Using Telehealth for Behavioral Crisis Assessments in Rural Communities

The third in a series of articles on developments in telepsychiatry.

Rural communities throughout the U.S. face severe shortages of trained mental health professionals. Here are some key statistics:

  • More than 60% of rural Americans live in mental health professional shortage areas.
  • More than 90% of all psychiatrists and psychologists and 80% of all MSWs work exclusively in metropolitan areas.
  • More than 65% of rural Americans obtain their mental health care from their primary care provider.

As a consequence, more than 91 million Americans live in areas with a mental healthcare provider shortage. Further, nearly 1 in 8 patients who present to the hospital emergency department (ED) come with a mental health and/or substance abuse issue, which on average require a lengthier boarding periodthan patients with non-psychiatric complaints. Telehealth presents a potential solution to the challenges confronted by patients and providers in rural settings, especially within the context of the ED.

Small towns face a number of unique behavioral care challenges. These challenges include elevated stigma around issues of mental health, increased liability and inpatient admissions, inadequate medical necessity documentation, higher rate of patient return visits to the emergency department, and a general lack of access to behavioral health resources. To tackle these issues, small towns should aim for better assessment and clearer patient psych picture in the ED, increased support for patients discharged from the ED, reduce repeat visits to the ED, and reduced re-admissions to the behavioral health unit.

Telehealth administrators should anticipate and prepare to respond to several concerns that emergency room providers may voice, including the potential for delay to ED patient care, loss of decision-making rights, and concerns about the process specific to behavioral health. Administrators must also manage effective networking and partnerships for successful treatment of patients in rural settings, including between the care team, patient and family, community providers, hospitals and clinics, and technology partners.

Providers can assess the success or failure of a telehealth implementation at their care site by measuring a number of metrics around patient care, including: (i) number of discharged patients connected to care (ii) percentage reduction in inpatient lengths of stay (iii) percentage reduction in inpatient re-admissions (iv) percentage reduction in re-assessments (v) percentage reduction in total admissions (vi) percentage reduction in denials (vii) percentage reduction in 1-to-1 patient watch (viii) percentage reduction in transportation costs (ix) percentage reduction in wait times (x) percentage increase in shared decision-making (xi) percentage improved assessment and documentation (xii) percentage bed access rate.

A successful telehealth program can provide small town providers with increased ED care team education, appropriate treatment recommendations, clearer clinical picture with thorough documentation, improved communication between the ED and follow-up care, and expansion of behavioral health services. In addition, telehealth enables providers increased access to health history and leads to better performance in provider reviews and surveys and, for patients, provides reduced travel expenses, comprehensive care, access to more providers, and timely access to follow-up care.

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