Veterans Administration is Leader in Telemental Health

By John Thomas, Associate Editor
July 21, 2014

 Veterans Administration is leader in telemental healthLong waits for care at Veterans Administration facilities have drawn harsh criticism and congressional action, but the VA is a leader in another area of care – telemental health.

With 44 percent of veterans returning home from Iraq and Afghanistan to rural zip codes, the VA is relying increasingly on telemental health and other technologies to deliver needed care to those suffering from war experiences who live far from VA facilities.

The first such program to be funded by the Office of Rural Health, the Oregon Rural Mental Health Team at the Portland VA Center, is saving veterans time and money but giving them quality mental health care though the latest technologies, says Mark F. Ward, Ph.D., director of the program.

“In 2012-2013, the team saved the state’s veterans enrolled in the program 1,088,148 miles of driving and the associated costs in gasoline,” Ward said. He noted in 2013, the savings in miles driven was 826,290, with an estimated savings of $161,126 worth of gasoline.

Ward said his team of six psychologists and 19 other full-time employees has a current case load of 940 active cases. The program began in 2010.

The team connects with veterans using videoconferencing and webcams. Some of the veterans who live far from Portland and do not have high-speed internet, but do have cellular coverage are being provided electronic tablets and notebooks, Ward added.

The VA telemental health movement got a boost a couple years ago when veterans who agreed to receive counseling and other services in their homes were exempted from any co-payment requirements. The VA also has added nearly 2,000 psychologists and other mental health professionals to its staff during the last two to three years.

Nationally, the VA plans to deliver at least 300,000 telemental-health visits to 115,000 veterans this year, compared to last year when 80,000 veterans benefited from more than 200,000 telemental-health visits. Since the VA started its widely adapted telemental health outreach program 10 years ago, more than 650,000 sessions have been recorded.

Including all kinds of telehealth care, the VA provided services to nearly a half-million veterans through more than 1.4 million telehealth-based episodes of care in 150 medical centers and 750 community-based outpatient clinics, according to testimony given by Robert A. Petzel, MD, the former undersecretary of health for the U.S. Department of Veterans Affairs. He said 30 percent of clinics are in rural areas.

Petzel said the VA’s objective is to ensure that any mental health service available at its main health care facilities also is available via telemental health at its clinics.

The VA is also making free apps that veterans can use with smart phones to help them deal with post-traumatic stress disorder. The app allows veterans to seek help anytime with the PTSD Coach application created by the VA and the Department of Defense.

PTSD Coach lets users track their PTSD symptoms, links them with local sources of support, provides accurate information about PTSD and teaches helpful individualized strategies for managing symptoms at any moment. The app is designed to enhance services for veterans who are already receiving mental health care, though it is also helpful for those considering entering mental health care and those who just want to learn more about PTSD, the VA reported in rolling out the new app.

A recent report presented the most convincing evidence to date that telemental health is not only effective, but that it can surpass the efficacy of in-person encounters when delivered by a wide variety of mental health professionals for a range of commonly treated mental health disorders.

The study found that telemental health services provided by the VA decreased psychiatric admissions of telemental health patients by more than 24 percent and the patient days of hospitalization decreased by an average of almost 27 percent.

The June audit, the first nationwide look at the VA network following the uproar that started two months ago when it was revealed that thousands of veterans were being denied primary care appointments, reported that there were long waits for some veterans seeking mental health treatments as well. The worst waits were in areas that included large military populations, such as Durham, N.C., and Hampton, Va.

By and large, however, most waits for first-time mental health appointments ran about 30 to 40 days, while waits by those already in the VA system were negligible. The Durham facility had a wait time of 104 days, while the wait in Hampton was 54 days. Other facilities with above average wait times for initial mental health appointments were Clarksburg, W. Va.; Amarillo, El Paso, Dallas and Harlingen,Texas; Erie, Pa., and Montgomery, Ala.

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