Approximately one in five adult Americans experience a behavioral health disorder each year; however, limited reach of behavioral health services remains a pervasive problem in the United States, especially among rural and underserved populations. Telehealth is widely believed to be a promising strategy to address geographic barriers, improve access to and increase the quality of healthcare for patients living outside urban areas, and to strengthen behavioral health workforce capacity. Advantages to utilizing telehealth include reduced travel time and cost, reduced separation of families, reduced number of missed appointments, higher treatment program completion rates, and the perception of increased confidentiality.

Although telehealth is considered useful in providing behavioral health care, states vary in their implementation. Researchers at the Behavioral Health Education Center of Nebraska at the University of Nebraska Medical Center and the National Council for Behavioral Health will lead this project, which seeks to determine who is using telehealth and whether telehealth impacts access to and quality of care for different populations. Additionally, this project seeks to determine what types of populations are frequently utilizing telehealth, what services they are utilizing in telehealth visits, and whether reciprocity for delivery of telehealth exists across states.

Key Findings from Nebraska Study

Receiving treatment from a mental health professional can be challenging in a rural state like Nebraska, where there are few providers. Telehealth is a promising solution to healthcare workforce shortages that uses videoconferencing technology to deliver services, precluding the need for clients to travel long distances to access mental health services.

This study determined the perceived barriers that keep providers in Nebraska from offering telemental health services. To provide context, we reviewed Nebraska’s policies on Medicaid telehealth reimbursement. We then analyzed the mental health workforce availability in Nebraska by region, using the Nebraska Health Profession Tracking Services database. We developed and conducted surveys and semi-structured key informant interviews, collecting information from providers and healthcare administrators on how telehealth is used. The interviews further asked about what resources are needed to increase telehealth services.

Researchers found that there are few legal limitations on telehealth use in Nebraska, and our rural areas match trends of having generally inaccessible mental health services. Despite this, only about 27% of providers have implemented telehealth services for patients and only 33% of providers use telehealth to communicate with other providers since it became a widely accessibly option for providers in 2008. Providers and administrators report a number of policy and technology barriers, but these reported barriers were often unfounded because they are based on outmoded information. Findings indicate that telehealth training could have a considerable influence on implementation in the state by increasing provider comfort with its regulation, use, and application.

Key Findings from the National Council Study

Telehealth use among behavioral health providers is a promising strategy to reduce the maldistribution of professionals and improve access to mental health and substance use disorder treatment across the U.S. However, adoption of telehealth by behavioral health providers has lagged behind primary care and other physical health providers. To better understand the utilization of telehealth among behavioral health providers, quantitative and qualitative data were collected from 329 behavioral health provider organizations representing all 50 states. Additionally, qualitative data were collected from ten key informants. The majority of respondents believe telehealth is important to the success of their organization and a valuable tool for improving access to services and quality of care. Nearly half of the respondents (48%) reported that they use telehealth for behavioral health services. The most common type of telehealth being used is direct video conferencing. Psychiatrists are the most common behavioral health professional to use telehealth, followed by mental health counselors. Financial barriers to implementation were most commonly reported, which included lack of reimbursement; cost of implementation; and cost of maintenance. Other barriers identified by participants included a lack of organizational and political leadership; workforce shortages; educational and training barriers; client-related barriers; and compliance barriers such as licensure regulations.