Providers like MDLIVE and the VA highlight the promise of digital behavioral health treatment.
A vigil for victims of the Parkland shooting. Photo has been cropped and edited. Courtesy of Fabrice Florin, Flickr.
When a 19-year-old shot and killed 17 people at Marjory Stoneman Douglas High School in Parkland, Florida, on Valentine’s Day, Rich Berner, CEO of telehealth service MDLIVE, felt compelled to help. His company is headquartered in the same county, and three of his employees have children who attended the school on the day of the shooting. Like many in his South Florida community, he and his workforce were directly affected—and moved—by the massacre.
“It was an incident that hit very close to home for us,” he says. “And we look for opportunities to give back.”
Acting quickly, Berner and MDLIVE offered free, unlimited behavioral counseling services, beginning the next day and through March, to any affected students, school employees, parents, and family members. All they had to do was dial a number and give a code (MDLIVECARES), and then a behavioral health specialist would assist them.
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MDLIVE reached out to the district that oversees Marjory Stoneman Douglas to coordinate distribution of the offer, but school officials declined, according to Cathleen G. Brennan of the Broward County Public Schools information office. Brennan says via email that the district instead decided “to provide intense therapeutic services through a face-to-face modality due to the gravity of the situation early on and the ensuing trauma experienced by the students and staff.”
Although the district opted for face-to-face treatment, the fact that telehealth provided a non-district-aligned option for victims of the Parkland shooting shows how far digitized behavioral health has come, especially as it relates to treating patients who’ve suffered from cases of extreme trauma. Thanks to easier-to-use apps and a growing acceptance of patients to seek treatment through smartphones and computers, telemedicine is making it easier to recover from disasters and other traumatic events.
The numbers behind the increase in behavioral health treatment via telemedicine bear this out. According to a 2017 National Business Group on Health study, in states where telehealth is allowed, the majority of employers that offer the service planned to give covered employees behavioral-health telemedicine treatment options. That same study also claims that “nearly 20 percent of employers [experience] employee utilization rates of 8 percent or higher.”
Although Berner declined to say how many people took up MDLIVE’s offer (and the only student who replied to Healthcare Analytics News™ says that neither she nor her classmates were aware of the offer), he noted that the company saw a 41 percent increase in visits from the state of Florida since February 14.
On the whole, he points to the destigmatization of mental health issues and the fact that MDLIVE employs more than 100 psychiatrists and 400 therapists, in addition to licensed social workers and family and marriage counselors, to account for the six sessions it conducts for the typical patient. Once patients commit, receiving help via telemedicine from a behavioral health specialist is no different from attending an in-person session.
“You can research [and] look through the counselors that are available, and you can decide when you want to do it,” Berner says. “You can try multiple folks if you want and find the counselor that you like. You set up the time, and you can do it via your computer or mobile device, and you can do it at the location that you want.”
For the US Department of Veterans Affairs (VA), the accessibility of behavioral health sessions is one of telemedicine’s biggest advantages. The agency has offered a form of telehealth since 1959, when it first offered mental health services through two-way televisions at the Grand Island, Nebraska, VA hospital with the assistance of the Omaha VA and the University of Nebraska Medical Center. However, the agency is now transitioning into telemedicine services for behavioral health at a scale previously unimagined.
According to John Peters, deputy director of telehealth services, the bulk of the behavioral health services the VA offers involves psychotherapy, but significant resources have been dedicated to treating posttraumatic stress disorder (PTSD) and insomnia too. The VA doesn’t actively push veterans toward telehealth, but when a veteran visits the primary care facility in their home region, a discussion about moving the patient to sessions via telemedicine will be broached if the desired treatment warrants it. If a veteran gives consent, often they will begin treatment via teleconferencing with a doctor at a primary care facility from a closer VA community-based outpatient clinic, otherwise known as a CBOC.
The VA found that in fiscal year 2017, it delivered 473,000 telemental health consultations to 156,000 veterans.
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“That mental health service is almost exactly the same,” Peters explains. “The doctors and the patients say after the first I-don’t-know-how-many-seconds that technology kind of falls away: the screen, the monitor, the keyboard. Then it’s just two people talking.”
What the VA hopes to specifically expand in the near future, however, is the use of its VA Video Connect app. Similar to app-based services already provided by private services like MDLIVE, VA Video Connect allows veterans to receive treatment from anywhere they feel most comfortable—like their own home. According to Peters, veterans who use the app don’t need to download any software to access their sessions; they need only to click a link that’s emailed to them at the time of their appointment to receive treatment.
There’s an obvious benefit for battle- and war-scarred patients.
“There are stories of veterans with [PTSD]...They know they need care, they made an appointment, they go out to their car and put the key in the ignition, and they just can’t do it,” Peters says. “There’s something that’s keeping them back. We think [VA Video Connect] is a great solution. They can do it from the privacy of their own homes.”
Peters and his team plan to expand the VA Video Connect app. And before the Parkland tragedy, Broward County Schools had already been investigating a telehealth option for its students, which it plans to run with one of its partners, Memorial Healthcare Systems, and it has since reopened conversations about providing that service. For Berner and MDLIVE, the future is all about increasing the use of artificial intelligence and integrating their new chatbot, Sophie, into the triage process.
It’s Berner’s hope that Sophie will more quickly and accurately identify patients’ symptoms and get them to a clinician, a counselor, or a psychiatrist sooner. Ultimately, though, Berner thinks the technology and ease of use will encourage people to pursue behavioral, mental, and trauma-related health treatment if they need it.
“We’ve seen research that shows over 20 percent of Americans suffer from behavioral health conditions,” he says. “And oftentimes people don’t recognize [they need help], and/or they might be embarrassed to ask for help. It’s a great way to leverage the technology to get the high-quality care you’re looking for and counseling advice but also in the privacy of your own home.”
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