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On Aug. 15, 2013, the North Carolina Department of Health and Human Services alongside state governor Pat McCrory announced a plan to invest $4 million in a new telepsychiatry initiative that would improve patient access to mental health professionals and potentially improve case management throughout the state.

According to Healthcare IT News, McCrory was joined by Aldona Wos, M.D., the state Human Services Secretary, and other local leaders at East Carolina University in Greenville, N.C.

"No matter where you live in North Carolina, you will soon have better access to mental health providers with the expansion of telepsychiatry across our state," McCrory noted in an address. "Technology will help us connect people with appropriate treatment programs so patients can avoid long waits in the emergency room. North Carolina can be a national leader with this program."

Answering an urgent need
According to a fact sheet released alongside the plan, North Carolina is in need of new mental health initiatives that concentrate on delivering coordinated care to those that need it most.

In North Carolina today, there is a shortage of mental health services in 58 of the state's 100 counties. According to federal guidelines, those counties are qualified as Health Professional Shortage Areas because they lack the necessary providers to meet population needs.

Furthermore, the majority of North Carolina hospital emergency departments don't have full-time psychiatrists on staff. This means that behavioral health patients in need of emergency services may have to wait for hours – or, the fact sheet noted, sometimes as long as days and weeks – for treatment. This is paired with what the fact sheet noted was an uptick in emergency room use for mental healthcare in recent years. Between 2008 and 2010, 9.3 percent of visits to emergency departments in North Carolina hospitals were tied to acute psychiatric episodes. This compared to only 5 percent of visits nationally.

There's also a need for improved discharge management. According to the fact sheet, more than 25 percent of individuals with mental health crises who are admitted to emergency departments then return to the hospital within 30 days.

What telepsychiatry can do
The plan defines telepsychiatry as the delivery of care for mental health or substance abuse, which includes either diagnosis or treatment, via two-way, real-time audio and video conversations between healthcare providers in remote locations and patients in referring sites.

To help illustrate the benefits that telepsychiatry could offer North Carolina through the $4 million initiative, the plan authors cited a pilot program.

The study, the results of which appeared in the North Carolina Medical Journal in 2011, was conducted through East Carolina University's Center for Telepsychiatry and e-Behavioral Health of how a telepsychiatry program worked to help improve care for people with mental illness in rural North Carolina.

The ECU has worked with telemedicine since 1992, and even within that first year, participating hospitals witnessed the average patient length of stay in emergency departments reduce significantly. Among the other outcomes of the study were indications of potential cost savings, improved patient convenience, greater patient compliance with therapy, higher attendance rates for telehealth visits and lower frequency for missed appointments compared to traditional outpatient therapy and more coordinated care and case management.

Perhaps just as importantly, the new telepsychiatry program is able to build on an existing network set by the ECU's structure.

A second inspiration and building block for the initiative is the Albemarle Hospital Foundation's telepsychiatry project, which is funded by the Duke Endowment. Over 4,000 psychiatric assessments have been performed through this project since May 2011, and numerous benefits and improvements have been cited.

Since the implementation of the telepsychiatry project, average length of stay for individuals in inpatient treatment has dropped from 48 hours to 22.5 hours. Thirty-day recidivism rates have also dropped, this time from 20 percent to only 8 percent since the project began. Furthermore, participating hospitals reported a reduction rate of 33 percent in involuntary commitments, which has in turn led to cost savings for psychiatric hospitals and state inpatient treatment facilities.

"During my travels to hospitals around North Carolina, it is apparent that improving quality and access to mental health services must be a priority for our state," said Wos during a news conference, quoted by Healthcare IT News. "By investing in a statewide telepsychiatry program, we are confronting one of North Carolina's biggest and most important healthcare challenges. Through this program, we will be able to help hospitals struggling to meet mental health and substance abuse treatment needs in their communities and connect people in underserved areas of our state to qualified behavioral health providers."