Telemental health has gone mainstream. Most services involve assessment, diagnosis and/or therapy, and care models have evolved over the years to include, for example, hospitals establishing telepsychiatric assessment programs in their emergency departments as well as the creation of virtual networks of mental health professionals providing services to underserved areas.
Many reasons exist for the boom. First, telehealth is a good fit for providing mental health services because providers rarely have to lay hands on the patient in conventional face-to-face encounters. Second, telemental health is accepted by a large number of payers as a legitimate use for telehealth—more so than other telehealth disciplines. Finally, patients surveyed have consistently stated that they believe telemental health to be a credible and effective practice of medicine, and studies have found little or no difference in patient satisfaction as compared with face-to-face mental health consultations.
The case for telemental health
Perhaps the most significant reason for the increasing popularity of telemental health is the fact that while millions of Americans suffer from mental illness or substance abuse disorders, there is a shortage of qualified mental health providers to address these issues. The numbers speak for themselves: An estimated one in four adults (about 60 million Americans) experiences mental illness in a given year, and yet, only one mental health provider exists for every 790 individuals.
Notwithstanding mental health parity laws, the cost of care also remains an issue for those seeking to access treatment—not to mention the social stigma and mistrust of mental health providers that exists in some communities.
Telemental health is bridging the gap. Numerous studies have shown the effectiveness of telemental health services. For example, a recent study showed that providing telemental health services to patients living in rural and underserved areas significantly reduced psychiatric hospitalization rates. Note, however, obstacles remain, including how to properly assess non-verbal cues by video, technical difficulties, and the lack of proper training of many providers regarding telehealth.
Legal and regulatory issues
A number of significant legal and regulatory issues are implicated by the use of telemental health, including privacy and security, follow-up care, emergency care, treatment of minors and reimbursement. While telemental health touches on some federal laws and regulations (such as HIPAA), most of the significant issues involve state law.
- Delaware requires an individual practicing telepsychology to conduct a risk-benefit analysis and document findings specific to issues such as whether a patient’s apparent condition is consistent with the use of telepsychology.
- Kansas requires psychologists and social workers providing telemental health services to obtain the informed consent of the patient before services are provided.
- Montana psychologists can initially establish a “defined professional relationship" electronically so long as the means of communication involves a two-way, real-time, interactive platform providing for both audio and visual interaction.
Demand for mental health services is unlikely to recede given the shortage of mental health provider around the country. Telemental health will increasingly be viewed as a viable solution by more and more clinicians, payers, and policymakers. There are, however, significant legal and regulatory considerations all stakeholders must wrestle with.
René Y. Quashie is a senior counsel in Epstein Becker Green’s Health Care and Life Sciences practice, in the firm's Washington, D.C., office. He focuses his practice on federal regulatory and administrative health care matters, including Medicare and Medicaid, legislative and health policy, privacy and security, general compliance, clinical research, health information technology, FDA issues, and telemedicine.
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