Community in Action
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 practitioners1. 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
Reduced vehicle miles traveled
Evidence of Effectiveness
There is some evidence that telemental health services improve mental health2, 3, 4, 5. 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 depression2, 3, 4, 5. Telehealth treatments can reduce post-traumatic stress disorder (PTSD) symptoms4, 5, but appear to be less effective than face to face interventions4. Telemental health services may also positively affect conditions such as dementia, schizophrenia, panic disorder, substance abuse, and eating disorders, and may aid in suicide prevention5. Participation in telecounseling can also reduce depression and anxiety, and improve quality of life among ethnic minorities such as Asians, Hispanics, and Blacks3.
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 symptoms6.
Initial cost analysis of videoconferencing telepsychiatry appears favorable, with potential savings in time, costs, and patient travel7. One study of telephone care management and cognitive behavioral therapy found only a modest increase in the cost of services compared to usual primary care8, although additional study is needed to confirm effects on cost9.
Telemental health services have the potential to reduce the carbon footprint of the health care industry, primarily by reducing vehicle miles traveled (VMT) and greenhouse gas emissions from patients driving to appointments. Telemental health appointments generate some carbon emissions and those amounts vary, for example, with the length of the appointment, type of teleconferencing platform used, energy used to support the virtual connection, and different broadband capacities. In general, telemental health appointments that replace a car trip of a few kilometers or more reduce carbon emissions10, 11.
Impact on Disparities
The University of Virginia Health System in Charlottesville uses videoconferencing to link rural patients to the University’s psychiatric fellows and residents12. 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 District13. 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 departments14.
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1 Lambert 2013 - Lambert D, Gale J, Hansen AY, Croll Z, Hartley D. Telemental health in today’s rural health system. Portland, ME: Maine Rural Health Research Center, University of Southern Maine Muskie School of Public Service. 2013:PB-51.
2 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.
3 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.
4 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.
5 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.
6 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.
7 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.
8 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.
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.
10 Dacones 2021 - Dacones I, Cave C, Furie GL, Ogden CA, Slutzman JE. Patient transport greenhouse gas emissions from outpatient care at an integrated health care system in the Northwestern United States, 2015–2020. The Journal of Climate Change and Health. 2021;3.
11 Holmner 2014 - Holmner Å, Ebi KL, Lazuardi L, Nilsson M. Carbon footprint of telemedicine solutions - Unexplored opportunity for reducing carbon emissions in the health sector. PLoS ONE. 2014;9(9).
12 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.
13 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.
14 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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