Behavioral health access remains one of the most urgent and complex challenges in U.S. healthcare.
A 2024 Mental Health America report shows nearly 60 million adults experienced a mental illness in the last year, and 13 million reported serious thoughts of suicide. Many of these individuals turn to emergency departments for help — yet, less than half of EDs and general hospitals have dedicated psychiatric services, and many have limited psychiatric capacity.
Expanding access to behavioral health services, particularly through virtual care, is becoming an imperative for systems striving to meet patient needs and support front-line clinicians.
To explore how health systems can close these critical gaps, Becker’s Healthcare spoke with Michael Genovese, MD, chief medical officer of behavioral health at Access TeleCare, about the evolving role of virtual behavioral health and its impact on care delivery.
Note: Responses have been lightly edited for length and clarity.
Question: Health systems are grappling with rising behavioral health needs and strained EDs. How might virtual behavioral health help?
Dr. Michael Genovese: There is a huge unmet behavioral health need across the country, with estimates that two-thirds of people who need behavioral health services don’t receive them. Many people don’t receive treatment, wait and then eventually go to the ED.
However, the majority of EDs — more than 50% — do not have psychiatrists available to provide psychiatric services. As a result, patients with behavioral health needs are often seen by emergency physicians, not psychiatric experts. These emergency physicians are uncertain and nervous about sending these patients home, so they want to admit patients to the hospital to ensure they are safe. But there are often no options to admit these patients, which means patients stay in the ED, often for days.
Access to virtual behavioral health enables an expert psychiatric provider to evaluate a patient and decide whether the patient can be safely discharged or requires hospitalization. A psychiatric provider can also initiate appropriate treatment, which means prescribing the most appropriate drug, which an ER physician wouldn’t do.
Access to virtual behavioral health is better for patients, who are quickly seen, evaluated and treated by psychiatric experts. It is also good for the hospital, as it takes a huge burden off of the ED staff and allows them to focus on other patients in the ED where they have greater expertise.
Q: What impact could virtual behavioral health have on patient flow in the ED?
MG: Virtual behavioral health results in patients being seen faster by a psychiatric provider, which increases the ED’s patient flow.
When Access TeleCare partners with facilities, we commit to provide a psychiatric consult within two hours. Patients no longer have to wait for hours or days before being evaluated by a psychiatrist. Faster access to psychiatric services gets patients the care they need sooner and increases the ED’s throughput, as patients are discharged home faster or sent to an appropriate site like an inpatient behavioral hospital.
Here’s an example. A regional medical center in North Carolina was experiencing an increased volume of behavioral health patients. The behavioral health resources in its ED were spread thin. Behavioral health patients were diverting resources away from other emergency patients, triggering an overflow of more than 1,700 “code purple” ED ambulance diversion hours.
After partnering with Access TeleCare for virtual behavioral health services, this medical center reduced its ED length of stay by 70% and reduced its code purple ambulance diversion hours to 148.
Q: Beyond EDs, are there other parts of the healthcare system where virtual behavioral health has value?
MG: Yes. Many behavioral health hospitals don’t have enough psychiatric provider capacity. For example, a hospital might have 40 beds but only have enough provider capacity to admit 20 patients.
By partnering with a virtual behavioral health provider like Access TeleCare, this hospital has access to additional psychiatric capacity and can fill all 40 of its beds. This means being able to care for more patients in need and generating more revenue.
Another common situation is patients are admitted to a hospital with a medical diagnosis like cardiac or respiratory disease. However, some patients also have a severe psychiatric illness that requires psychiatric attention, like depression or anxiety, but the hospital may not have a psychiatrist available for consults. Virtual behavioral health can fill this gap by providing virtual psychiatric consultations for hospitalized patients.
Q: Looking ahead, how do you see tele-behavioral health shaping access to care and the patient experience more broadly?
MG: I see tele-behavioral health decreasing barriers and increasing access to care.
One reason why people delay in seeking behavioral care is because of perceived stigma. The situation is much better now than in the past, but many people are still reluctant to seek care. Telemedicine increases access and makes people more comfortable seeking care.
Expanding access to behavioral healthcare is especially important for reaching underserved, vulnerable populations. Telemedicine is truly a gamechanger in enabling people to get care who would not otherwise get it.
Q: Is there anything else you’d like to share with Becker’s readers?
MG: Patients with psychiatric illness experience a full continuum of care, ranging from not very acute to extremely acute. This goes from outpatient care to intensive inpatient care, to partial hospitalization, to assessment and care in an ED, to an inpatient unit.
There are capacity constraints throughout this continuum. At Access TeleCare, we cover the entire psychiatric journey and use our capabilities to customize the telecare solution based on the need — there’s not a one-size-fits-all approach.
