Half of US adults experience mental illness during their lifetime and 1 in 5 each year. Less than half receive treatment. Barriers to mental health care include a shortage of providers, particularly in rural areas, and logistical challenges like difficulty taking time off work or school, arranging childcare, and other family responsibilities. For some individuals, symptoms of anxiety or depression make it difficult to leave their homes for treatment. Inability to pay for services and stigma also stand in the way of seeking and receiving mental health care.
Technology solutions such as web-based treatments, mobile apps, and telehealth address some of the barriers. Recent advances in telehealth include the expansion of mental health services directly to patients’ homes, allowing mental health providers to reach patients who are unable to attend in-person appointments. While there seems to be great potential in connecting patients to care using video and other technologies, questions remain about how virtual delivery compares to in-person care.
We reviewed the current literature on video-to-home mental health care to examine how this type of virtual delivery compares to in-person mental health treatment in terms of clinical effectiveness, patient and provider satisfaction, and cost. We analyzed ten studies reporting on the clinical effectiveness, cost, feasibility, and satisfaction of video telehealth.
Adult patients of all ages reported high rates of satisfaction with video delivery of mental health care, with 77-99% reporting they would like to receive their care this way again.
Nine studies reported on the clinical effectiveness of video for delivering psychotherapy and one reported on video delivery of psychiatric medication management services. The treatments targeted a variety of mental health concerns including depression, post-traumatic stress disorder, obsessive compulsive disorder, and substance use. Eight studies were randomized controlled trials comparing video-to-home delivery with in-person treatment. These studies reported comparable treatment effectiveness for the two types of delivery, suggesting that mental health treatment delivered to patients’ homes by video is as effective as in-person meetings.
Adult patients of all ages reported high rates of satisfaction with video delivery of mental health care, with 77-99% reporting they would like to receive their care this way again. Patients identified several benefits of video mental health treatment including convenience, the ability to see and connect with their provider virtually, and privacy. The few studies reporting on provider satisfaction highlighted differences between providers experienced with video-to-home delivery and those without.
Providers with no experience reported concerns about whether video would be a good fit for their patients, whereas providers experienced with video-to-home delivery viewed it as an effective method of providing needed mental health treatment to patients with limited access to care.
Three studies examining cost effectiveness of video-to-home healthcare delivery found that outcomes were influenced by the type of technology being used.
Three studies examining cost effectiveness of video-to-home healthcare delivery found that outcomes were influenced by the type of technology being used. Video-to-home delivery was less costly than in-person care when patients used their personal computers, tablets, or smartphones to connect to their providers rather than devices supplied by their mental health provider.
Overall, these results suggest that video telehealth is an effective and efficient way to deliver mental health care. For patients facing barriers to in-person care, video telehealth may be the only feasible option to access needed mental health care. Mental health providers should embrace video telehealth as an effective mode of delivery and integrate this service into their current practices. First steps may include becoming familiar with best practices in video telehealth, consulting with colleagues, and reviewing federal and state telehealth guidelines.
