How Do Complex Mental Health Conditions Affect Treatment Engagement in Telehealth?

What you need to know

• Having physical health conditions may actually help patients stay engaged with mental health treatment
• Manic symptoms can make it harder for patients to start therapy
• Drug use issues are linked to attending fewer therapy sessions
• The severity of PTSD symptoms does not affect whether patients stick with treatment

The Challenge of Getting Mental Health Care

Imagine living in a small rural town, struggling with serious mental health symptoms, but the nearest psychiatrist is two hours away. This is the reality for millions of Americans who need specialized mental health care but face significant barriers to accessing it. While primary care doctors do their best to help, complex conditions like post-traumatic stress disorder (PTSD) and bipolar disorder often require additional expertise.

Two Models of Virtual Mental Health Care

To address this challenge, healthcare systems are using two main approaches to provide mental health care virtually:

Teleintegrated Care involves an onsite care manager at your primary care clinic who works with remote mental health specialists to coordinate your treatment. The care manager provides therapy and helps ensure you’re getting the care you need.

Telereferral Care connects you directly with remote psychiatrists and therapists through video visits, similar to a traditional referral but delivered virtually.

Both models aim to bring expert mental health care to underserved areas. But do certain patient characteristics affect how well people engage with these different approaches?

What the Research Found

This study looked at over 1,000 primary care patients with PTSD and/or bipolar disorder across three states. The researchers wanted to understand what factors influenced whether patients stuck with their mental health treatment.

Some key findings challenged common assumptions:

• The severity of PTSD symptoms didn’t affect treatment engagement. This suggests that even those with severe symptoms can benefit from virtual care if given the opportunity.
• Physical health problems were actually associated with better engagement in both therapy and medication treatment. Each additional physical condition increased the odds of staying engaged with treatment.

However, certain factors did make engagement more challenging:

• Patients experiencing manic symptoms were less likely to start therapy, though once they began, they attended a similar number of sessions as others.
• Those with drug use issues attended fewer therapy sessions overall, highlighting the need for integrated substance use treatment.

The Support Makes a Difference

One clear finding was that patients in the teleintegrated care program, with an onsite care manager, completed about 60% more therapy sessions than those in the telereferral program. The care manager’s ability to provide face-to-face support and proactive outreach seemed to help keep patients engaged.

What This Means for You

If you’re struggling with complex mental health conditions and live in an area with limited access to specialists, virtual care options can help bridge the gap. Here are some key takeaways:

• Don’t let severe symptoms discourage you from seeking virtual care - the research shows you can benefit regardless of severity
• If you have physical health conditions, use your existing healthcare connections to help stay engaged with mental health treatment
• Consider whether having an onsite care manager would be helpful for keeping you on track with treatment
• Be open with your providers about any substance use issues so they can adjust treatment accordingly

Conclusions

• Both teleintegrated and telereferral care can effectively deliver mental health treatment to underserved areas
• Having an onsite care manager helps patients complete more therapy sessions
• Physical health problems may motivate rather than hinder mental health treatment engagement
• Additional support strategies may be needed for patients with manic symptoms or substance use issues