Tackling changes in mental health practice: The impact of information-age healthcare

Abstract

For decades, the field of mental health, despite its obvious importance to general physical health and well-being, has been marginalized by healthcare organizations, public and private payers, and society at large, often leaving patients and families to suffer the consequences of stigma and inadequate access to care. Depression, for example, is a major contributor to poor clinical outcomes among patients with comorbid medical disorders as well as being a leading cause of lost productivity in the workplace. Depression, like most mental disorders, responds to available, effective, evidence-based treatments. Unfortunately, barriers to care have markedly reduced the potential benefit of these treatments. Telemedicine and its derivative-telemental health-offer the opportunity to remove one major barrier by delivering evidence-based behavioral treatment to the patient wherever she may be, at a time of her choosing, and to integrate that treatment into the care provided by her primary care doctor or specialist. This chapter will (1) review the market opportunity for an expanded array of behavioral services that can be integrated into primary care; (2) describe the evolution of technology solutions and how they are being incorporated into treatment modalities; (3) address the regulatory and legal issues, including the challenge of practicing across state lines and liability for adverse outcomes; and (4) analyze the barriers to successful implementation and dissemination of behavioral telehealth solutions in clinical practice. Finally, we will discuss implications for the clinical practice of the future and the impact of telemental health on the careers of those entering, advancing, or continuing their training in behavioral health fields such as psychology, social work, nursing, and psychiatry.