Telepsychiatry

The Future of Psychiatry is Online

Demand for psychiatry and mental health medication is high - and increasing.

15

min read

The mental health of Americans reached crisis proportions by early 2020. Since the onset of the COVID-19 pandemic, it has become even worse. But there’s hope for significant improvement thanks to advances in technology, policy changes, and increased cultural awareness and acceptance. One opportunity is in the field of medication for mental health.


Mental health in America is worse than it has been at any point in the past two decades.[1] 41% of Americans are currently struggling with mental health issues, including those stemming from the pandemic.[2] These issues cause more days of lost work and work impairment than many other common chronic conditions, including diabetes, asthma, and arthritis. They also cost the U.S. healthcare system more than $200 billion annually - the highest among all chronic conditions.[3]


The Supply and Demand of Psychiatric Services in the United States

Demand for psychiatry and mental health medication is high - and increasing. 15.8% of adult Americans take mental health medications - that’s over 50 million people, with over 350 million prescriptions written per year. Here’s how that breaks down by condition [5]:

  • Depression_______11.1%
  • Anxiety__________ 4.9%
  • Sleep____________4.1%
  • Attention_________2.9%


The use of antidepressants has increased by 15% since 2015 [6]. 13% of adult Americans take an antidepressant, as do 18% of all women [7]. By comparison, 10% of Americans are left-handed, and less than 6% of Americans are redheads [8][9]. Mental health issues are far from uncommon, but the process of being treated for these disorders can often be time-consuming and overly expensive for many Americans.


Below are the most commonly used anti-anxiety and depression medications and information about how many prescriptions are written on an annual basis. The numbers can be shocking and only illustrate how vital having options for mental health care is for many people across the United States and beyond.

Popular Antidepressants and Anti-Anxiety Medications


[10]

COVID has made mental health issues worse. Fear of contracting the virus or having loved ones get it, isolation, social distancing, inability to visit friends and family, restricted access to travel and entertainment, job losses, and homeschooling have caused a spike in the number of mental health prescriptions. Anti-anxiety medication prescriptions have increased 35% since the onset of COVID. The impact on women is even more challenging than for men. Even before COVID, twice as many women took mental health medication compared to men. Now, during the pandemic, more women report having anxiety, insomnia, and depression than pre-pandemic. [11][12] 


Now, during the pandemic, more women report having anxiety, insomnia, and depression than pre-pandemic.  

Beyond that, many of the most commonly prescribed drugs in the United States treat depression, anxiety, and other mental disorders. In fact, nine of the top 50 drugs prescribed in the U.S. are considered mental health medications. This list includes sertraline, escitalopram, alprazolam, citalopram, bupropion, trazodone, fluoxetine, clonazepam, and venlafaxine.[13]

Problems Related to Access and Availability of Mental Health Care


Meanwhile, access and availability to mental health care and, in particular, psychiatric care continue to be in short supply. Less than half of people with mental illness get treatment. [14] A leading cause is the severe shortage of psychiatrists. Sixty percent of U.S. counties have zero psychiatrists. [15] It is essential to note that 60% of psychiatrists are over 55, and the number of psychiatrists is decreasing as these medical professionals age out of their profession. [16] Another reason is that 45% of psychiatrists don’t take insurance and charge prices well out of reach for many Americans - as high as $450 per hour. [17] Many people cannot pay the fees required by psychiatrists and therefore never seek out treatment. Those who do find alternatives may not get the same level of care as those who can afford the monetary investment needed to have a psychiatrist. 


Given these obstacles, many people prescribed medication by psychiatrists switch to having their primary care physicians continue their treatment. Others have no choice but to be diagnosed and treated initially by a primary care physician. [18] As many as 70% of people taking mental health medications are treated solely by a primary care physician.  Unfortunately, primary care physicians often don’t receive specialized training in psychiatric medication treatment, and many are reluctant to prescribe certain medications - particularly those that are controlled medications. To make matters worse, an increasing number of people - including 36% of those 30 and under - don’t have a primary care physician. [19]


The existing approach to managing mental health medication is broken. People who are stable on their prescriptions for their mental health must visit with their psychiatrist, nurse practitioner, physician assistant, or prescribing doctor once every 30-90 days for an appointment.  This appointment usually lasts around five minutes to get a new prescription - typically for a medication they’ve taken for a year or more. Then they must visit their pharmacy every month to pick up their medication(s). It all takes a considerable amount of money and time to stay healthy and well.

Diagnosing and treating people new to medication requires close supervision and experimentation with medications and dosages, which can take hours of medical visits over three to six months or more. That’s particularly difficult with antidepressants, which can take weeks to demonstrate effectiveness and can cause unwanted side effects such as weight gain, fatigue, and loss of sexual desire. When these side effects are present, it can cause some patients to stop taking the drug. Discontinuing medication without a physician overseeing the problem can lead to additional risks and issues.


Once a person finds a medication regimen that works for them, the visits tend to become short check-ins to see if anything has changed. That’s where the value disconnect exists. Paying hundreds of dollars for hour-long visits makes sense if they help a person find the treatment that makes them feel better. But paying hundreds of dollars for a five-minute check-in can feel unnecessary and wasteful. Most people would prefer a less expensive and more convenient option that fits seamlessly into their lives. 


Recent Regulatory Changes Creating the Option for Online Psychiatry


The truth is that alternatives did not exist in many cases - until COVID. The Ryan Haight Act of 2008 required a doctor to establish a relationship with a patient in-person before prescribing a controlled substance. Those controlled substances include over 50 million prescriptions per year of anti-anxiety medications and over 18 million prescriptions per year of sleep medications. Before COVID changed the medical landscape, the only option was to see a medical professional in person to get many essential medicines. Those who could not do this were not able to get prescriptions and take care of their health.


On January 31, 2020, in response to the COVID-19 pandemic, the Secretary of the U.S. Department of Health and Human Services declared a public health emergency, which triggered an exception to the Ryan Haight Act, and enabled doctors to prescribe controlled substances via telehealth. [20] The rule will stay for as long as the current public health emergency remains in effect. Effective January 21, 2021, the Department of Health and Human Services renewed this exception. Now that telehealth practices can prescribe these medications, the following prescription drugs are easier and less expensive to access.

Anti-Anxiety Medications


Sleep Medications


Minded Customer Feedback

“I visit my psychiatrist every three months and pay $250, then pick up at the pharmacy every month for another $10. The hassles and costs are frustrating, but I have no other choice”


“I started out seeing a psychiatrist, which was expensive, then switched to a primary care physician who didn’t have expertise in mental health medication. It was annoying to visit just for a prescription, and I felt judgment each time.”


“I go to a psychiatrist who charges $200 to renew the same meds I’ve been on for five years. It takes a lot of time and money, and I worry about running out.”


The Future of Mental Health Services is Telepsychiatry


Telehealth holds the promise of improving access and availability to mental health treatment during the current pandemic and beyond. Adoption of telehealth has increased over 3,000% since the onset of the coronavirus crisis, and with patients and medical doctors getting used to the medium, many will be reluctant to return to a more time-consuming in-person approach. Just as millions of people have welcomed time-saving digital services for ordering household supplies (Amazon), prepared food (Door Dash), transportation (Uber), and pet supplies (BarkBox), they now realize similar benefits from online therapy and online psychiatry. 


Telehealth is an ideal solution for managing mental health medication. mHealth is another solution and refers to a specific way of using mobile phone technology to help achieve improved health goals. The World Health Organization refers to mHealth as “the use of mobile and wireless technologies to support the achievement of health objectives.” [21] This solution is vital since mobile technology is now almost universal in the United States. Nine out of 10 people in the U.S. have a cell phone, while about half have a tablet. mHealth is a specific version of telehealth powered using consumer apps without the help of a clinician. The use of devices daily also creates an environment where patients can more easily self-monitor and comply with their healthcare and medicine protocols.


Without the need to travel and wait, it’s easier for patients to connect with doctors using telehealth services. Live video services like Zoom have taken off during the pandemic, with over 100 million people using the medium daily. Industry-standard questionnaires like the PHQ-9 and GAD-7 are used online to screen, diagnose and monitor mental health conditions such as depression and anxiety. Automated reminders can reduce the chances and fears of people running out of medication and potentially increase treatment adherence. In many cases, telehealth can even remove the barriers of time. In many situations, medical professionals can prescribe non-controlled medications, such as antidepressants, asynchronously. A patient fills out an online form whenever it’s convenient for them, and then a doctor or other prescriber reviews the responses and prescribes if clinically appropriate.


Telehealth can benefit medical doctors as well. Psychiatrists spend much of their time with “renewer” appointments, leaving less time to diagnose patients seeking help. Telehealth and online psychiatrists can allow traditional psychiatrists to help more of these new patients by taking the renewers off their plate. It can also enable doctors to work from home, which can help those struggling with work-life balance. It gives both patients and physicians more time to focus on other things, reducing both parties’ burden.


New Technologies, Including Artificial Intelligence, Offer Real-Time Solutions for Mental Health Problems


Over the last few decades, digital health services have come a long way. Doctors in various medical specialties can now offer clinical care, talk therapy, cognitive behavioral therapy, and all manners of psychiatry through smartphone apps and wearable devices. New mobile applications can also recognize patterns that signal mood disorders such as mania, depression and psychosis before they occur. Individuals who otherwise wouldn’t have access to mental health professionals due to location or lack of funds can now enjoy the mental health care that they need for a fulfilling life. 

The American Psychiatric Association the FDA now both offer information on telepsychiatry resources. [22][23] Even the National Institute of Mental Health features resources about telepsychiatry. Many examples of research show the usefulness of outpatient telehealth services for individuals with a mental illness. One randomized controlled trial examines the effectiveness of integrated telehealth services for patients with depression. These examples show that telehealth services are being taken seriously, and it’s likely that their use will continue to increase in the coming years.


The medical algorithms used in telemedicine offer a great deal of support to clinicians. The algorithms can use machine learning to run before, during, or after the session and create big data to give extra health information to a patient’s doctor. A clinical practice can use the information to identify risk factors for diseases and illnesses such as autism, bipolar disorder, depressive disorders, schizophrenia, and other psychiatric disorders in patients. It can be used autonomously in a session’s background to gather information and send alerts to a physician if the findings are abnormal. Algorithms are also useful to give doctors information about potential issues before a session with a patient begins. None of this is possible without innovative technology, and telehealth takes advantage of it to the highest degree.


Telemedicine also uses artificial intelligence to offer the best data and information for patients and medical care providers. This technology can be used in everything from psychiatry to neuroscience and beyond. Artificial intelligence is capable of helping with analysis of medical records. It can automate repetitive tasks, make it easier to share personal medical data, and even assist in medication management. Artificial intelligence is transforming medicine and making it easier for patients and doctors to communicate and handle physical and mental health issues.


Introducing Minded:

Mental Health Prescription Management 


Minded is a new type of psychiatric practice that transforms medication management with online, on-demand care, affordable, predictable pricing, and compassionate, professional psychiatric providers. We serve “renewers” - people already taking mental health medications instead of those getting diagnosed for the first time. Minded provides online appointments and consultations, both via live video and asynchronously when appropriate. We can renew a prescription and deliver medication in less than 24 hours, for $30 per month, with no insurance needed. We also provide ongoing care, including adjustments to prescriptions as needed. Our first categories include controlled and non-controlled medication for depression, sleep, and anxiety, with more coming soon. For more information, visit tryminded.com

About the Authors

This article was written by two co-founders of Minded. David Ronick takes an antidepressant daily, and controlled medications for anxiety and sleep occasionally, as-needed. Chris Dennis, MD is a board-certified psychiatrist who has practiced for over twenty years and is licensed in 35 states.


The information contained in this article is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription medication or following any treatment or regimen. Minded makes no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the article.


1. https://news.gallup.com/poll/327311/americans-mental-health-ratings-sink-new-low.aspx 2. https://www.cnn.com/2020/08/13/health/mental-health-coronavirus-pandemic-cdc-study-wellness/index.html 3. AMERICA’S STATE OF MIND U.S. trends in medication use for depression, anxiety and insomnia AN EXPRESS SCRIPTS REPORT | APRIL 2020 https://www.express-scripts.com/corporate/americas-state-of-mind-repor 4. https://www.cdc.gov/nchs/products/databriefs/db380.html 5. AMERICA’S STATE OF MIND U.S. trends in medication use for depression, anxiety and insomnia AN EXPRESS SCRIPTS REPORT | APRIL 2020 6. AMERICA’S STATE OF MIND U.S. trends in medication use for depression, anxiety and insomnia AN EXPRESS SCRIPTS REPORT | APRIL 2020 7. Ibid 8. http://editorialstage.traveltrivia.com/4-places-that-are-home-to-the-most-redheads/ 9. https://www.washingtonpost.com/health/the-big-number-lefties-make-up-about-10-percent-of-the-world/2019/08/09/69978100-b9e2-11e9-bad6-609f75bfd97f_story.html 10. https://clincalc.com/DrugStats/Top300Drugs.aspx 11. AMERICA’S STATE OF MIND U.S. trends in medication use for depression, anxiety and insomnia AN EXPRESS SCRIPTS REPORT | APRIL 2020 https://www.express-scripts.com/corporate/americas-state-of-mind-report 12. https://www.psychcongress.com/article/gender-differences-mental-health-effects-covid-19-pandemic 13. https://www.drugreport.com/50-commonly-prescribed-drugs-in-america/ 14. https://nami.org/NAMI/media/NAMI-Media/Infographics/NAMI_MentalHealthCareMatters_2020_FINAL.pdf 15. https://www.psycom.net/inside-americas-psychiatrist-shortage 16. https://www.psycom.net/inside-americas-psychiatrist-shortage 17. Ibid 18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925161/#B24 19. https://www.reuters.com/article/us-health-pcp-trends/declining-numbers-of-americans-have-a-primary-care-provider-idUSKBN1YK1Z4 20.  https://www.foley.com/en/insights/publications/2020/03/covid19-public-health-exception-telemedicine
21. https://news.careinnovations.com/blog/what-is-mhealth-how-is-it-different-from-telehealth#:~:text=Recently%2C%20the%20World%20Health%20Organization,to%20improve%20health%20outcomes%2C%20health 22. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry 23. https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health

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