The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Safety and Effectiveness of Telehealth-delivered Mental Healthcare
Takeaway: Most available studies reported telehealth-delivered mental healthcare and in-person delivery of the same intervention were similarly safe and effective. However, a lack of high-quality studies meant that strong conclusions could not be made about the comparative safety and effectiveness of in-person and telehealth-delivered treatment.
VA is a national leader in the use of telehealth and an early adopter of telehealth technologies. Over the last few decades, VA has expanded telehealth programs to improve Veterans’ access to healthcare and established the Office of Connected Care (OCC) to administer telehealth programs. In 2018, the number of VA clinical video telehealth encounters surpassed one million (a 7-fold increase from 2009), and from 2019 to 2020, VA-provided video visits to Veterans’ homes increased by more than 12-fold. These increases – spurred in part by technological advancements and the COVID-19 pandemic – reflect a demand for telehealth services that is likely to persist beyond the pandemic.
Telehealth-delivered mental health services (telemental health) have been a critical application of telehealth technologies due to shortages of specialized mental healthcare providers and a high need for these services in rural and other underserved areas. To inform the delivery of mental healthcare across the VA healthcare system, VA’s Office of Mental Health and Suicide Prevention (OMHSP) requested VA’s Evidence Synthesis Program (ESP) conduct a review of evidence on the safety and effectiveness of telehealth-delivered, evidence-based mental healthcare for PTSD, depression, anxiety, bipolar disorder, substance use disorders, suicidality, or serious mental illness. For this review, ESP investigators with the ESP Coordinating Center in Portland, OR searched MEDLINE, Cochrane Database of Systematic Reviews, PsycInfo, and other sources up to April 2022. From 5,326 potentially relevant articles, the investigators identified 50 studies, including 27 randomized controlled trials (RCTs). Most studies were conducted in the U.S. and 28 were conducted among Veterans.
Summary of Findings
Most available studies reported telehealth-delivered mental healthcare and in-person delivery of the same intervention were similarly safe and effective. However, for all eligible mental health conditions, a lack of high-quality studies meant that strong conclusions could not be made about the comparative safety and effectiveness of in-person and telehealth-delivered treatment. Additional findings include:
- PTSD was the most extensively studied condition, and symptom severity appears similar after in-home video teleconference and clinic-based in-person delivery of individual psychotherapy. The certainty of this conclusion was limited by methodological differences and concerns across available studies.
- Serious harms associated with telehealth delivery appear to be rare, but reporting of adverse events was not consistent among studies.
- Available studies varied in populations, interventions, comparison conditions, and outcomes. Only two studies examined the effects of clinical characteristics on effectiveness outcomes, and many studies excluded higher-risk patients such as those who were actively suicidal.
Implications for VA
An advantage of telehealth services is the capability to treat patients who may not have access to in-person mental healthcare, may prefer to access treatment from home, or are only available to attend treatment during a work break. However, research is needed to clarify whether the effectiveness and safety of telehealth-delivered mental healthcare, particularly for conditions other than PTSD, differs based on treatment modality, format, or presenting condition.
Rigorous studies are needed comparing evidence-based mental healthcare delivered via video teleconferencing in the home versus in-person clinic treatment for mental health conditions common among Veterans. Studies assessing benefits and risks of telehealth-delivered treatments among higher risk patients (for example, suicide-specific interventions) are also needed. Additionally, it is unclear whether the dramatic shift to telehealth during the COVID-19 pandemic has altered patient or provider beliefs and attitudes about telehealth-delivered mental healthcare, potentially in ways that make research conducted prior to the pandemic less relevant. Future research also is needed to investigate whether such changes have occurred, and whether they impact the use and outcomes of telemental health services.
Beech EH, Young S, Anderson JK, Belsher BE, Parr NJ. Evidence Brief: Safety and Effectiveness of Telehealth-delivered Mental Health Care. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-199; 2022.
To view the full report, go to http://www.hsrd.research.va.gov/publications/esp/telehealth-mh-brief.cfm
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
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