COVID-19 tele-mental health: Innovative use in rural behavioral health and criminal justice settings.

Abstract

Tele-mental health (tele-MH) is an important asset in rural areas across the United States where in-person service access can be limited. This resource is even more critical now during the COVID-19 pandemic, which has increased demand for a virtual alternative to community-based mental health and substance use disorder services. Many individuals are seeking behavioral health services due to distress related to COVID-19, in addition to a new group of individuals in need of these services who have been released from jails and prisons to prevent transmission of the virus within the facilities. Jurisdictions around the country have rapidly implemented and/or expanded tele-MH to continue vital service provision. The authors conducted semistructured phone interviews with five senior-level professionals involved in tele-MH provision across four rural U.S. regions (a six-county region of western Montana; Cumberland County, Maine; Polk County, Iowa; and a 10-county region of western South Dakota) concerning tele-MH services before and since COVID-19, benefits of the expanded technology, challenges to implementation, and any data collected thus far regarding satisfaction and effectiveness of tele-MH. These examples of rural communities that have accelerated policy and programmatic changes around tele-MH may be beneficial for other communities considering tele-MH as well as serve as valuable opportunities for additional evaluation and sustainability post-COVID-19. Public Significance StatementThis article provides an overview of the particular challenges in rural community behavioral health service delivery since the COVID-19 outbreak, as well as how telemental health can assist with addressing these significant needs. The discussion includes program descriptions of four rural areas of the United States that have implemented or expanded tele-mental health in behavioral health and criminal justice system services since the outbreak, which may serve as guidance for other rural communities around the United States.

Telehealth among substance using justice‐involved persons on community supervision: Benefits, challenges, and suggestions for future use

“…The use of telehealth technology can allow the house to be observed as well as the client, and the client can show staff the bathroom. The client turns off their camera when using the restroom but then immediately returns so that the data can be analyzed in real‐time 9 …”

“…Prior to COVID‐19, telehealth programs were only available in a limited capacity to most of the probation offices in the state. Consistent with CJ settings across the country, including courts, 9 the COVID‐19 pandemic caused many service disruptions and led to a transition of many services that were traditionally in‐person to online, at least temporarily. Given that study participants generally liked telehealth services, more services could be provided through telehealth, such as mental health services.…”

“…The client turns off their camera when using the restroom but then immediately returns so that the data can be analyzed in real-time. 9 In further sharing their experiences and suggestions for telehealth, many participants also indicated the need for additional telehealth services, such as mental health services and material needs. The pandemic also affected self-care needs, such as food and mental health among participants in our sample.…”

“…Notably, agencies which primarily relied on face‐to‐face services prior to the COVID‐19 pandemic were forced to quickly adapt services to a virtual format, such as telehealth, due to public safety concerns 8 . The pandemic caused many correctional settings in rural areas to switch to telehealth 9 . Switching to telehealth during the pandemic was based on various factors, including agencies having access to and familiarity with the use of such technology 8 .…”

Clinician Perspectives for Mental Health Delivery Following COVID-19 in Carceral Settings: A Pilot Study

“…This increasing incidence applies to tele-mental health services as well [ 13 ]. While tele-mental health utilization is well documented for carceral settings in individual studies during the COVID-19 pandemic, [ 5 , 8 , 9 , 14 ] quantitative metrics characterizing its incidence over this time are sparse.…”