WASHINGTON, DC—The Department of Defense is planning to increase access to mental health services for beneficiaries living in rural areas through telehealth mobile units.

The telehealth mobile units will be outfitted with video teleconferencing equipment that will allow beneficiaries to access telebehavioral health services from providers in a different location. “Rather than having beneficiaries—such as those in remote or rural areas—come to a large MTF that may be hundreds of miles away, the concept is to take these units out to different locations in the community,” said Dr Matt Mishkind, division chief of Clinical Telehealth at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury’s National Center for Telehealth & Technology.

The idea is to deploy mobile telehealth units to reach beneficiaries who need mental health care, but have difficulty gaining access to resources. “There are a significant number of beneficiaries out there who are unable to access care due to geographic or mobility concerns,” said Dr Mishkind. He noted that members of the National Guard and Reserve units and their families are often the ones having difficulty accessing care.

Doctor Mishkind said that while DoD has used some telehealth units oriented towards primary care, DoD has not previously outfitted mobile units specifically for psychological or TBI health care.

Delivering Mental Health Services

There are two different mobile platforms that will be used. One is a drivable platform that can be driven to different locations and the other is a modified shipping container that can be transported to a location. Both types of mobile units will be outfitted with computer and video teleconference equipment that will allow the beneficiary to interact with a behavioral health provider. A licensed provider on site will take care of technology trouble shooting, but the behavioral health provider that the patient will correspond with for care will be in a separate location.

The services that will be available through these units will be those that have shown to be effective via telebehavioral health, and will include assessments, treatment, and even medication management. “Specific issues would be depression, PTSD, and anxiety. It runs the spectrum,” said Dr Mishkind.

The use of computer technology to access care should not be a difficult adjustment for servicemembers and their families, since many are accustomed to using computer technology. “We are excited about providing our warriors with access to trained professionals in a convenient and comfortable setting,” said Army Brig Gen Loree Sutton in a statement. “For this generation, virtual connection is at least as real as face-to-face.”

The mobile units could be placed at a National Guard or Reserve location, or somewhere else in a community, and would be closer to patients than an MTF. Accessing care through mobile units may help beneficiaries who feel some stigma in reaching out for care at an MTF or traditional mental health clinic. “It would limit having to go to an MTF, and if there is stigma, you are even more reluctant to drive that distance to go to an MTF,” said Dr Mishkind.

Pilot Program

Currently, DoD is gearing up for a pilot program in which the telehealth mobile units will be deployed. Potential pilot sites include with the National Guard in Washington or Oregon, as well as Washington DC and American Samoa. “There has been a need expressed in the Washington DC area to help provide for child psychology services. Another concept that has come more to the forefront based in the Tsunami down in American Samoa is using one of these to help with clinic augmentation space in that location. It is a project that we are working on logistically to determine whether we can augment it to meet a disaster need,” said Dr Mishkind.

Both the drivable mobile platform as well as the modified shipping container will be used in the pilot. The pilot is expected to provide more information as to when the program will be expanded on a wider scale. “Part of the assessment we will do is return on investment, including cost,” he said. “We do believe there will be a cost saving. One of the true benefits of the mobile units is that we are delivering care out to individuals that more than likely would not access the care, so it is in some ways prevention to offset more long-term concerns or issues. So, to the best of our ability, we will map out long term savings as well.”

The plan after the pilot is to deploy as many of the telehealth mobile units as are needed.According to Dr Mishkind, “We know there is a need out there, and we are incredibly confident that this is a way to meet a great need to access to care,”

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