MUSC News Center
Telehealth sessions effective for mentally ill patients
Staff Report | MUSC News Center | August 25, 2015
|Dr. Leonard Egede says telehealth allows patients to talk about mental illness in a comfortable setting.|
Patients who have been struggling with mental illness and access to care now have assurance from a new study that telehealth services delivered at a patient’s convenience are as effective in treating mental illness as in-person care at a provider’s office.
The Medical University of South Carolina-led study was recently published in The Lancet (http://tinyurl.com/nh6je3v) and received special commentary because it’s the first large randomized clinical trial showing that telehealth is equivalent in terms of treatment success to in-person office visits at one year post-treatment. Journal commentators said the study is notable for not excluding veterans with significant co-morbidities; for example, two-thirds of participants with depression also had a lifetime history of post-traumatic stress disorder. The study was funded by the Veteran's Health Administration Health Services Research and Development Program and was conducted at the Ralph H. Johnson VA Medical Center.
Leonard E. Egede, M.D., Allen Johnson Endowed Chair, professor of medicine and MUSC Center of Health Disparities director, was the study's lead author and principal investigator. “Anecdotally, we have found telehealth to be helpful to our patients for decades, and we were excited to see that after rigorous testing, those receiving care through in-home telehealth services had equal outcomes as those receiving care in person,” Egede said “Telehealth can offer a way to address mental health concerns without adding additional trips to the doctor’s office and in a setting where patients feel comfortable since it is often new and sometimes difficult to discuss topics like distress and depression. This is one way we can try to increase access to mental health treatment and improve the mental health of Americans.”
Access to mental health services has diminished during recent decades, even as providers are discovering just how common and widespread mental illness is in the U.S. The Centers for Disease Control and Prevention reports that 8 percent of the U.S. population (12 years and older) reported depression in any given two-week period. Depression was more prevalent, however, in those 40-59 years-old. Unfortunately, only 35 percent of those reporting severe symptoms also reported seeing a mental health professional.
Advantages of telehealth treatment include enhancing access for people in remote locations, reducing stigma and bringing services to those with chronic health conditions that restrict mobility such as the veterans who participated in this trial. Telehealth also offers the advantages of convenience and cost savings. As telehealth continues to grow as a service, the study points out that although there may be administrative, technical or legal challenges associated with delivering telehealth, these challenges can be overcome and the benefits far outweigh the potential problems.
It’s not just veterans who stand to benefit from telehealth. “Not addressing early signs, or not seeking help when it is needed, can often lead to increasing impacts in patients’ lives,” Egede said. “Many physical illnesses, such as diabetes, are also associated with increased risk of mental illnesses, so it is important to consider the mental health of those with chronic diseases like diabetes and the ripple effects on our community.”
To further illustrate this point, consider older adults with diabetes who are unable to access the care they need because they are unable to drive to their appointments, have no means of transportation or have negative attitudes about psychotherapy or going to a mental health clinic. These issues can be overcome by providing equally effective care via telehealth in the patient’s home. In the study, video phone devices allowed providers and patients to see and speak to each other during behavioral treatment. The patients did not need any extra technology expertise and could receive treatment in their homes.
“People with diabetes are twice as likely as those without diabetes to develop depression, so it is something I take into consideration every time I see a patient,” Egede said. “As depressive symptoms increase, people often lose interest in taking care of themselves and their diabetes becomes worse. The stress of managing diabetes can also increase depression and if left untreated lead to severe complications like amputations, heart attack, and stroke. It’s important for people to be aware of the symptoms of depression so they can seek care for themselves, or help those they love find appropriate care. Depression can be treated, but finding help is often the first step.”