Opinion: Telepsychiatry needed to bridge gap for rural VA patients

It’s a startling statistic-an average of 20 veterans died by suicide each day from 2001 to 2014, according to a report analyzing suicide rates by the U.S. Department of Veterans Affairs (VA). There is no doubt that the Veterans Health Administration provides a vital service to tens of thousands of veterans every year. Nevertheless, according to the same study, six of the 20 were recent users of VA services.

Unfortunately, the issue for many vets who experience trauma is that the mental health services they need are too far away from home. About 5 million (24.1% of) U.S. veterans 18 years and older lived in areas designated as “rural” between 2011 and 2015, according to a recent report from the U.S. Census Bureau’s American Community Survey. And almost 50% of all outpatient mental health patients are diagnosed with post-traumatic stress (PTS). The impact extends beyond the VA to a large number of managed care organizations that carry the responsibility of these cases that easily could be addresses through technology.

Two other factors also contribute to the high suicide rate among vets:

• There is a shortage in the psychiatry behavior workforce. The field needs 27,000 mental health professionals to close the gap. Without them, veterans incur long wait times to see a doctor or end up in the emergency room because they have nowhere else to turn. And like other medical professionals, psychiatrists are concentrated in metropolitan areas, leaving 77% of U.S. counties ranked as “underserved.” And that’s a lot of people to consider-42.5 million Americans are diagnosed with some form of mental illness, and more than 90 million Americans live in Mental Health Professional Shortage Areas.

• Men are less likely to seek treatment. Men, who make up 85% of active military, seek treatment half as often as women. In a culture that often encourages men to suppress their feelings, men may not be inclined to ask for help as it is a sign of weakness. This weakness is heightened for men that serve in the military. The National Institute of Mental Health finds that males tend to disregard symptoms of poor mental health and therefore do not receive the treatment necessary. The numbers tell us a lot of men out there are suffering, but most men aren’t showing up to get help. This may be why men die by suicide 3.5 times more often than women.

How telepsychiatry can help

Responding to the mental health services shortage and changing mental health stigma among men should help increase services for rural veterans, but it is only part of the solution.

Men need expanded access to telepsychiatry services to link them with mental health consultation and expertise that is in close proximity to where they live. This will also assist women veterans suffering from PTS. The American Psychiatric Association says telepsychiatry is especially effective in the treatment of PTS and depression. In team-based environments and with some patient groups, it also may be more effective than in-person care.

The VA is the country’s pioneer in advancing the study of telepsychiatry. It was the first to publish data showing that increasing access through telepsychiatry dramatically reduces inpatient admissions and emergency department visits. The VA, along with leading telepsychiatry organizations in the U.S., has demonstrated over the past decade that telepsychiatry expands access, improves care, and helps the most underserved get high-quality care at the right place and in the right time. We need to expand on this foundation. 

Large-scale collaboration can also make a big difference. The National Council of Behavioral Health, which endorses telepsychiatry, notes that the “expansion (of telepsychiatry) has been hampered by conflicting and burdensome regulations and limits on reimbursement. The national trade associations must press state and federal agencies for clarity on these regulations.”

The VA, Veteran Services Organizations, private healthcare organizations, and telehealth providers need to work together to develop a comprehensive approach to serve veterans in remote areas. Managed care organizations can play a role by monitoring the patients they do see and reporting data to the VA; thereby curbing costs and inefficiencies for both organizations.   

Symbolic step for healthcare execs

In addition, improving these important veteran outpatient services would be an important symbolic step for healthcare executives. In the Advisory Board Company's latest Annual Health Care CEO Survey released in mid-2017, healthcare executives said their top concern was improving patients’ access to care including outpatient settings. Healthcare executives have considerable lobbying and public relations power that could be directed at improving veterans’ health.

Initial efforts should be focused on urging the leaders in healthcare to work with policymakers and healthcare providers to adopt telehealth options, particularly telepsychiatry, to aid rural veterans. The currently stalled Veteran’s Choice program, enabling veterans to use a community provider when a VA appointment is not accessible in the short term, needs to move forward in the U.S. Senate. The VA needs to continue advancing telepsychiatry providers to make it easier to support our rural veterans with more choices for their mental health needs. This will respond to the Veteran’s plea, “It’s just too far from home.”

General Peter Chiarelli is a retired United States Army General and past CEO of brain health research organization One Mind.

John Figueroa is CEO of Genoa Healthcare, whose 400 pharmacies, and telepsychiatry services, impact more than 650,000 individuals annually in 45 states and the District of Columbia. These ideas and other healthcare topics will be discussed at The Future of Healthcare Symposium organized by Pepperdine Graziadio Business School on March 22, 2018, in Marina del Rey, CA.