Objective: Mental illness continues to rise in the United States, burdening a healthcare system set to dive further into a shortage of mental health practitioners. The effects of this are already being felt in many rural areas, which are all too frequently understaffed to address the mental health concerns of their populations. To further compound this growing crisis, COVID-19 has led to a reduction in access to in-person care. Furthermore, COVID-19 has led to reduced access to in-person care. As a result, Telehealth has become more essential. Knowledge of the strategies and barriers to implement a successful Telehealth program is necessary to deliver a sustainable, accessible, and quality care. Design: In this review, we analyze published research on the efficacy of Telehealth for mental health, discuss how these services have been implemented, and explore how to address barriers to quality care delivery via Telehealth. Results: Telehealth, when the appropriate resources and supports are considered, is effective in a wide range of patient populations and care locations. Multiple modalities, including via video, apps, and telephone were shown to be efficacious. Interventions have been shown to increase the accessibility to care without compromising quality of care. Conclusions: Telehealth constitutes a well-researched, efficacious tool to address the issues in access to care. Telemental health programs should address the barriers to implementation, including training, access to technology, reimbursement and regulations, and adequate program oversight. Telehealth interventions should be strongly considered in areas facing shortages of mental health practitioners and long wait times for patients with mental health disorders, to reduce the burden of mental illness on healthcare.
Mental health by the numbers | NAMI: National alliance on mental illness. Nami org. 2020;
2.
Follow-up after hospitalization for mental illness-NCQA. 2020;
3.
Perle JG, Nierenberg B. How Psychological Telehealth Can Alleviate Society’s Mental Health Burden: A Literature Review. Journal of Technology in Human Services. 2013;31(1):22–41.
4.
Public poll: Emergency care concerns amidst COVID-19.
5.
Emergencyphysicians, Org. 2020;
6.
KFF health tracking poll-May 2020-Health and economic impacts. 2020;
7.
Talarico I. The use of telehealth to increase mental health services access and promote medication adherence in rural locations. Sigma.nursingrepository.org. 2020;
8.
Tarlow KR, McCord CE, Du Y, Hammett J, Wills T. Rural mental health service utilization in a Texas telepsychology clinic. Journal of Clinical Psychology. 2019;76(6):1004–14.
9.
Mace S, Boccanelli A, Dormond M. The use of telehealth within behavioral health settings: Utilization, opportunities, and challenges. 2018;
10.
Zhou X, Snoswell CL, Harding LE, Bambling M, Edirippulige S, Bai X, et al. The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and e-Health. 2020;26(4):377–9.
11.
Langarizadeh M, Tabatabaei M, Tavakol K, Naghipour M, Moghbeli F. Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review. Acta Informatica Medica. 2017;25(4):240.
12.
Bischoff RJ, Hollist CS, Smith CW, Flack P. Addressing the Mental Health Needs of the Rural Underserved: Findings from a Multiple Case Study of a Behavioral Telehealth Project. Contemporary Family Therapy. 2004;26(2):179–98.
13.
Yuen EK, Herbert JD, Forman EM, Goetter EM, Juarascio AS, Rabin S, et al. Acceptance based behavior therapy for social anxiety disorder through videoconferencing. Journal of Anxiety Disorders. 2013;27(4):389–97.
14.
Gros DF, Yoder M, Tuerk PW, Lozano BE, Acierno R. Exposure Therapy for PTSD Delivered to Veterans via Telehealth: Predictors of Treatment Completion and Outcome and Comparison to Treatment Delivered in Person. Behavior Therapy. 2011;42(2):276–83.
15.
Bouchard S, Paquin B, Payeur R, Allard M, Rivard V, Fournier T, et al. Delivering Cognitive-Behavior Therapy for Panic Disorder with Agoraphobia in Videoconference. Telemedicine Journal and e-Health. 2004;10(1):13–25.
16.
Jakubowski KP, Jhamb M, Yabes J, Gujral S, Oberlin LE, Bender FH, et al. Technology-assisted cognitive-behavioral therapy intervention for end-stage renal disease. Translational Behavioral Medicine. 2019;10(3):657–63.
17.
Stewart RW, Orengo-Aguayo RE, Cohen JA, Mannarino AP, de Arellano MA. A Pilot Study of Trauma-Focused Cognitive–Behavioral Therapy Delivered via Telehealth Technology. Child Maltreatment. 2017;22(4):324–33.
18.
Carpenter AL, Pincus DB, Furr JM, Comer JS. Working From Home: An Initial Pilot Examination of Videoconferencing-Based Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home Setting. Behavior Therapy. 2018;49(6):917–30.
19.
Hunkeler E, Hargreaves W, Fireman B. A web-delivered care management and patient self-management program for recurrent depression: A randomized trial.
20.
Hunkeler EM, Hargreaves WA, Fireman B, Terdiman J, Meresman JF, Porterfield Y, et al. A Web-Delivered Care Management and Patient Self-Management Program for Recurrent Depression: A Randomized Trial. Psychiatric Services. 2012;63(11):1063–71.
21.
Tuerk PW, Yoder M, Ruggiero KJ, Gros DF, Acierno R. A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. Journal of Traumatic Stress. 2010;23(1):116–23.
22.
Grubaugh AL, Cain GD, Elhai JD, Patrick SL, Frueh BC. Attitudes Toward Medical and Mental Health Care Delivered Via Telehealth Applications Among Rural and Urban Primary Care Patients. Journal of Nervous & Mental Disease. 2008;196(2):166–70.
23.
Gibson G, Timlin A, Curran S, Wattis J. The impact of location on satisfaction with dementia services amongst people with dementia and their informal carers: a comparative evaluation of a community-based and a clinic-based memory service. International Psychogeriatrics. 2007;19(2):267–77.
24.
Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM. The Empirical Evidence for Telemedicine Interventions in Mental Disorders. Telemedicine and e-Health. 2016;22(2):87–113.
25.
U. Substance Abuse Mental Health Services Administration/SAMHSA. Treatment improvement protocol (TIP) 63: Medications for opioid use disorder: Medications for opioid use disorder. 2018;
26.
Ben-Zeev D, Brian RM, Jonathan G, Razzano L, Pashka N, Carpenter-Song E, et al. Mobile Health (mHealth) Versus Clinic-Based Group Intervention for People With Serious Mental Illness: A Randomized Controlled Trial. Psychiatric Services. 2018;69(9):978–85.
27.
Zaheer S, Garofalo V, Rodie D, Perivolaris A, Chum J, Crawford A, et al. Computer-Aided Telephone Support for Primary Care Patients with Common Mental Health Conditions: Randomized Controlled Trial. JMIR Mental Health. 2018;5(4):e10224.
28.
Roberts N, Hu T, Axas N, Repetti L. Child and Adolescent Emergency and Urgent Mental Health Delivery Through Telepsychiatry: 12-Month Prospective Study. Telemedicine and e-Health. 2017;23(10):842–6.
29.
Dham P, Gupta N, Alexander J, Black W, Rajji T, Skinner E. Community based telepsychiatry service for older adults residing in a rural and remote region- utilization pattern and satisfaction among stakeholders. BMC Psychiatry. 2018;18(1).
30.
Jacobs JC, Blonigen DM, Kimerling R, Slightam C, Gregory AJ, Gurmessa T, et al. Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets. Psychiatric Services. 2019;70(11):976–82.
31.
Rathbone AL, Julie Prescott. The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review. Focus. 2018;16(4):456–65.
32.
Fairchild RM, Ferng-Kuo SF, Laws S, Rahmouni H, Hardesty D. Telehealth Decreases Rural Emergency Department Wait Times for Behavioral Health Patients in a Group of Critical Access Hospitals. Telemedicine and e-Health. 2019;25(12):1154–64.
33.
Rui P, Kang K, Ashman J. National hospital ambulatory medical care survey: 2016 emergency department summary tables. 2016;
34.
Health-Amwell. 2020;
35.
Mohr NM, Vakkalanka JP, Harland KK, Bell A, Skow B, Shane DM, et al. Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients. Telemedicine and e-Health. 2018;24(3):194–202.
36.
Mohr NM, Young T, Harland KK, Skow B, Wittrock A, Bell A, et al. Emergency Department Telemedicine Shortens Rural Time-To-Provider and Emergency Department Transfer Times. Telemedicine and e-Health. 2018;24(8):582–93.
37.
Pangka K, Chandrasena R, Wijeratne N, Mann M. Exploring the views of emergency department staff on the use of videoconferencing for mental health emergencies in southwestern Ontario. Stud Health Technol Inform. 2015;114–20.
38.
Takahashi PY, Pecina JL, Upatising B, Chaudhry R, Shah ND, Van Houten H, et al. A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits. Archives of Internal Medicine. 2012;172(10).
39.
Meyer JD, McKean AJS, Blegen RN, Demaerschalk BM. Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps. Telemedicine and e-Health. 2019;25(1):18–24.
40.
Roberge J, McWilliams A, Zhao J, Anderson WE, Hetherington T, Zazzaro C, et al. Effect of a Virtual Patient Navigation Program on Behavioral Health Admissions in the Emergency Department. JAMA Network Open. 2020;3(1):e1919954.
41.
Narasimhan M, Druss BG, Hockenberry JM, Royer J, Weiss P, Glick G, et al. Impact of a Telepsychiatry Program at Emergency Departments Statewide on the Quality, Utilization, and Costs of Mental Health Services. Psychiatric Services. 2015;66(11):1167–72.
42.
Komaromy M, Ceballos V, Zurawski A, Bodenheimer T, Thom DH, Arora S. Extension for Community Healthcare Outcomes (ECHO): a new model for community health worker training and support. Journal of Public Health Policy. 2017;39(2):203–16.
43.
Addiction Technology Transfer Center (ATTC) Network Attcnetwork.org. 2020;
44.
Ospina-Pinillos L, Davenport T, Mendoza Diaz A, Navarro-Mancilla A, Scott EM, Hickie IB. Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study. Journal of Medical Internet Research. 2019;21(8):e14127.
45.
Shore JH. Intended and Unintended Consequence in the Digital Age of Psychiatry. Psychiatric Clinics of North America. 2019;42(4):659–68.
46.
Shore JH, Brooks E, Savin DM, Manson SM, Libby AM. An Economic Evaluation of Telehealth Data Collection With Rural Populations. Psychiatric Services. 2007;58(6):830–5.
47.
Shore JH, Schneck CD, Mishkind MC. Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care. JAMA Psychiatry. 2020;77(12):1211.
48.
Goetter EM, Blackburn AM, Bui E, Laifer LM, Simon N. Veterans’ Prospective Attitudes About Mental Health Treatment Using Telehealth. Journal of Psychosocial Nursing and Mental Health Services. 2019;57(9):38–43.
Citation
Copyright
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.