Online Mental Health Counseling Hindered by Lack of Reimbursement

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Although Internet access has grown rapidly in recent years, the use of "telepsychiatry" -- or Web-based mental health counseling -- has yet to catch on, the New York Times reports.

Proponents of Telepsychiatry

Supporters of Internet-based mental health therapy say recent research shows that the strategy can be effective in managing conditions such as depression and anxiety. For example, a 2009 study published in the journal Lancet found that cognitive-behavioral therapy delivered remotely to patients with depression showed benefits eight months after the initial treatment.

Lynn Bufka -- a psychologist and staff member at the American Psychological Association -- said applying Web-based telehealth tools to mental health counseling could "open access to those who might be reluctant to go to an office or to those who might be physically or psychologically unable to."

Telepsychiatry Companies

Cope Today, a company that aims to match patients to therapists online, first tested its service with the North Carolina National Guard and since has opened its program to the public. The service allows prospective clients to view a list of therapists and their availability for consultation via video, phone or online chat. The first 10 minutes of a session are provided at no cost, and then the company charges $35 for each 15-minute increment.

Tania Malik -- Cope Today's CEO -- said that it is difficult to sell the service to individuals paying out-of-pocket, adding that she hopes to contract with employers that could offer the service to their workers.

Another company, called HealthLinkNow, offers online mental health services through contracts with institutional clients, such as hospital emergency departments and employers.

HealthLinkNow CEO Barb Johnston said, "I think you're going to see larger companies provide rooms in which employees can seek telemedicine services, including mental health services. That way, the employee won't lose half or a whole day of work for a consult."

Challenges to Widespread Adoption

One of the most significant hurdles to widespread adoption of telepsychiatry is insufficient reimbursement from most private insurers, Medicare and Medicaid.

Health plans that do reimburse for telehealth services typically provide a lower payment rate than for in-person treatment. In addition, Medicare reimburses for telehealth services only if the beneficiary lives in an area with a shortage of health care providers.

Another concern about telepsychiatry is that remote therapists might be unable to respond effectively to a crisis situation.

Carolyn Turvey -- associate professor of psychiatry at the University of Iowa and vice chair of the American Telemedicine Association's telemental health group -- recommended that therapists collect emergency contact information before providing online consultations (Stross, New York Times, 7/9).

Ruth Textor
Very Helpful. As a retired Clinical Social Worker, I would like more information to be a part of the telehealth services in rural Michigan. Please assist me on how to proceed with this process. Thank You.

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