Establishing an Evidence-Base for Telemental Health

By Mike Grove
Based on the ATA 2012 Informational Session “Establishing an Evidence-Base for Telemental Health” hosted by:

Lisa J. Roberts, PhD, Global Clinical & Innovations Manager1, Eve-Lynn Nelson, PhD, Associate Professor, Pediatrics and Telemedicine2, Kathleen M. Myers, MD, MPH, Associate Professor3,4, Carolyn Turvey, PhD, Associate Professor5,6. 1Viterion TeleHealthcare: A Business of Bayer HealthCare, Bellevue, WA, USA, 2University of Kansas Medical Center, Kansas City, KS, USA, 3University of Washington School of Medicine, Seattle, WA, USA, 4Seattle Children’s Hospital, Seattle, WA, USA, 5University of Iowa, Iowa City, IA, USA, 6VA Iowa City Health Care System, Iowa City, IA, USA.

No area seems to be as obvious a candidate for telehealth service delivery as mental health.  Given the talk-therapy nature of much of the domain of mental health services and the lack-of-access issues especially in rural communities, using communication technology to facilitate care delivery makes sense.  Many practitioners likely disagree as they feel strongly that the patient-therapist alliance requires face-to-face contact as body language and other subtle cues are key to effective diagnosis and treatment.  It’s an interesting dialogue and one that I now realize after attending this session, presents far more nuance and consideration than I had previously understood.

Like many of the topics discussed at ATA, reimbursement is a driving factor for telemental health service delivery.  Demonstrations of effectiveness are required to justify payment for services and though there appear to be intriguing preliminary results from a number of studies, some fundamental research issues remain.  For instance, how exactly can the field agree to define the metrics of clinical encounters that can be universally captured, measured, and compared?  And how can research be designed that informs telepsychology implementation programs? 

What emerged to me as a non-domain expert was the emphasis by all panel members placed on measurement of patient satisfaction with telemental health services.  Implicit in this theme was the idea that a patient who feels engaged in a therapeutic program will likely demonstrate better outcomes and that the field is acutely aware of this.  Thus, it seems as though there is broad acceptance of telemental health services by clinicians and that they are working diligently on improving the patient experience and “buy-in” factor.  Most interestingly, panel member Carolyn Turvey, PhD noted there is a fine line between patient empowerment and “patient-centered” care.  She has learned through her research that “patient-centered” care is evolving into the patient having to perform the clinician’s job and that we should be mindful of how much burden is being placed on the patient when using telemedince technologies.