by Jordan Roberts
Director of Government Affairs, John Locke Foundation
American society often tends to stigmatize those with mental health disorders. While there are several factors that determine one’s overall health, our mental health plays a significant role in mediating physical health. Children and teens, in particular, suffer from a wide range of mental illnesses. Often times when these problems are not addressed early on in a child’s life, they can persist into adulthood and become more serious issues that become an even bigger burden on one’s overall health. In order to address these issues, there needs to be greater access to physicians and facilities for those who are in need. The story of Sarah Ford offers an example of how telemedicine can extend access to those who need treatment the most:
When Sarah Ford, 14 years old, was struggling with depression, hallucinations and suicidal thoughts last spring, her pediatrician in Springfield, Mo., was able to call in help from afar. Through a live videoconference link with Mercy Virtual, a telemedicine center three hours away, a child-psychiatry expert evaluated Sarah, prescribed a medication and set follow-up appointments.
Sarah Ford first confided her feelings to her mother, Susan Ford, who immediately made an appointment with Sarah’s pediatrician, Ashley Merrick. Dr. Merrick linked Sarah by video to Cassandra Turner, a Mercy psychiatric nurse practitioner who evaluated her to rule out the need for hospitalization. The two then chatted for about 40 minutes, to get at the root of Sarah’s issues. Her father had committed suicide in their home when she was 7 years old, and she had been afraid of the dark since then and said she sometimes heard and saw things.
Sarah says she was hesitant to confide in friends. She often uses FaceTime on her iPhone and was comfortable with the idea of the video session with the nurse practitioner; after a few minutes she was able to relax and talk to Ms. Turner freely. Ms. Turner recommended a temporary medication for anxiety and insomnia and a genetic test to help identify the best antidepressant for Sarah, which was later prescribed, along with a referral to a therapist. Sarah says the hallucinations have stopped and she feels much better about life. She urges other teens with depression to speak up and ask for help. “I’m just glad I told my mom and she was able to help,” she says.
Sarah’s mother, Susan Ford, says she is grateful that the virtual consult program was in place to help the pediatrician. “I was able to get help and get it quickly instead of getting on a waiting list,” she says.
Sarah Ford’s story is not all that uncommon. Individuals who suffer from mental health illnesses are often times afraid of the perception that others will hold of them if they are willing to admit they suffer from a mental illness. Fear of public judgment can result in those who need treatment the most choosing not to reach out for help. Just like with any other illness, prolonging treatment can often make the condition worse:
As many as one in five children experiences a mental-health issue in a given year. But children must often wait months and travel long distances for an appointment with a specialist. According to the nonprofit group Mental Health America, 62% of children with major depression in the U.S. don’t receive any treatment at all. Small towns and rural areas are the most underserved, but there is growing concern for youth in urban and suburban areas as well, according to the American Academy of Child and Adolescent Psychiatry.
As with most health problems in society, lawmakers try to legislate equality of services or treatment which often leads to unintended consequences:
State laws regulating the delivery of medical care via videoconferencing vary widely. Insurance coverage for so-called telepsychiatry also varies by state and by payer, and private insurers don’t always reimburse telepsychiatry on par with in-person care.
As the John Locke Foundation has argued before, these parity laws can result in negative consequences for the innovation and use of telemedicine. Costly insurance regulations placed on insurers to provide telemedicine are antithetical to the cost-effectiveness of this technology. Further, state lawmakers that feel as if they know more than physicians who practice medicine daily disregard the inherent personal characteristics of medicine and the physician-patient relationship. Instead of trying to mandate this relatively new form of technology into use, let physicians, patients, and insurers realize the benefits without legislation that raises costs and fails to incentivize innovation.