There is a gaping disconnect in the medical community’s ability to serve patients with mental health ailments, and tech firms and health providers are using creative methods to fill the hole, including telehealth, virtual reality, alternative care models, and other means.
Due to a worsening shortage of mental health professionals, especially in remote areas, providers of telehealth services are rapidly investing in psychiatric resources. New York firm 1DocWay expanded its telepsychiatry network to 11 states in 2015, and Doctor on Demand, which provides corporate telemedicine services, is adding psychiatric services in 2016. Through teleconferencing, telehealth providers extend services to rural areas and other regions with scarce resources.
Adoption of virtual reality therapy is also expanding. Veterans Administration clinics and other facilities use VR to assist in treatment of post-traumatic stress disorder (PTSD) and other mental health ailments. The technology has helped veterans learn to cope with symptoms of PTSD, including anxiety and depression, and, alongside traditional therapy services, VR has been found to speed the recovery process.
Some companies are creating mental health programs that can be accessed through web portals or mobile applications. For instance, mental health startup Lantern offers online cognitive therapy programs, with coaches available for phone and chat support. While direct access to a mental health practitioner is ideal, patients who live in an area lacking care facilities or who cannot afford services can benefit greatly from phone, videoconferencing, or online programs.
Psychiatry is the third-largest grouping of health professional shortage areas (HPSAs) designated by the Health Resources and Services Administration (following general practitioners and dentists), with 4,000 HPSAs in the US. These areas have fewer than one psychiatrist per 30,000 people. Some areas also lack sufficient psychologists, social workers, family therapists, and psychiatric nurses.
Improving patient access to behavioral care is a growing public concern due to well-publicized instances of violence by patients not receiving proper psychiatric treatment. While programs exist to draw medical students towards mental health fields and to increase local funding of care programs, state budget allocations cut during the recession have yet to be recovered. Cost barriers and social stigmas are additional factors in undertreatment of ailments, especially in low-income and ethnic minority groups.
Another trend linked to inadequate mental health resources is the shift towards alternative payment systems among psychiatrists and other mental health providers. Some providers are rejecting inclusion on insurance plans — due to low reimbursements and burdensome paperwork duties — and opting to provide cash-only services. While such decisions may allow providers to spend more time with patients who can pay, the weight of the payment burden leaves many patients unable to access available care. Some psychiatrists won’t handle complex cases where physical violence is a threat, and inpatient mental health facilities are also in short supply and unable to fill the gap.
Currently about 12% of psychiatrists operate on a cash-only basis and 3% operate concierge practices where patients pay a flat annual fee, according to the 2015 Medscape Psychiatrist Compensation Survey.
Another 23% of psychiatrists participate in accountable care organizations (ACOs), which seek to provide holistic, coordinated care across multiple providers and facilities. These models bring faster identification of psychiatric need and reduce unnecessary medical costs, which can lead to bonus payments from government and commercial insurers. Recent studies indicate that integrating behavioral care in ACOs improves medical outcomes and patient and provider satisfaction.
Health care technology firms that provide mental care tools are benefiting from strong consumer demand for services. For mental health professionals, use of technology tools can facilitate a broader patient base, improved patient satisfaction, and positive medical outcomes. Psychiatrists and psychologists can benefit financially from participating in alternative care models (for instance, via ACO payer bonuses and telehealth consult fees), but are challenged with providing sufficient services to high-need populations.
Anne Law has been a member of the D&B editorial department for more than a decade, providing content for the Hoover’s and First Research products. She currently covers the health care and insurance industries for First Research. For industry news, follow Anne on Twitter.