Telemental health services are mental health care services provided over a distance via telephone or videoconference. Services can include psychotherapy, counseling, supplemental support services accompanying face to face therapy, and self-directed services such as online cognitive behavioral therapy. Patients can receive care via their home computer through services such as Skype or be hosted at clinics or hospitals where telemedicine equipment is housed. Direct real time services are generally provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners (Lambert 2013). Supplemental or self-directed services such as cognitive behavioral therapy programs may or may not involve direct interaction with a practitioner. Telemental health services can supplement or provide services to individuals in areas with limited access to mental health care professionals (e.g., rural communities or other Health Professional Shortage Areas (HPSAs).
Expected Beneficial Outcomes (Rated)
Improved mental health
Reduced post-traumatic stress
Other Potential Beneficial Outcomes
Increased access to mental health services
Evidence of Effectiveness
There is some evidence that telemental health services improve mental health (Osenbach 2013, Dorstyn 2013*, Sloan 2011*, Hailey 2008*). However, additional evidence is needed to confirm effects on access to care and identify the types of services that are most effective for each condition.
Telecounseling, psychotherapy or counseling by telephone or videoconference, appears to be as effective as face to face psychotherapy for treating depression (Osenbach 2013, Dorstyn 2013*, Sloan 2011*, Hailey 2008*). Telehealth treatments can reduce post-traumatic stress disorder (PTSD) symptoms (Sloan 2011*, Hailey 2008*), but appear to be less effective than face to face interventions (Sloan 2011*). Telemental health services may also positively affect conditions such as dementia, schizophrenia, panic disorder, substance abuse, and eating disorders, and may aid in suicide prevention (Hailey 2008*). Participation in telecounseling can also reduce depression and anxiety, and improve quality of life among ethnic minorities such as Asians, Hispanics, and Blacks (Dorstyn 2013*).
Programs and services that are comprehensive and involve some contact with a therapist for feedback and follow-up appear to be more effective than less comprehensive programs and those that do not involve therapist contact. Telemental health services may be more effective when treating mild or moderate symptoms, rather than more severe symptoms (Penate 2012).
Initial cost analysis of videoconferencing telepsychiatry appears favorable, with potential savings in time, costs, and patient travel (Pesamaa 2004*). One study of telephone care management and cognitive behavioral therapy found only a modest increase in the cost of services compared to usual primary care (Simon 2009), although additional study is needed to confirm effects on cost (RAND-Brown 2015).
Impact on Disparities
The University of Virginia Health System in Charlottesville uses videoconferencing to link rural patients to the University’s psychiatric fellows and residents (AHRQ HCIE-Burket). In Texas, the University of Texas Medical Branch, working with community-based partners, provides remote mental health services to students and parents in the Galveston Independent School District (AHRQ HCIE-Raimer). In South Carolina, a statewide partnership established by the Department of Mental Health, the University of South Carolina School of Medicine and 18 predominantly rural hospitals provides psychiatrists via teleconference to assess and treat patients with mental health issues in hospital emergency departments (AHRQ HCIE-Narasimhan).
Citations - Evidence
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Osenbach 2013 - Osenbach JE, O’Brien KM, Mishkind M, Smolenski DJ. Synchronous telehealth technologies in psychotherapy for depression: A meta-analysis. Depression and Anxiety. 2013;30(11):1058-67.
Dorstyn 2013* - Dorstyn DS, Saniotis A, Sobhanian F. A systematic review of telecounselling and its effectiveness in managing depression amongst minority ethnic communities. Journal of telemedicine and telecare. 2013;19(6):338-46.
Sloan 2011* - Sloan DM, Gallagher MW, Feinstein BA, Lee DJ, Pruneau GM. Efficacy of telehealth treatments for posttraumatic stress-related symptoms: A meta-analysis. Cognitive Behaviour Therapy. 2011;40(2):111-25.
Hailey 2008* - Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: A review. Canadian Journal of Psychiatry. 2008;53(11):769-78.
Penate 2012 - Peñate W. About the effectiveness of telehealth procedures in psychological treatments. International Journal of Clinical and Health Psychology. 2012;12(3):475–87.
Pesamaa 2004* - Pesamaa L, Ebeling H, Kuusimaki ML, et al. Videoconferencing in child and adolescent telepsychiatry: A systematic review of the literature. Journal of Telemedicine and Telecare. 2004;10(4):187-92.
Simon 2009 - Simon GE, Ludman EJ, Rutter CM. Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care. Archives of General Psychiatry. 2009;66(10):1081-9.
RAND-Brown 2015 - Brown RA, Marshall GN, Breslau J, et al. Access to behavioral health care for geographically remote service members and dependents in the US. Santa Monica: Rand Corporation; 2015.
Citations - Implementation Examples
* Journal subscription may be required for access.
AHRQ HCIE-Burket - Burket RC, Merkel RL. Videoconferencing enhances access to psychiatric care for children and adults with mental illness in rural settings. Rockville: AHRQ Health Care Innovations Exchange.
AHRQ HCIE-Raimer - Raimer BG. Remote assessment and treatment via telemedicine combined with onsite case management enhance access to mental health services for low-income and minority students. Rockville: AHRQ Health Care Innovations Exchange.
AHRQ HCIE-Narasimhan - Narasimhan M, Magill J. Statewide partnership provides mental health assessments via telemedicine to patients in rural emergency departments, reducing wait times, hospitalizations, and costs. Rockville: AHRQ Health Care Innovations Exchange.
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