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Editorial: Expand access to mental health telemedicine

The Daily Herald - 4/30/2019

By The Herald Editorial Board

Cell phones and the internet get enough blame — only some of it deserved — for various social ills that result from their misuse, but both are tools and have the potential to do a lot of good.

One of those potential tools, telemedicine ­ — which connects patient and medical professional via video conferencing — has been around since the 1960s in various forms but has yet to make full use of the connection most of us carry around in our pockets and purses.

Recent legislation in Congress and the state Legislature, however, seeks to provide greater access to the potential, especially in rural communities where services — in particular, mental health providers — can be hours away.

A 2018 report by the American Journal of Preventive Medicine found that among West Coast states, 56 percent of nonmetropolitan counties did not have a psychiatrist and 37 percent did not have a psychologist. Nationwide, 65 percent of nonmetropolitan counties had no local access to a psychiatrist and 47 percent had no local psychologist.

In Washington state, there are at least 158 areas with a shortage of mental health professionals, said U.S. Rep. Suzan DelBene, D-Washington, when she first introduced legislation last year to expand access to telemedicine. Nationwide, an estimated 3.6 million people each year miss or delay care because of a lack of transportation to a doctor's office or clinic.

That lack of access to care can mean that treatment is sought out only during a crisis — if at all — rather than as preventive medicine.

DelBene, who represents Washington's1st District, has reintroduced the bill that would open up behavioral health services through telemedicine to all Medicare beneficiaries. The bill effectively considers a patient's home to be a qualified "originating site," allowing for consultation and counseling through use of a smart phone and a video app or a computer.

The bill has bipartisan support, including seven Republican and six Democratic co-sponsors, as well as endorsements from the Washington State Medical Association and the Washington chapter of the National Alliance on Mental Illness.

Opening that access to rural Medicare patients, however, removes only one potential barrier. Other factors, DelBene said need to be addressed, include the spotty availability of broadband internet in those same rural areas and restoration of Obama-era net neutrality rules that can keep internet connections affordable and at adequate speeds.

Among those in need of mental health services are children and young adults, and legislation that passed the Senate, 45-2, this session but did not get to the House floor, deserves adoption next year.

State Sen. Randi Becker, R-Eatonville, sponsored four bills related to telemedicine, two of which were adopted. One of those that didn't pass, SB 5389, would have directed the University of Washington Medical School to design a training curriculum for staff at middle, junior high and high schools to identify students at risk for suicide, substance abuse and violence and develop a pilot program at three school districts where at-risk students would be referred to at least two telemedicine visits with mental health professionals and potential referrals for further treatment.

Becker's bill didn't advance out of House appropriations, but earlier won approval, 16-2, from the House education committee, including that of Rep. Lillian Ortiz-Self, D-Mukilteo, who is a school counselor for the Everett School District.

Mental health telemedicine did get a boost from the Legislature this session: approval of a new 150-bed psychiatric teaching hospital at the University of Washington that will include a telemedicine center, available all hours, which would increase the availability of mental health care to communities with limited access.

Ideally, the care of a doctor, a nurse practitioner or other medical professional is best when patient and provider are in the same room, but the connection that telemedicine can provide fills in the gaps when distance and a lack of adequate transportation prevents that meeting.

These and other efforts at the state and national level are necessary to increase access to preventive care that heads off more serious and costly crises.