60% of mentally ill adults go untreated every year, according to the National Alliance on Mental Illness. A patient’s geographical location is an important factor; of the 3100 counties in the U.S, more than half have no practicing psychiatrists, psychologists or social workers. But the human cost of mental illness is enormous, and mood disorders are the third-most common cause of hospitalization for people between the ages of 18 and 44.

In the national conversation around telehealth, the term “under-served” has often referred to low-income or minority populations that lack access to health care. But mentally ill adults serve as another population that telehealth may be able to radically assist.

A burgeoning practice

Apps like PTSD Coach, eCBT Mood and CopeSmart help reach under-served groups, seamlessly coordinate care, and connect people to peers in similar situations. While different apps specialize in different areas, telemental health apps can provide depression screening, stress management, self-help resources, and resources for those with suicidal thoughts.

“According to the American Psychological Association’s Center for Workforce Studies, practitioners’ use of videoconferencing with clients increased from 2% in 2000 to 10% in 2008,” demonstrating the increasing adoption of technological tools in the diagnosis and treatment of mental illness (iHealthBeat). Mobile apps, like the Department of Veterans Affairs PTSD Coach, provide a range of psychological counseling services that may be difficult or expensive to access in person.

The research

Josh Klapow is a clinical psychologist and chief behavioral scientist at ChipRewards, a consumer health incentives company.  He argues that while some believe a patient should be in the same room as a provider to benefit from psychotherapy, research suggests that videoconferencing and other telepsychology methods are equally effective.

A systematic review published in Psychological Science in 2012 found that “VCP [videoconferencing psychotherapy] is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy.”

Pioneering companies

Patient usage data from a company called Doctor on Demand supports this notion; according to the company’s CMO, Pat Basu, patients that use their service on average have five videoconferencing sessions with one of the company’s psychologists. Doctor on Demand’s Video Therapy allows patients to battle stress and anxiety, relationship issues, depression, trauma and loss, addictions and other problems from the comfort of their own home and at a lower cost.

Beyond using videoconferencing to digitize the traditional model of psychotherapy, telepsychology companies are using technology to provide resources and support and connect patients to peers.

Prevail Health, launched by a former Navy pilot who saw the prevalence of depression, PTSD and substance abuse in veterans, aims to finally move the needle on rates of mental health in the U.S. Prevail Health’s platform “uses peer-to-peer support, trusted social networks, behavioral economics, and interactive technology to engage hard to reach populations and drive demonstrate able outcomes.”

Important considerations

Currently, jurisdictional restrictions are limiting the ability of psychologists to extend telemental health services to patients in other states. A patient that has an existing relationship with a therapist but then moves to another state, for example, may not wish to begin therapy anew with a new psychologist. For such patients, telehealth could serve as a valuable tool, but only if regulations catch up with the technology. California, Kentucky and Vermont have passed specific licensing guidelines for the use of telepsychology; with the rapid rate of telehealth adoption, hopefully other states will follow suit.

It is likewise important for psychologists to consider the potential for security breaches or other patient safety concerns. Marlene Maheu, PhD, is the executive director of the Telemental Health Institute. “Greater use of online therapy is definitely realistic,” she argues, “but only with focus on research-based patient safety and other protocols.”

According to Prevail, rates of depression in America are higher than any time in the past thirty years. We’re not just not moving forward – we’re moving backward. Something is clearly not working when $147 billion is spent annually on mental health yet 3 of every 4 of sufferers never receive care. Hopefully, the integration of telepsychology methods with existing healthcare delivery models will help serve those mentally ill adults currently failing to receive proper care.


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