MERCED — Talking to a psychiatrist over a television screen instead of face-to-face may seem unorthodox for some, but UC-Merced health administrators have found it’s just fine for millennials. Telemedicine feels mainstream for the technology generation.
“This way of communicating with others seems very natural for this generation,” said Brandon Boggs, executive director of student health and counseling services at the H. Rajender Reddy Student Health Center. “Student feedback has been wonderful. They love the technology.”
And it’s a good thing because without telepsychiatry, the health center would be at a loss. “Without this service, there would have been very few options available to us,” Boggs said. “In Merced, there was nothing.”
Rural Merced County Lacks Access to Psychiatrists
The county of Merced has one of the lowest numbers of psychiatrists in the state. According to a study by California HealthCare Foundation, which publishes California Healthline, the county has 2.3 psychiatrists per 100,000 people. In comparison, neighboring Madera County, which is also rural, has 9.2 psychiatrists per 100,000 people. San Francisco’s numbers are much higher at 76.6.
When UC-Merced first opened 10 years ago, it had a contract with the county for psychiatric services. That ended when the county realized it didn’t have the resources to meet its own increasing demands. The university then worked with another local psychiatrist, but the same issue of demand arose. That’s when administrators realized they needed to come up with an innovative solution to help meet the growing mental health needs of their campus.
Even as the United States is experiencing a severe shortage of psychiatrists, there is an increase in mental health issues both on and off campuses, Boggs said.
Telemedicine: A Valuable Tool for Underserved Areas
“We had heard about telemedicine in other sectors of health and wondered if it would be a way to provide services in a highly underserved area in Merced,” Boggs said. The Veterans Administration has been using telepsychiatry for years; it’s also used in prisons and in rural health clinics.
In Northern California, Community Psychiatry has been providing telepsychiatry in rural areas for about six years. Each year, the number of patients it serves via telemedicine increases. In the past three years, patient numbers have increased from 178 to 800. “We’ve seen a rapid acceptance of it,” said Mark Levine, president, founder and director of Community Psychiatry.
Telepsychiatry is a good option for universities in rural areas that have few, if any, psychiatrists, Levine said. Chico State in Northern California has contracted with Community Psychiatry for years. Typical challenges students face are depression and anxiety, Levine said.
Access to psychiatric services on campus is critical. “Telepsychiatry is a great idea, it meets a need,” he said. “It protects people and improves immediate outcomes for them so they don’t get worse.”
UC-Merced Contracts With Community Psychiatry
UC-Merced decided to contract with Community Psychiatry last spring. It is the first UC campus to use telepsychiatry, and it seems to be working out well. Students see the same psychiatrist at every visit, primarily for medicine management.
Boggs said a primary care doctor at the UC-Merced health center initially refers students to the psychiatrist. Appointments take place at the health center in private patient rooms. But instead of talking to a doctor on site, students are linked through a secure video-conferencing system to the off-campus doctor.
“It is proving at this point to be a viable way to expand or initiate mental health service in underserved areas,” Boggs said. “But it doesn’t serve as a replacement for all mental health care.” Students still have face-to-face talk therapy at the health center.
And there are certain hard-to-manage cases where telepsychiatry just isn’t effective, Boggs said. For those situations, he still hopes to hire an onsite psychiatrist.
Telemedicine is a valuable tool for communities with limited psychiatric services, Levine said, but it doesn’t replace onsite interactions. “In my opinion, nothing is better than face-to-face,” Levine said.
In his practice, Levine said patients in general prefer face-to-face interactions. “We treat a lot of people over 50 who are still uncomfortable with technology,” he said.
Levine said psychiatrists from Community Psychiatry currently spend up to 20% of their time doing telemedicine. They connect with patients via televisions, laptops, desktops and even cell phones. “It’s like FaceTime or Google Chat but it’s a secure, encrypted video connection,” he said.
Technology is also changing the way we interact, he said, and telemedicine may become much more common in the near future.
“I would predict in the next five years, we will see a rapid adoption because it makes so much sense,” Levine said. “Outcome studies show there’s not a difference in clinical outcomes between telepsychiatry and face to face.”
Collaboration for Quality Assurance
As for quality assurance, Boggs said the university has an intense review program. Psychiatrists from another UC campus health center review student medical charts and make recommendations if necessary. “We make sure psychiatrists review psychiatrists,” Boggs said.
And there’s a high level of collaboration between the telepsychiatrist and primary care providers at the health center, something Boggs said is necessary for this type of telemedicine to work. “We absolutely require co-management with a primary care provider,” he said. As long as there’s collaboration, telemedicine is “a very valuable and needed service.”
The center currently provides 20 hours a week of scheduling for students. There are plans to expand to an additional 40 to 80 hours a week. The university would never be able to offer those hours without telepsychiatry, said Boggs, especially in light of the national shortage of psychiatrists.
He said the health center might consider telemedicine for other specialties if the need exists and the current psychiatry service continues to work well for students. Dermatology would be one area that might benefit from telemedicine, he said.