To create a more effective and affordable healthcare system, we need to accept that behavioral health is health.
If you’re not convinced, consider the enormous burden lifestyle-related conditions place on our system. Chronic diseases like hypertension, heart failure, and diabetes account for 75% of healthcare spending. While only a fraction of these patients meet the criteria for psychiatric diagnoses, almost all could benefit from behavioral and social support to better manage their conditions. As anyone who has lost weight, quit smoking, or started an exercise program can attest, behavior change is often our biggest barrier to healthy living.
Unfortunately, few patients have the bandwidth to travel to multiple in-person doctor visits, counseling sessions, and support groups each week. So how do we integrate behavioral health without making complex disease management a full-time job? One possible solution is to leverage telemedicine and, more specifically, telepsychiatry.
A Critical Turning Point for Psychiatric Care
In the spring of 2020, I traveled to New York City to provide medical disaster relief. While I received a relatively safe assignment to the COVID hotel (where patients who could not isolate on their own stayed during their quarantine or infectious period), some of my emergency medicine colleagues were sent to a nearby ICU. At one point, one of my peers reported that every local doctor on the unit was out with COVID-19, and two were hospitalized.
In this context, hospital-based providers nearly all turned to on-demand telepsychiatry services for consults. During the early days of the pandemic and as regions across the country experienced surges, it was safer for patients and psychiatrists to interact virtually. In fact, many psychiatrists simply refuse to work in hospitals (with 60% of psychiatrists over age 55 and therefore in a higher risk category for viral transmission, this isn’t surprising).
Beyond the context of the pandemic, virtual behavioral health is the only available option for many emergency physicians and hospitalists. Relatively few health systems have the case volume to support a psychiatric hospitalist. Meanwhile, local psychiatrists often hesitate to consult on medical cases due to reimbursement barriers.
While some psychiatrists were early adopters of virtual care, telepsychiatry exploded during the pandemic. As a result, resistance to telepsychiatry has rapidly lifted. Both patients and providers started virtual care out of necessity but quickly warmed to its convenience and effectiveness. Meanwhile, regulators eased their historically onerous restrictions on telehealth reimbursement (at least for the duration of the pandemic). And health systems and physician groups see the writing on the wall and have begun investing in telehealth infrastructure.