A qualitative analysis of mental health care usage showed that telemedicine was most often used in conjunction with in-person care, according to findings published in Psychiatric Services. The study also demonstrated that patient preference, acuity, and ability to recruit and maintain in-person providers played a significant role in the decision to use telepsychiatric care.
Access to specialty mental health providers is limited in the United States. Telepsychiatry, practiced as interactive video conferencing between a patient and a provider, may increase patient access to health services. For services such as medication management, individual and group counseling, assessment, consultation, and crisis services, reliance on telemedicine has been increasing.
However, little is known in regards to how telepsychiatry is implemented. This study sought to address this gap in knowledge by investigating how mental health care is used in conjunction with in-person services. The researchers also examined the factors that contribute to the decisions relating to remote, virtual mental health care.
Lori Uscher-Pines, PhD, of RAND Corporation in Arlington, Virginia, and colleagues, used the 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator database to select federally qualified health centers (FQHCs) and community mental health center (CMHCs) with telehealth capabilities (N=1319). The researchers focused on FQHCs and CMHCs since they play a critical role in servicing vulnerable populations who have the greatest barriers to access for specialty mental health providers.
The researchers selected 20 health centers representing 14 states, using maximum variation sampling to include a diverse sample. Health center staff including chief operating officers or presidents (N=6), chief operating officers (N=3), executive directors (N=3), clinical directors (N=3), and other staff (N=5), participated in 60-minute telephone interviews, which were analyzed using a cloud-based, qualitative analysis program.
All of the healthcare centers used telemedicine services for psychiatric diagnostic assessment and medication prescribing, whereas 10 health centers also offered therapy. Most of the health centers conducted telepsychiatric care at on-site clinics. However, a few offered services in patients’ homes. In most cases, telemedicine was combined with in-person care, consisting mostly of psychotherapy and case management.
The decision to use telepsychiatry was largely motivated by an inability to recruit or maintain in-person providers. Some of the participants who were interviewed stated that they believed the combination of telepsychiatry and in-person services improved patient engagement. Clinics with a lower perceived need for providers did not offer psychotherapy via telemedical modalities based on beliefs about challenges related to building rapport with and assessing patients. Patient health insurance, preference, and acuity were also considered when determining whether to use telepsychiatric services on an individual case-by-case basis.
The study was limited by several factors, including the decision to focus on CMHCs and FQHCs, which may limit applicability to other types of mental health providers. Other limitations included the small sample size and potential bias based upon the interviewed participants’ role at the health centers.
“If carefully designed and implemented, tele–mental health can help make care more integrated, patient centered, and accessible,” the researchers concluded.
Uscher-Pines L, Raja P, Qureshi N, Huskamp HA, Busch AB, Mehrotra A. Use of tele-mental health in conjunction with in-person care: a qualitative exploration of implementation models. Psychiatr Serv. 2020;71(5):419‐426.