Bradford Frank, MD, MPH, MBA Clinical Assistant Professor Department of Psychiatry University of North Dakota School of Medicine and Health Sciences Grand Forks, North Dakota
Thomas Peterson, MD Clinical Assistant Professor Department of Psychiatry University of North Dakota School of Medicine and Health Sciences Grand Forks, North Dakota
Sanjay Gupta, MD Clinical Professor Department of Psychiatry Jacobs School of Medicine and Biomedical SciencesUniversity of Buffalo Chief Medical Officer BryLin Health System Buffalo, New York
Timothy Peterson, MD Clinical Assistant Professor Department of Psychiatry University of North Dakota School of Medicine and Health Sciences Grand Forks, North Dakota
Disclosures Drs. Frank, Thomas Peterson, and Timothy Peterson are staff physicians at Rural Psychiatry Associates, whose telepsychiatry practices are described in this article. Dr. Gupta reports no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Increasing access to cost-effective care where it is needed most
There is a crisis in mental health care in rural areas of the United States. A study assessing delivery of care to US residents who live in rural areas found these patients’ mental health–related quality of life was 2.5 standard deviations below the national mean.13 Additionally, the need for treatment is expected to rise as the number of psychiatrists falls. According to a 2017 National Council for Behavioral Health report,14 by 2025, demand may outstrip supply by 6,090 to 15,600 psychiatrists. While telepsychiatry cannot improve this shortage per se, it can help increase access to psychiatric services. The potential benefits of telepsychiatry for patients are summarized in Table 1.15
Telepsychiatry may be more cost-effective than traditional face-to-face treatment. A cost analysis of an expanding, multistate behavioral telehealth intervention program for rural American Indian/Alaska Native populations found substantial cost savings associated with telepsychiatry.16 In this analysis, the estimated cost efficiencies of telepsychiatry were more evident in rural communities, and having a multistate center was less expensive than each state operating independently.16
Most importantly, evidence suggests that treatment delivered via telepsychiatry is at least as effective as traditional face-to-face care. In a review that included >150 studies, Bashshur et al17 concluded, “Effective approaches to the long-term management of mental illness include monitoring, surveillance, mental health promotion, mental illness prevention, and biopsychosocial treatment programs. The empirical evidence … demonstrates the capability of [telepsychiatry] to perform these functions more efficiently and as well as or more effectively than in-person care.”
Clinician and patient attitudes toward telepsychiatry
Clinicians have legitimate concerns about the quality of care being delivered when using telepsychiatry. Are patients satisfied with treatment delivered via telepsychiatry? Can a therapeutic alliance be established and maintained? It appears that clinicians may have more concerns than patients do.18
A study of telepsychiatry consultations for patients in rural primary care clinics performed by clinicians at an urban health center found that patients and clinicians were highly satisfied with telepsychiatry.19 Both patients and clinicians believed that telepsychiatry provided patients with better access to care. There was a high degree of agreement between patients and clinician responses.19
