Telepsychiatry to the Rescue

April 25, 2015
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A North Carolina telepsychiatry program is helping hospital emergency departments overcome practitioner deficits. But is this a one-size-fits-all solution?

North Carolina needs more psychiatrists, social workers and psychologists. The federal government has designated 58 out of the state’s 100 counties as areas without enough mental health professionals, putting people in these communities with depression, anxiety or other behavioral issues at risk.

To address this health challenge, North Carolina public health officials launched a statewide telepsychiatry program in January 2014 to help hospital emergency departments without enough mental health care resources. With nearly 91 million Americans across the country living in federally designated mental health professional shortage areas, the North Carolina initiative could serve as a model for addressing this common problem, which, according to experts, is even more pronounced in pediatric mental health care.

“Telepsychiatry offers lots of opportunities,” says Chris Collins, MSW, the director of the North Carolina Office of Rural Health and Community Care. Her office oversees the program, which has already resulted in shorter wait times in emergency departments and prevented unnecessary commitments to state psychiatric facilities, Collins says. By the end of the fiscal year 2017, she predicts the program will save about $7 million in hospitalization costs.

Mental health professionals at four locations use secure audio and video technology to diagnose and treat individuals at the hospital emergency departments participating in the program.

“You have the provider in the emergency room, and you have the psychiatrist going through the exam, just like they would in person,” Collins says. “It’s all in real time, and then you have the psychiatrist providing consultation to the medical provider for whatever course of action is appropriate.”

In 2013, North Carolina state officials invested $4 million to expand a smaller pilot telepsychiatry initiative funded by the Albemarle Hospital Foundation. Since then, the program has grown to include 50 hospitals throughout the state and is projected to increase to 77 by 2017. The East Carolina University Center for Telepsychiatry and e-Behavioral Health is partnering with the state on the project.

David Axelson, MD, medical director for Behavioral Health Services at Nationwide Children’s Hospital, praises the North Carolina effort.

“You often can’t afford to have a trained mental health professional in an emergency room,” Dr. Axelson says. “There would be a lot of downtime, and it would be very expensive. So this is a way of getting that expertise where it’s needed in a more timely fashion.”

When Nationwide Children’s experimented with telepsychiatry in the past, Dr. Axelson says, the initiatives worked best when augmenting outpatient centers or large pediatric practices that already had established programs and therapists on site.

“It’s been effective in the practices that were committed to providing a fair amount of mental health care themselves and were looking for additional assistance,” Dr. Axelson says.

Still, telepsychiatry may not completely fill the mental health void.

“It’s definitely worth trying and seeing where it might be helpful, but I don’t think it’s a substitute for getting more mental health practitioners,” Dr. Axelson says.


Join the conversation. How might telepsychiatry improve or detract from the quality of mental health care available at community hospitals? Would you want the service at your institution?