Specifically, it can be used to treat military sexual trauma (MST) remotely without clients being required to go to Veterans Affairs hospitals, where individuals who likely look like MST survivors’ perpetrators would be present (Gilmore et al., 2016). Telemental health services can also alleviate many difficulties related to attending weekly sessions, including taking time off work and childcare needs. Telemental health services can be adapted to better fit with particular client groups within varied provider settings. Military service members are long-time users of telemental health services; there are currently more than 300,000 U.S. military service members and 1 million military family members located in areas where telemental health services provide help (Luxton, Pruitt, et al., 2016). The versatility and variability of telehealth technology continue to improve treatment quality while simultaneously reducing costs (Lambert et al., 2016). Many insurance policies, including Medicare and Medicaid programs, cover telehealth and telemental health services for some provider types and created waivers to allow for versatility in telehealth to expand during the height of the COVID-19 pandemic (Whaibeh et al., 2020). In doing this, they help to improve the integration of physical and behavioral healthcare, especially in rural areas. Specific aspects of funding for telemental health services are discussed in a later section of the course.The NIMH Advisory Board (2017) reports that 29% of health-related telehealth applications focus
specifically on mental health issues. Technologies such as sensors in health bands and online tools to manage symptoms and activities are used to monitor behavioral correlates of mental health problems. Some applications are used to track moods in the moment. There is also increasing utilization of text and messaging platforms for interim care and assistance with engagement and additional support (Hadler et al., 2021). These technologies can be used to track sleep, physical activities, and changes in activity levels. Research into the use of web- and Internet-based treatments shows them to be as effective as face-to-face treatments (NIMH Advisory Board, 2017). Emerging research on the use of technologies for behavioral health now focuses on gaming, that is, the use of interactive games to teach treatment principles and promote behavioral change among youth. In 2016, South Carolina implemented a telehealth service project across four state prisons. By doing this, the state sought to improve inmate healthcare, reduce costs, and reduce security risks in the community. The project includes an emergency care component that utilizes videoconferencing rather than having clients transported out of prison to a hospital. The state’s prison director reported that the use of telemental health and telehealth services will result in lowering the burden on South Carolina taxpayers by providing fewer expensive trips to outside providers (Wicklund, 2016).
HEALTHCARE ACCESS
Limited access to mental healthcare is a problem not only in many low- and middle-income countries worldwide but also in low-income urban and rural areas (Bischoff et al., 2017). In the U.S., access to mental healthcare is more readily available to those who live in urban middle- and high-income areas. Many individuals with disabilities also have difficulty accessing mental healthcare because of physical limitations, geographical distances, or the need for specialized therapists (Crowe, 2016, 2017b; Crowe et al., 2016; Khubchandani, & Thew, 2016). The U.S. Department of Health and Human Services’ division of Health Resources and Services Administration (HRSA) has criteria that officially designate whether a geographic area or population group is medically underserved. HRSA (2017) collects and aggregates data about the availability of primary care, dental services, and mental health resources across the U.S. As of December 31, 2016, HRSA identified a shortage of 4,627 mental healthcare professionals to serve 106,389,368 individuals in these areas (Kaiser Family Foundation, 2017). Simply adding a specific number of behavioral healthcare providers will not necessarily reduce the disparities in access to care. Adding a telemental health service alone, without input from and collaboration with community stakeholders and providers, is not enough to increase access. Providers must also consider other factors, such as (a) how much mental health information is available to the population in need; (b) the shared attitudes, perceptions, and cultural mores in the community; (c) how stigma and discrimination are barriers to access; and (d) to what degree mental health services are embedded in the existing healthcare framework (Bischoff et al., 2017). In areas where mental health resources are scarce or populations have specific needs, collaboration among existing community resources is a vital component of reducing disparities. Providers should employ a collaborative framework that builds on the existing infrastructure, including community members, medical providers, family members, laypersons, and clients. By using a collaborative model, clinicians using telemental health services can ensure that mental healthcare is being delivered in a way that fits with the community’s cultures,
traditions, and practices, thereby increasing accessibility (Bischoff et al., 2017). Related to equity in accessible mental healthcare is the issue of mental health parity. Historically, insurance plans have covered mental health and substance use treatment differently than treatment for physical problems (Lerman & Quashie, 2016). Many insurance plans place restrictive limits on the type and amount of mental healthcare individuals can receive. They often have caps on coverage and limit the number of days for inpatient psychiatric hospitalizations and outpatient visits. The National Alliance on Mental Illness (NAMI, 2015) reports that despite federal legislation to improve insurance coverage for mental health and substance use treatment, there continue to be multiple barriers that prevent individuals from receiving care. Individuals seeking care continue to have problems with locating in-network behavioral health providers. There are high rates of authorization denials and barriers that inhibit access to psychiatric medications. Individuals experience high out-of-pocket costs for prescriptions and mental health visits. Finally, clients often do not have sufficient information about mental health treatment and insurance plan coverage. Once clients have access to telemental health services, they typically report high levels of satisfaction and acceptance (Bergquist et al., 2014; Bischoff et al., 2017; Crowe, 2016, 2017a, 2017b; Lustgarten, 2017; Martin-Khan et al., 2015; Vernig, 2016). They also report increased knowledge, enhanced confidence, and decreased isolation (Lauckner & Whitten, 2016; Lustgarten, 2017). In addition to client satisfaction and accessibility, telemental health services can be used to deliver an array of behavioral health services. It should be noted, however, that even with recent expansions, there appear to be barriers to telemental health access for those of increasing age, lower socioeconomic status, and/or a history of schizophrenia and psychiatric hospitalization (Connolly et al., 2021).
Residents of rural Minnesota experience a variety of stressors that result in increased numbers of individuals with depression and substance use problems. The Minnesota Department of Health
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