rates.”

Lovejoy explains that the app takes only a few seconds to use. It asks the user to select an emotion on his or her smartphone. The intensity of the emotion is also selected, and a few other points of data (such as what the user is doing and whether the user is alone or with other people) are collected. Users get a log of their own data so they can track their own moods and possibly draw conclusions as to what makes them happy and what does not.  “If the app identifies patterns in your own emotions that may need to be addressed,” Lovejoy writes, “it will point you to tools and resources that may be useful. [This is] the largest democratic mental health survey in the world – with the aim of collecting over 70 million emotions.”

The benefit of the survey is access to a massive, international database that could well provide “unprecedented understanding of mental health across an extremely vast range of demographics and geography,” Lovejoy reports. “All data is completely open-source, meaning any individual, NGO or business can utilize the information gathered. It should be noted that no personally-identifiable information is collected from any participant.”

As telepsychiatry professionals, we are no strangers to the use of technology to provide mental healthcare solutions. The goal of the “How is the world feeling” project is to help prevent some of the more than 42,000 suicides that occur annually in the United States. That’s a laudable goal, and it will be interesting to see what insights the resulting database helps give mental healthcare providers in our own nation and around the world.

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The Struggle to Get Mental Health Training for Police

The Struggle to Get Mental Health Training for Police

One of the biggest issues facing law enforcement today is the debate over appropriate use of force. Critics claim police are too quick to use force on various demographics (the nature of which tends to change depending on who is doing the complaining). Law enforcement, meanwhile, points to the dangerous nature of the profession and the fact that police officers can hardly be expected to risk death when suspects behave in an overtly threatening manner.

The problem is complicated when police deal with those suffering from chronic mental illness or acute mental health crises. Such individuals tend to behave in ways that are distinctly irrational — often to their own detriment, as their actions can be perceived as threatening. Something as simple as the failure to comply with police commands, coupled with abrupt movements that may be interpreted as hostile or even potentially lethal, can result in a police shooting that takes a life.

Aamer Madhani, reporting in USA Today, underscores the problem succinctly. “Police departments and policymakers around the country are grappling with how to bolster training for cops on mental health issues in the midst of a string of high-profile fatal incidents involving suspects believed to be in the throes of mental breakdowns,” Madhani writes. “The current debate on policing in America has largely focused on whether inherent racial bias has led to police disproportionately using deadly force against African-Americans. But long simmering on the back burner is the struggle for police departments to deal with the eye-popping number of deadly incidents that involve people with mental health issues, law enforcement and mental health experts says.”

Madhani points to a study by the Treatment Advocacy Center that found a high correlation between mental illness and being killed by police. Those suffering from mental illness are 16 times more likely to die at the hands of law enforcement than those who aren’t mentally ill. “The National Alliance on Mental Illness estimates 15% of men and 30% women annually booked at U.S. jails have mental health problems,” Madhani goes on. “The issue of mental illness and policing was drawn back into the spotlight after police in El Cajon, Calif., on Sept. 27 fatally shot Alfred Olango, 38, an unarmed man who was killed after his sister says she called police for help because he was in the midst of a mental health crisis. Olango’s sister, who has not been identified, says she told police that Olango did not have a weapon. Police in the San Diego suburb said officers fatally shot Olango only after he rapidly pulled an object from his waistband and took what was described as a ‘shooting stance.’ After shooting him, police discovered the object that Olango drew from his pants was a vape device.”

To get the police the mental health support they require, mental healthcare providers must step up and provide the necessary training. Telemental health and telepsychology could play a role in this. Especially given the shortages in qualified mental healthcare providers, telepsychology represents one of the ways this need can be addressed. Taking the time to provide that support to law enforcement will benefit us all.

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REACH Magazine – Fall 2016

Here is the latest issue of REACH magazine. We hope you enjoy it and find it to be of value.

Here is what you’ll find inside:
The Case for Collaborative Care
Addressing Common Criticism of Telepsychiatry
Is Home-Based Telepsychiatry a Viable Option?
Mental Healthcare: As Close As Your “Candy Crush” App?
Telepsychiatry Tech Continues to Grow and Innovate

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Using Telemedicine and Telepsychiatry to Combat Opioid Addiction

It’s no secret that the nation is facing rising level of opioid addiction. According to the American Society of Addiction Medicine (ASAM), drug overdose is the leading cause of accidental death in the United States. In 2014, there were almost 19,000 overdose deaths. From 1999 to 2008, overdose death rates, sales of prescription opioids, and substance use disorder treatment admissions related to prescription pain relievers all increased in parallel to each other. The overdose death rate increased by 400% during that same period. In 2010, sales of prescription painkillers were also 400% of what they were in 1999.

The connection is startling. Again, according to the ASAM, four in every five new heroin users start out misusing prescription opioid painkillers. The rate of heroin overdose deaths almost quadrupled from 2000 to 2013. A staggering 94 percent of respondents to a 2014 survey said they used heroin because prescription opioid painkillers were more expensive and harder to get.  The problem continues to worsen, and now the medical and mental healthcare communities are responding to that increase in opioid addiction, combatting it with treatment and preventive care.

Eric Wicklund, writing for mHealth Intelligence, explains that federal officials are investing in telemedicine — delivering healthcare remotely through secure video teleconferencing — to combat this growing abuse. “A key component of the program,” writes Wicklund, “is Project ECHO, a telemedicine training model launched in 2011 in New Mexico that pushes education and peer support through a hub-and-spoke model to rural healthcare providers. The platform has been adopted in several states and is now being proposed as a national network in the Expanding Capacity for Health Outcomes (ECHO) Act, unveiled in April by Sens. Brian Schatz (D-Hawaii) and Orrin Hatch (R-Utah).”

Wicklund explains that technology can be used both for education and for treatment and care. These are services often unavailable, or not available in a timely fashion, in underserved and remote rural areas. Telemedicine, he writes, “is proving to be an effective tool for treating patients when experts otherwise would be unavailable. Hospitals, schools and training centers across the country are successfully using telecommunications to deliver specialized care to area residents.”  This is an encouraging development. As the opioid addiction problem in the United States continues to worsen, our only hope to combat it is through the very things technology, telemedicine, and telepsychiatry do best: education and treatment in a timely, cost-effective manner.

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Building the Foundation for Telepsychiatry to Work

Telepsychiatry and telemedicine have proven track records when it comes to providing care at remove from the patient. Multiple fields have benefited from the integration of secure, regulation-compliant video teleconferencing software and hardware. Telemedicine generally, and telemedicine specifically, are perceived as equally effective by patients, while sometimes even preferred. Even more intriguing, remote care may prove to be more successful than in-patient care for certain specific follow-up treatment, such as in the case of ADHD patients. While there is still much work and research to be done to prove out these concepts, the success of telepsychiatry thus far is encouraging… and the mainstreaming of remote care appears all but inevitable. But certain foundations must be laid to ensure that this progress is not stalled by technological, social, or legislative obstacles.

John Andrews, in Healthcare IT News, says that while the healthcare industry may not dispute the efficacy of remote care, “it is in the potential limitations that skeptics might find flaws…  With physician offices becoming part of accountable care organizations, the value of electronic communications technology has become paramount due to its ability to connect patients with caregivers… Logistically, a face-to-face physician office visit can be a convoluted series of processes and time-consuming exercises that outstrip the value of the appointment for patients and physicians… The viable virtual care centers operating today are situated to deliver care through electronic means with the ‘right mix’ of physicians, nurses, therapists, technicians and experts… By having a team of clinicians under one roof, it eliminates the circuitous referral process of going from primary care doctor to the specialist to the diagnostic center and back.”

This necessary infrastructure, this foundation, is of course integration of telepsychiatry at the primary care level. It works, and it has been shown to work. Electronic tools are one component of that support and care infrastructure. Technological infrastructure issues are also present, including the need to integrate medical devices and support technology that doesn’t always work together. That’s changing as technology evolves — and the success of virtual care programs centered around intensive-care services with co-located personnel is one very obvious marker that this can work.

The goal, as Anderson stresses, is improved care for patients. We could not agree more. The sooner the medical community integrates mental healthcare in the form of telepsychiatry, the better off we will all be. The goal is better service at lower cost, resulting in a greater degree of health across society. With the tools and talent available to us, that goal is an entirely attainable one.

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Telepsychiatry Can Solve Maryland’s Youth Facility Treatment Shortages

One of the primary benefits of telepsychiatry is that it enables qualified providers to reach populations that would otherwise be out of reach. This includes those who are physically remote to any sources of care, and also those whose environment might represent a danger to personnel who travel there. For good or ill, the very populations that are hardest to reach are often also those that are underserved due to other factors. These include youth in juvenile facilities, who are not receiving the mental healthcare they require.

CBS Baltimore reports that youth incarcerated in juvenile facilities in Maryland, for example, “do not receive adequate therapeutic care or enough staff attention, according to a quarterly report released by an independent monitoring agency under the umbrella of the attorney general’s office… Although the report does credit the Department of Juvenile Services with making an effort to reduce the population of youth incarcerated in facilities, it says that nearly all youth facilities in the state are understaffed.”

Untreated mental health issues in these facilities can lead to undue suffering, obviously, but it can have grave consequences, up to and including self-harm and suicide. “In another instance at [a youth detention facility],” reports CBS Baltimore, “a teen suffered a miscarriage four days after entering the facility, but was forced to wait for an hour and a half before nurses were authorized to call an ambulance. When she was transported, she was placed in shackles.”

There has been push back to the report, as there always is. “The Department of Juvenile Services in the agency’s written response took issue with the report’s assertion that its facilities do not offer therapeutic treatment, and pointed to weekly therapy sessions and regular psychiatric evaluations. Additionally, the agency said it is addressing the need for additional services by contracting with a local university to provide tele-psychiatry services [emphasis added].”

The solution to the lack of care in juvenile facilities throughout the United States is quite clearly telepsychiatry. Telepsychiatric services can reach populations that would otherwise be inaccessible to traditional care providers. Those providers are perfectly safe in their remote locations, and the nature of telepsychiatry allows those providers to treat more patients in less time. This reduces costs as well, making such programs accessible to cash-strapped agencies. Again and again, telepsychiatry proves its value to patient populations, particularly those not yet getting the mental health services they desperately require. It is for this reason that ARCADIAN continues to push for mainstream acceptance and integration of remote mental healthcare services.

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