Innovation in Crisis: How Telehealth Led to Better Care for Veterans During the Pandemic

Obtaining the right mental health care is often difficult for veterans since the private sector frequently lacks the military cultural competency needed to care for them. A breakthrough on this front occurred during the pandemic as telehealth provided veterans with increased access to care. May is both Military Appreciation and Mental Health Awareness month; the intersection of those two demonstrates how breaking down barriers to telehealth can benefit our military veterans.

During “Stand-To 2021: A National Veterans Convening,” Dr. Amanda Spray, program director at the Steven A. Cohen Military Family Center, reported on how the pandemic resulted in telehealth breakthroughs regarding veteran mental health care.

Mental telehealth service expanded significantly due to necessity during the COVID pandemic. Dr. Spray explained that initially there was resistance to telehealth because it was viewed as a compromise to in-person care. Prior to the pandemic, only 10 percent of patients at the Cohen Center had tried mental telehealth treatment. Participation quickly changed to 100 percent during the pandemic. The pandemic forced both patients and providers that may have been biased against telehealth to try it. With the increase in participation on both sides has come an increased comfort level with telehealth. Dr. Spray noted that exposure has resulted in a lot of adoption of telehealth and satisfaction with this delivery method of mental health service.

Data gathered from large randomized controlled trials and program evaluations indicate that the effectiveness of telehealth services is nearly equivalent to in-person care. Telehealth also has lower no-show rates, which can lead to a greater adherence to treatment. Other benefits of telehealth are decreasing barriers to access for veterans with disabilities, eliminating commute time – saving veterans time and money, and increasing anonymity of receiving care. Contrary to their own expectations, Dr. Spray observed that veterans and their families are expressing a high degree of satisfaction with telehealth after trying it.

While great strides were made during the pandemic to improve access to telehealth for veterans, opportunities remain to remove regulatory barriers to improve telehealth access for veterans. Mental health providers are licensed on a state-by-state basis. While this is less of an issue in the VA system, private providers currently must be in the same state as the veteran being treated. This licensing barrier creates a major challenge for veterans, who must change providers when they change states. Interjurisdiction practice compacts between multiple states (e.g. PSYPACT) provide a potential solution to this barrier. These interstate compacts are agreements between states to enact legislation and enter into a contract for a specific, limited purpose or address a particular policy issue. In this case, such a pact would allow telehealth providers licensed in compact states to apply and start practicing under the compact’s authority in other states participating in the compact.

It is encouraging to see that the crisis led to more veterans being able to receive high-quality mental health care due to telehealth.  As telehealth becomes increasingly popular with veterans, hopefully the regulatory barriers will be eliminated as well so that more veterans can receive the quality care that they need.

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