Feature A new emphasis on telehealth December 1, 2012

The expansion of telehealth would help address several hurdles to securing mental health services. Nearly 80 million Americans live in a mental health professional shortage area, according to the U.S. Health and Human Services Health Resources and Services Administration. Even in urban environments where psychologists abound, cost, transportation and time constraints often prevent people from seeking mental health services.In addition to these structural barriers, a 2009 Substance Abuse and Mental Health Services Administration survey found that less than one-quarter of the estimated 45 million American adults who have a mental illness received treatment. One major reason for the low number: stigma and embarrassment about making contact with a therapist. Telehealth — be it by phone, email or video conferencing — can help solve many of these access problems, says Eve-Lynn Nelson, PhD, assistant director of research at the University of Kansas Center for Telemedicine and Telehealth.

“Technology really helps us get more bang for our buck and extend our service reach,” says Nelson, who has been researching and providing video-based mental and behavioral health services to children and adults for nearly a decade.

A 2008 meta-analysis of 92 studies, for example, found that the differences between Internet-based therapy and face-to-face were not statistically significant (Journal of Technology in Human Services, Vol. 26, No. 2). Similarly, a 2009 review of 148 peer-reviewed publications examining the use of videoconferencing to deliver patient interventions showed high patient satisfaction, moderate to high clinician satisfaction and positive clinical outcomes (Clinical Psychology: Science and Practice, Vol. 16, No. 3).

In addition, a 2010 study in the Journal of Clinical Psychiatry (Vol. 71, No. 7) found that videoconferencing can be successful in treating post-traumatic stress disorder. In that study, researchers compared the effectiveness of 12 sessions of anger management therapy delivered via video to in-person delivery of the same treatment to 125 rural combat veterans with PTSD. The researchers found that the video-based anger management therapy was just as effective as the face-to-face care.

“This is not a small statement to make when you’re trying to get buy-in from providers or clinics about how well this works,” says the study’s lead author, Leslie Morland, PsyD, a clinical psychologist with the National Center for PTSD, Pacific Islands Division.

But such findings don’t mean every mental and behavioral health intervention can or should be provided online, cautions Bufka. She says the research remains inconclusive about which treatments are suitable for telehealth and which are better done face-to-face.