It should not be news to anyone in the healthcare industry that the nation is suffering a profound shortage of mental health professionals, which was exacerbated by the pandemic. What is news to many is the different ways various telemedicine technologies are being used to help chip away at the mental health-staffing problem.

As Iris Telehealth's chief medical officer, Dr. Tom Milam manages a team of clinicians and guides them in telemedicine and industry best practices.

Milam has served in leadership roles throughout his psychiatric career and spearheaded the telepsychiatry initiative at the Virginia Tech Carilion School of Medicine and Research Institute, where he still serves as an associate professor. Milam also is an ordained Episcopalian priest and got his master of divinity degree from Yale.

We interviewed Milam to discuss:

• how provider organizations are using telehealth to try to curb provider burnout as demand for behavioral health services increases. 
• how streamlined licensing and credentialing can help with the psychiatrist shortage
• how telepsychiatry is helping with issues surrounding behavioral health that are leaving vulnerable populations at an even greater disadvantage.

Q. How are hospitals and health systems turning to telehealth to address provider burnout as demand for behavioral health services mounts?

First, I think it's important to understand the dynamics of "provider burnout." Most people who go into healthcare or behavioral health services are service-oriented, compassionate people. They're focused on wanting to use the skills they have to serve people. Anything getting in the way of that happening creates dissatisfaction.

Unfortunately, electronic health records systems can increase burnout by forcing behavioral health professionals to spend excessive amounts of time navigating their screens and conducting data entry and administrative work.

In addition, new reporting requirements are adding to that administrative workload and exacerbating burnout for clinicians. When you spend most of your day looking at a keyboard or digital screen instead of a patient, it's depersonalizing and demoralizing.

Telehealth is one of the keys to better work-life balance for providers, because the setting gives them more control. They can interact with their families when they have breaks, spend time with their pets, cook or do other things around the house to restore that balance.

Telehealth can mitigate provider burnout by eliminating long commutes that can be stressful and costly, while also freeing up time for a clinician to see patients from their homes.

So, while offering coffee and a physicians' lounge and meditation areas are nice gestures, they don't address the core need to restore work-life balance for clinicians. Telehealth, however, does so directly and immediately.

Q. How can telehealth, combined with streamlined licensing and credentialing, help solve the nation's current psychiatrist shortage?

A. More than three-quarters of U.S. counties face a shortage of psychiatrists, and more than two-thirds of primary care providers have trouble referring patients to psychiatric providers. But I want to emphasize that the shortage extends to other behavioral health professionals, such as nurse practitioners and licensed clinical social workers, all of whom can bring value to the behavioral health needs of patients.

While using licensing and credentialing software at the state and hospital or health-system level has helped make credentialing and licensing somewhat more efficient, it still requires a lot of data from the provider. Every time they change jobs, physicians must account for everything they've done since college and any breaks longer than three months.

In terms of alleviating the psychiatrist shortage, the key will be encouraging more people to go into psychiatry to begin with, which means offering competitive salaries, good working environments and ensuring meaningful time with patients.

While providers are willing to work hard, they also want to feel like what they are doing is making a difference. That's why being able to interact with patients is so critical to behavioral health professionals feeling fulfilled. Telehealth allows psychiatrists from anywhere to engage patients virtually across the country.

Q. How is telepsychiatry helping address the many issues plaguing behavioral health today that are leaving vulnerable populations, like low-income people, people of color and children, at an even greater disadvantage?

A. We all must ensure we're providing access to care for people who need it most. Those often are some of the populations you mentioned – low-income families, people of color, children, other disenfranchised populations and older adults.

That being said, I have friends, family members and neighbors who call me every week asking if I can help them see a mental health professional. So it's a problem across the board.

I see access as a three-part issue: access to a provider, access to a clinic and then access to pharmacies. Regarding access to a provider, there are huge wait lists for people just to make an appointment with a mental health professional.

And getting to a provider is not as easy as it sounds. An average doctor's appointment across the U.S. is about a two-hour encounter, including travel time, check-in, waiting, seeing the clinician, paying and traveling home. People who have jobs or are taking care of children or elderly family members may not be able to spare that much time.

It's also costly to transport elderly patients from nursing homes or assisted living facilities to clinics or hospitals and back, and then to a pharmacy. Even with Medicare and Medicaid vans available to transport eligible patients, no-show rates for many clinics exceed 20% and, in some cases, are reaching 50%.

The efficiencies built into telehealth that allow patients to log on from their homes or work provide an excellent solution for vulnerable populations to increase access to behavioral health specialists when they need them. The default option is for the patient to go to an emergency room, which not only is expensive but may not be able to provide the right treatment.

COVID triggered a fundamental paradigm shift in how we deliver care. While we'll always need clinics and hospitals, we now know how effective it can be to leverage telehealth to get care to patients where they are and when they need it.

Q. How are hospitals leveraging telehealth to improve patient throughput by balancing the influx of patients seeking fast access to high-quality behavioral healthcare?

A. In the emergency department, telepsychiatry is becoming available 24/7, allowing patients to access high-quality providers around the clock. This access reduces the amount of time patients spend in the waiting room, as well as length of stay in the ED. Psychiatric patients typically are in the ED more than three times longer than nonpsychiatric patients.

Telepsychiatry provides the expertise attending ED physicians need to properly manage patients with acute and complex mental health conditions. In addition, telepsychiatry offers significant financial benefits by cutting down on psychiatric boarding, which some studies estimate costs an average of $2,264 per admission.

Telepsychiatry helps organizations save on these costs and increases the opportunity to treat patients in need of medical and surgical care.

Outside of the ED, telepsychiatry also can open up access to specialty behavioral healthcare across the continuum and can help hospitals and health systems manage their referral queues and triage patients to the right provider at the right time.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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