Telemedicine Can Improve Likelihood of Obtaining Mental Health Services

JAMA Psychiatry recently published a cohort study looking at how telemedicine in nonmetropolitan counties can improve access to mental healthcare and adherence to medication. The scientists concluded that telemedicine could improve the likelihood of obtaining mental health services but does not directly impact medication adherence.  

This study specifically looked at Medicare patients in rural communities. The beneficiaries examined included any patients with either two or more outpatient visits with a diagnosis of schizophrenia, schizophrenia-related illness, or bipolar I in any diagnosis field or 1 outpatient visit with one of the diagnoses in the first 2 diagnosis fields.  

According to the WHO, schizophrenia affects 24 million people globally. Symptoms of schizophrenia include delusions, hallucinations, agitation, disorganized thinking, and social withdrawal. The WHO also states that only 31.3% of people with psychosis have access to specialized care.  

Furthermore, the NIH states that, in the United States, 4.4% of adults will experience bipolar disorder.  

The JAMA researchers looked at these diagnoses between 2010 and 2018, and a total of 118,170 patients from 2916 counties were studied.  

Counties were classified as no, low, moderate, or high telemental health service use.  

The study stated that telemental health services increased from 2010 to 2018. The percentage of counties with high use increased by 15% in that 8 year time frame. Furthermore, the study found that specialty mental health visits increased in the same time frame. 

The researchers also concluded that patients in counties with high telemental health services were more likely to obtain proper mental healthcare. The counties with high telemental health access had a 1.2% higher chance of receiving 4 or more specialty mental health service visits. Furthermore, they were 2.2% more likely to follow up within 7 days of hospitalization for mental health issues. 

“In this cohort study, at a county level, among nonmetropolitan beneficiaries with SMI, we found that greater use of telemental health service was associated with modest increases in contact with outpatient specialty mental health professionals and a greater likelihood of follow-up after hospitalization. However, no substantive changes in medication adherence were noted, and an increase in hospitalizations was observed,” concluded the researchers in the publication.  

This conclusion has multiple implications in mental healthcare as there is a shortage of physicians, especially specialized physicians, in these rural communities. The study stated that counties with high telemental health services had an average of only 2.2 hospital beds per 1000 people and 1.1 physician or advanced nurses per 1000.  

Although this study has limitations, such as an uneven gender population, it may help inform advances for access to mental healthcare.