Telepsychiatry: An Opportunity to Expand Access to Psychiatric Care

According to U.S. Department of Health and Human Services data, in 2013 over 90 million Americans lived in areas where it was difficult to get psychiatric treatment, and in early 2014 “55% of the nation's 3,100 counties [had] no practicing psychiatrists, psychologists or social workers.”¹ Meanwhile, the bulk of the current population of psychiatrists is approaching retirement, with 70% of practitioners age 50 and older.²

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Benefits of telepsychiatry include:

• Supports patients whose location limits their access to psychiatric care (in remote or underserved areas, on military front lines, at correctional facilities, or on ships and oil rigs)
• Reduces time and money spent on travel by both patients and doctors
• Addresses patient concerns about privacy (they won’t be seen visiting the office)
• Provides fast access to expert psychiatric opinion in emergency or on-call situations
• Enables psychiatrists to continue working who might otherwise retire, thus increasing availability of care

Telepsychiatry is not a new practice. The earliest known use dates back to 1959, at the Nebraska Psychiatric Institute in Omaha.³ But what used to be a rare exception is becoming more common, especially since Internet-based video conferencing has become more widely available, cost-effective, and secure.

In recent years, states such as North Carolina and Alaska have launched telepsychiatry programs to meet the needs of remote and underserved communities. And correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia have found success using telepsychiatry to treat their inmates. Telepsychiatry has also proven useful in emergency rooms, enabling patients to receive psychiatric consults much sooner than if they had to wait for a local psychiatrist to arrive.

Video conferencing technology can facilitate telepsychiatry in a number of ways. Patients and doctors can participate in sessions from home, or from medical facilities or offices. Typically, all the hardware required is an Internet-connected computer, a webcam, a monitor or television screen, and an audio connection – and often a laptop can provide all of the above.⁴ To allay security concerns, video conferencing software that encrypts transmissions end to end is recommended.

The key limitation to telepsychiatry is the reimbursement issue. While Medicare, Medicaid and some third-party payers cover telepsychiatry in specific circumstances, regulations vary from state to state.⁵ However, as evidence showing the effectiveness of telepsychiatry continues to mount, it seems likely that insurance coverage for remote psychiatric treatment will increase,