Telehealth Technologies for the Delivery of Mental Health Services

Over the past decade, rural health disparities and access to quality health care in rural settings have been major priority areas in both Veteran and civilian populations. Persons in rural settings generally have fewer health care options and face a number of barriers to care, such as limited financial resources and long travel distances relative to their urban counterparts. Disparities in rural communities are particularly problematic with regard to the receipt of mental health care services. Recent research demonstrates that, relative to those in rural areas, residents in metropolitan areas are 47 percent more likely to receive general mental health services and 72 percent more likely to receive specialized services (Richardson et al., 2009). In response to these and similar data, a number of initiatives have been launched within the VA and other large health care agencies to address disparities in access to mental health care.

One proposed method to overcome barriers to mental health care access in rural settings is with the use of telehealth technologies to provide assessment and treatment services from metropolitan areas to patients in underserved rural or geographically remote areas. Telehealth has several advantages for patients over traditional treatment approaches, including decreased patient cost (e.g., lower cost of transportation, travel time, and missed work), decreased provider costs, and increased system coverage area. In addition, telehealth may be useful in overcoming several other barriers to mental health treatments, such as perceived stigma associated with mental health care in active military service personnel and Veterans, by providing services directly in patients' homes.

Telehealth has received preliminary support in a number of treatment settings and with a range of patient populations, including patients in rural areas, older adults, racial/ethnic minorities, patients adjudicated by the courts, and Veterans (for review, see Richardson et al., 2009). In addition, there is strong evidence for both high patient and moderately high provider satisfaction with mental health services delivered via telehealth. Of particular relevance to mental health services in the VA, recent studies support the effectiveness of telehealth for delivering evidence-based psychotherapies to rural Veterans with post-traumatic stress disorder (PTSD) (Tuerk et al., 2010). Similar beneficial effects of mental health care delivered via telehealth also have been demonstrated for other psychiatric conditions (e.g., obsessive compulsive disorder, panic disorder, and anger management).

To better understand the effectiveness of mental health services delivered via telehealth to rural Veterans, HSR&D, the U.S. Department of Defense (DoD), and other agencies have recently funded several treatment outcome studies within the Charleston Veterans Affairs Medical Center (VAMC) and its associated VA Health Services Research and Development Research Enhancement Award Program (REAP). These studies include:

  1. a randomized controlled trial (RCT) of Behavioral Activation for depression delivered via telehealth or in-person in elderly Veterans (n=224 ) (Egede et al, 2009);
  2. a RCT of Behavioral Activation and Therapeutic Exposure delivered via telehealth or in-person in OEF/OIF Veterans with PTSD (n=220); and
  3. a RCT of Prolonged Exposure delivered via telehealth or in-person in OEF/OIF Veterans with PTSD (n=226).

In addition to the above, the Charleston VAMC recently received funding from the Office of Rural Health to initiate a two-year clinical treatment program to provide evidence-based psychotherapies and pharmacotherapies to rural VAMCs and their associated community-based outpatient clinics across three states. The program provided funding for five psychiatrists, five psychologists, and two support staff in addition to telehealth equipment. Together, these projects will greatly improve and expand our understanding of use of telehealth services in the treatment of a wide range of mental health conditions for rural Veterans or Veterans who may simply prefer telehealth services over face-to-face care.

Telehealth services can overcome many of the current obstacles to quality mental health care in rural settings, including lack of local providers, transportation barriers, lost time from work, and stigma. Preliminary findings suggest that telehealth services are both effective and are received favorably by patients and providers alike. Together with ongoing research and clinical initiatives of the VA, telehealth services stand to bridge longstanding gaps in access and mental health care delivery to rural and underserved Veterans, ultimately resulting in improved mental health outcomes, health care-related costs, and overall quality of life in our nation's Veterans.

  1. Richardson LK, et al. Current Directions in Videoconferencing Tele-mental Health Research. Clinical Psychology: Science and Practice 2009; 16, 323-38.
  2. Tuerk PW, et al. A Pilot Study of Prolonged Exposure Therapy for Posttraumatic Stress Disorder Delivered via Telehealth Technology. Journal of Traumatic Stress 2010; 23, 116-23.
  3. Egede, LE, et al. Rationale and Design: Telepsychology Service Delivery for Depressed Elderly Veterans. Trials 2009; 10, 22.