Using telehealth to improve access to mental health care

David Mou, CEO, cerebral.

The healthcare system has reached a crisis point; millions of Americans who suffer from mental illness cannot find care. According to the National Institute of Mental Health, an estimated one in five adults suffers from a mental illness and more than half do not receive treatment.

Our mental health system is failing Americans. As a psychiatrist, I have seen patients wait months for their first appointment. More than half of US counties have exactly zero psychiatrists. This is not acceptable. But there is a promising solution in telehealth. Unlike other medical specialties where physical exams are critical, psychiatry is uniquely more dependent on building trusting relationships that can lend themselves to this form of remote care.

Barriers to reaching psychiatric patients

I think stigma is a big barrier for people seeking mental health care. Many do not feel comfortable sharing their struggles with their family members or friends. Some of my former patients went to extraordinary lengths to hide from their loved ones that they were seeking mental health care. Overcoming this culturally ingrained stigma should not be a prerequisite for receiving care.

Finally, the match between clinicians and patients is especially important in mental health care. The more clinicians can choose from, the better patients can find clinicians that match what they are looking for.

Three areas of focus for the industry

Taken together, these barriers illustrate why mental health providers should meet patients where they are, not the other way around. Telehealth in mental health is just getting started. What should we do to achieve telehealth 2.0? Here are three areas the industry should focus on.

1. Historically disadvantaged communities

Telehealth can be used to help those who have historically been disenfranchised, including those geographically out of reach of clinicians, as well as those who have been culturally disenfranchised; many ethnicities are particularly averse to the idea of ​​mental health care. As a Chinese American, I have experienced this firsthand.

Telehealth providers should prioritize hiring a diverse group of clinicians who can understand the cultural contexts and the unique challenges faced by any given individual. In addition, marketing campaigns should be tailored in a way that is culturally sensitive and accessible.

Finally, telehealth solutions can serve as a first-line care option, but if patients require an escalation of services, telehealth providers should be able to refer them to in-person care as needed. Brick-and-mortar clinics, hospitals, and telehealth providers must work together to create an integrated patient-centered experience. The care of the future will enable patients to seamlessly switch between different levels of care.

2. Results-based measurements

Shockingly, the vast majority of mental health professionals do not measure clinical outcomes. A 2015 survey found that a large percentage of psychiatrists do not even use electronic health records. Without data on how patients are doing, clinicians will struggle to know which of their patients need their attention.

Lessons learned from telehealth practices can help address many of these issues. Since telehealth platforms are built on newer technology platforms, important clinical measures can be more easily monitored. Depression scores, medication adherence, and other data enable clinicians to adjust their treatment plans accordingly, helping patients get better faster.

For example, you can determine which patients have not completed their labs and remind clinicians to contact those patients to ensure labs are completed. You can scan patient messages for suicidal content using machine learning and proactively reach out to those patients in minutes. This is just the beginning of how data can be used to improve care.

3. Affordability

Cost is a major obstacle to healthcare. Millions of Americans struggle to find a mental health professional to take their insurance. Research shows that the acceptance rate for all insurance policies is significantly lower for psychiatrists than for physicians in other specialties. Many psychiatrists are hesitant to get insurance because of low pay, cumbersome logistics, and late payments.

They are often hesitant to take on the most difficult cases; it’s an embarrassing fact, but I’ve seen many psychiatrists actively avoid taking patients with suicidal thoughts. Why take on a high-risk patient when you get paid the same for taking on a mildly depressed patient? Our most vulnerable patients end up having the hardest time seeking care. This is unscrupulous. Including these patients is not only morally sound, it also helps improve the reputation of our industry.

Using data

Using data, there is a unique opportunity to fuel a virtuous cycle that can benefit clinicians, payers and, most importantly, patients and their families. Data can show how providers can improve the quality of care while reducing costs (for example, by avoiding unnecessary visits to the emergency room). This, in turn, allows health insurers to better identify the best clinicians and pay them more. I think this will lead to clinicians being more and more open to taking on insured patients, as their compensation is contingent on performance. This allows more patients to receive care.

As medical professionals, we need to better meet patients where they are physically, culturally and emotionally. I believe telecare is an important part of the solution. For example, most of the patients my company has helped have never received mental health care before.

The future of mental health care should enable patients to transition seamlessly between all levels of care: app-based, telehealth, personal care, urgent care, and inpatient care. New technology and systems are opening doors and have the potential to improve the lives of millions of Americans who have been on too little for too long.


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Using telehealth to improve access to mental health care

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