Telemed Services For Remote Sites

oughly half of the nation’s incarcerated individuals have some sort of mental illness, and at the same time it is widely known that this population has long been underserved. Lack of proper psychiatric services in jails and prisons has led to untreated mental illnesses such as depression, anxiety, bipolar disorders, and schizophrenia that are common in the inmate population, according to a 2006 Department of Justice Statistics special report. Access to appropriate psychiatric care is limited in correctional facilities for several reasons. In some cases, such as in West Virginia, Ohio, and Georgia, various providers have been hesitant to provide mental health treatment inside correctional facilities because of safety concerns, notes a 2013 article in the Permanente Journal, National Center for Biotechnology Information (NCBI), National Institutes of Health. In other cases, costs for providers traveling to distant facilities have been a deterrent in providing adequate care to offenders.

Barriers to appropriate care, unfortunately, do remain, acknowledge Joseph M. Pastor, M.D., chief psychiatric officer and Anthony Waters, Ph.D., senior vice president, Behavioral Health Operations, with Corizon, a leading correctional health care provider. They agree these barriers include significant cost of travel to distant sites, geographic distance of jails/prisons from hospital and clinics, and add that there are challenges in recruiting and retaining staff willing to travel and work on site, in person.

The high cost of man hours to escort and transport inmates to outside facilities for mental health services has been a major barrier to receiving effective treatment. And providers are freR Telepsychiatry’s growing role in inmate treatment.

quently unwilling to treat inmates in a private practice setting due to increased danger— whether perceived or real—to themselves or their patients.

The remuneration for psychiatrists is also sometimes a hurdle. With the exception of those in several states, providers frequently don’t make sufficient compensation to outweigh the drawbacks of treating those incarcerated. One exception, for example: It has been reported that one psychiatrist earned more than $820,000 in 2011 working for one prison in California. Also, according to the same authors, 14 prison psychiatrists earned more than $400,000 in Calif. in 2011, a level matched by only 12 other states (Klopott F, Yap R, Dopp T., Bloomberg News, 2012).

Telepsychiatry Found Effective

Telepsychiatry in correctional facilities has been found to be effective in overcoming these barriers, according to the federal health authorities.

As noted, more than 50% of inmates in correctional facilities have a diagnosable mental illness, including substance abuse. Recidivism, or reoffending and reentering the correctional system within three years of release, has been high among offenders with mental illness; approximately 25% of those inmates surveyed by the Bureau of Justice who had been incarcerated three or more times had diagnosable mental illnesses, specifically mania, depression, or a psychotic disorder, according to the BJS special report by D.J. James and L.E. Glaze. With such a high rate of recidivism, correctional administrators and providers have had to examine ways to treat mental illness and decrease the revolving door in the justice system for the mentally ill. Clinical psychologists have said that telepsychiatry has the potential to change outcomes for the better.

Telehealth in general has moved into the mainstream and its outlook is rosy, according to the American Hospital Association (AHA). In 2013, 52 percent of hospitals utilized telehealth, and another 10 percent were beginning the process of implementing telehealth services. The AHA also points out that “consumer interest, acceptance and confidence in telehealth are growing as well.

The number of patients using telemedicine services was expected to increase to 7 million in 2018, up from less than 350,000 in 2013, according to a blog by evisit.com, a market leader in delivery of remote care platforms. As for telepsychiatry, the

American Psychiatric Association, the main organization representing psychiatrists in the U.S., champions the use of this subset of telemedicine. They note: “The use of video-based telepsychiatry helps meet patients’ needs for convenient, affordable and readily-accessible mental health services.” As for its outcomes, they add, “With a robust evidence base that shows telepsychiatry leads to improved outcomes and higher patient satisfaction ratings, policy makers, providers and payers are increasingly considering ways to implement it.”

Advantages within the corrections system are well known, note Drs. Pastor and Waters. These include “improved access to care, less cost to the system for medical staff travel, improved recruiting and retention of staff, timely responses to medically necessary care and improved clinical outcomes.” The evidence base supports the assertion that it is as effective as in-person therapy, they add.

Ohio’s Early Program According to the Permanente Journal, the Ohio Department of Rehabilitation and Correction partnered with the Ohio State University Medical Center in Columbus to provide telepsychiatry services to inmates in Ohio prisons, providing evaluation, patient education, and medication management to more than 4,000 inmates each year from 1998 to 2006.

Similarly, as of 1997, St. Mary’s Hospital and the University of Arizona in Tucson have collaborated with the Arizona Telemedicine Program to provide telemedicine and telepsychiatry to the Arizona Department of Corrections. The University of Arizona Medical Center and Maricopa Medical Center in Phoenix provided the base for this program to use telepsychiatry in rural prisons in the state, according to the NCBI article.

In 1998, the University of

Kansas Center for Telemedicine & Telehealth implemented a telepsychiatry program that has served the state prison system since then and has provided an average of 70 telepsychiatry consultations each month. Telepsychiatrists have provided care and been reimbursed on a fee-for-service basis, and have delivered psychiatric services such as evaluation, treatment planning, medication management, and crisis intervention, reports NCBI.

Savings at CDCR

The California Department of Corrections and Rehabilitation Division of Correctional Health Care Services implemented a telepsychiatry program using contracted providers to meet the mental health needs of the inmates in more than 20 prisons and treated several thousand inmates annually. In 2008, researchers B. Johnston and N.A. Solomon found that “the implementation and utilization of this telepsychiatry program saved about $850 in inmate transportation costs, a savings of $4 million in 2004 because of decreased travel and transportation costs, as well as decreased costs for providing correctional officers to facilitate the transport,” according to the Permanente Journal.

In West Virginia, mental health services are provided to inmates housed in the state’s prisons by an independent subcontractor, PsiMed Corrections LLC, under the contract of Wexford Health Services with the state of West Virginia. From 2003 to 2007, PsiMed Corrections’ telepsychiatry program effectively provided psychiatric treatment to more than 4,000 inmates annually, thus increasing inmate access to mental health treatment and decreasing travel costs for the treating psychiatrist.

According to a 2009 Pew Charitable Trust Report, J. Gramlich identified that approximately 70% of telemedicine visits provided in the Georgia correctional system were for mental health treatment. As of 2005, Georgia’s telepsychiatry program had increased access to psychiatric care in five prisons in Georgia since the mid-1990s.

According to Dr Thistlethwaite, the interviewed telepsychiatric practitioner, this technology has provided increased access to mental health services for inmates, and this increased access, in turn, has been instrumental in improving quality of care for inmates by ensuring no disruption in continuity of care, states the NCBI article. Incarcerated individuals have experienced greater consistency with medication management and have had less delay in receiving appropriate care. As inmates are transferred from facility to facility, psychiatric care and medication management can be disrupted. Telepsychiatry can prevent such disruptions.

Inmates have further experienced greater access to care because practitioners and clinical staff involved in patient care have been able to use the same videoconferencing capabilities to coordinate care, according to NCBI. For example, in the central hub, a psychiatrist and an assistant gather information about an inmate, while a counselor, psychologist, or nurse in the facility sits with the inmate to facilitate communication between the treating psychiatrist and the inmate. This increase in communication has been beneficial when more than one provider is involved in inmate care, because the clinicians also have utilized teleconferencing to communicate with each other and to provide better quality and continuity of care.

Growth, As Well As Challenges Ahead

Yet while telepsychiatry has many proponents inside the correctional system arena, challenges still exist to implementation within this field. “There is at times system resistance to telepsychiatry and often clients require only onsite, in-person care,” according to Drs. Pastor and Waters. “When resistance occurs, our patients may at times experience lack of access to a psychiatrist, lack of clinical improvement due to system resistance, and lengthy wait times to see a psychiatrist. When these situations occur, Corizon ensures medically necessary care is provided by backfilling positions, hiring temporary psychiatrists and working within the system to educate on the advantages of telepsychiatry.”

“Telepsychiatry is Corizon’s most utilized telemedicine service,” they point out. “Telepsychiatry is championed, yet still faces some challenges, including state specific medical board constraints. Telepsychiatry has increased significantly over the past three to five years despite barriers, as Corizon strongly advocates for our patients and educates our clients regarding the advantages of telemedicine.

“Just as in the community, a main benefit is access to care. We need to make sure patients have access to the care they need and telepsychology is a critical part of that mission.

“Increasing telemedicine utilization is a Corizon Health focus. We have increased telemedicine use 140 percent since 2015. In 2018, Corizon Health practitioners provided telehealth encounters in 28 specialties; more than half of those were in telepsychiatry.

“Our focus on telemedicine as a cost savings tool has allowed our client partners across the country to save $13 million in direct costs to the sites (savings are accrued from decreases in Correctional Officer labor and from lower transportation costs) along with saving $17 million in cost of care to the patients, report Corizon’s doctors. “On average each telemedicine encounter results in total cost savings of $323 per encounter.” ✪