Telepsych: Breaking Time, Distance, Stigma & Engagement Barriers

As part of unpacking digital mental health subcategories, let’s look at telepsych. Here we have the delivery of psych services via a range of digital channels spanning from low bandwidth (SMS/chat/messaging) to broadband (video/tele) connections. Note we use this term for applications where professional treaters are connected to clients to administer formal psycho- & pharmaco-therapies. This category is among the oldest uses of technology in the mental health going back to the 1950s. It is also the application most approximate to the traditional treater-client engagement. The American Psychiatric Association notes that “Telepsychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, and patient satisfaction; it often saves time, money and other resources.”

 

This subcategory includes mental health pure- and hybrid-plays. Pure plays, focused exclusively on mental health, include: 1DocWayAbleToTalkspaceGinger.ioOocaPacificaWoeBot, etc. Hybrid plays include tele-health services firms with a behavioral/mental health subcomponent like TelADocAmerican WellMDLiveDoctHers, etc.

Their transformative effects include their:

1. on-demand & remote nature, improving on the time and space limitations of office visits, expanding the number of contexts (time x location) within which help can be delivered and reducing wait times while increasing engagement volume,

2. impact on treater-to-client ratios, allowing fewer treaters to treat more clients, important as there is a global shortage of treaters,

3. anonymity option, allowing people to seek help who would otherwise forgoe such, because of stigma,

4. convenient, multi-modal flexibility allowing tiered engagement ranging from lean artificial intelligence robots programmed to administer professional therapies, to messaging or phoning a professional to broadband videoconferencing, and

5. expanded treator practice opportunities, geographically as well as therapy-wise, allowing treators (even traditional medicine practitioners in non-Western contexts) to offer their unique style and approach to anyone, anywhere, with a compatible device and bandwidth

That said, challenges facing this subcategory are:

1. client adoption where the availability of a service is not the same as clients remembering to use it as a lifestyle habit,

2. payor reimbursement, which is growing and needs even more growth,

3. licensure jurisdiction allowing more treators to offer their services across state, and even national boundaries,

4. need for engagement training to address the difference between the personal office visits and digital channels, and

5. privacy & security risks which grow with platform complexity and popularity.

Some additional thoughts that come up for me as I consider this subcategory include:

Insight #1: The Promise of Greater Outcomes from Greater, but Lower Cost Care: When considering the cost dynamics of this approach we see that while it brings down the unit cost of a care engagement, it also allows the increase in the number of engagements. Health outcomes being a further objective beyond cost effectiveness, we look forward to continuing to seeing this greater engagement improve therapeutic outcomes.

Insight #2: Opportunity for Use in Mental Health Sectors Beyond Psych: Even though we are seeing the application of this telepsych primarily in the engagement between treator and clients, there is opportunity ahead to expand leverage of this same application in social services, education & law enforcement contexts, which are often adjacent to mental/behavioral health contexts.

Insight #3: Wearables, IOT & Care Coordination Can Amplify TelePsych Effect: The potential for telepsych integrated into care coordination platforms and IOT (wearables & ingestible) ecosystems, makes for a situation where an increased line of sight into a client’s biometrics, location, diet, sleep, etc., in addition to live engagement, can significantly improve the possibility of time intervention and positive mental health resilience for a greater number of people.

More Reading:

  1. Telepsychiatry is Rising in Popularity, Despite Hurdles, Psychiatry Advisor, 2016
  2. History of TelePsychiatry, American Psychiatric Association

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As always, be (cognitively, psychologically & emotionally) well!

 

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