Wednesday, August 10, 2016

Madisonville girl provides example of emerging teletherapy that can help overcome shortage of psychiatrists in rural areas

When Ron Gadley searched for a therapist who could help his daughter, Rebecca, with depression near their Madisonville home, he found that their options were shockingly limited.

The few child psychiatrists within driving distance told him that Rebecca would be waiting months for an appointment, and another refused to accept new patients at all, Emma Ockerman reports for Time magazine.

Gadley finally found someone who could see his daughter every week. Even better, the treatment could begin immediately. There was a catch, though: Rebecca and her therapist would be 250 miles apart. She would be able to hear and see her therapist like normal, but her "telehealth" appointments, therapy sessions conducted by video conference, meant that Rebecca might never see her therapist face to face.

Cincinnati Children's Hospital Medical Center
(Photo from
Gadley, a machinist for Warrior Coal, told Ockerman he had never heard of teletherapy before his daughter’s depression diagnosis. After struggling to find local treatment for her, he learned that his company’s relationship with Cincinnati Children’s Hospital Medical Center meant Rebecca could receive treatment for free.

Mental health advocates hope that teletherapy can ease some of the burden on psychiatrists, especially in rural areas like Rebecca's, which often lack such professionals. A shortage of child psychiatrists is of particular concern. Mental health advocates say the U.S. needs more than 30,000 child and adolescent psychiatrists, but has only 8,300. Advocates and therapists alike have been struggling for years for an answer to the complicated problem.

The American Telemedicine Association reported earlier this year that the number of states requiring private insurers to cover telemedicine in the same way they cover in-person services had doubled in the past four years. Kentucky law requires Medicaid and private insurance to cover "tele-mental health encounters," including appointments with licensed social workers.

As technology has become cheaper and more reliable, teletherapy has emerged as a practical approach to reaching more patients, Ockerman adds. However, teletherapy has its critics, who question whether computer-assisted appointments like Rebecca's are as effective as traditional sessions carried out in person.

A 2013 study in the American Journal of Psychiatry cautioned that video conferencing could affect the natural conversation and bedside manner that would normally occur between mental health provider and patient. The appointment might initially feel impersonal; the therapist might have to make up for that with small talk to encourage “feelings of connectedness in a clinical encounter,” Dr. Jay H. Shore, a Denver psychiatrist and author of the study, writes.

But when it comes to children, they are used to interacting with technology, Dr. Michael Sorter, director of child and adolescent psychiatry at Cincinnati Children’s, told Ockerman. Computers and smartphones are where they maintain relationships with friends. Because of that, Sorter says, it might not be so unusual for them to see a doctor the same way. “They seem like they can easily relate to the TV screen.”

Others take a middle ground, seeing teletherapy as just one promising part of what must be a broader, more comprehensive solution to the shortage of behavioral health care in rural areas.

"It is part of an evolving landscape that has to change to get kids the services they need, and this is one very good part of that,” Dr. Kathleen Myers, program director for telepsychiatry and behavioral health at Seattle Children’s Hospital, told Ockerman. “But if you take a child psychiatrist here and have them practice [telehealth], all you’ve done is redistribute the manpower. We really need more than that.”

For Rebecca's part, she says teletherapy has helped her in her battle against depression. "It helped me put a jumbled-up mess into perspective," she told Ockerman. "The therapy put everything everywhere I needed it to be in my life. I’m getting active, I talk to more people, I’m making more friends."

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