Impact of telemental health on suicide prevention care in U.S. emergency departments.

Abstract

Background: Mental health concerns are the reason for 7% of U.S. emergency department (ED) visits, and telehealth is increasingly used to provide emergency mental health care. Rural, critical-access hospitals have limited access to in-person mental health care. We sought to describe telemental health care programs in U.S. EDs and test whether access to telemental health care affects use of suicide prevention practices.

Methods: We conducted a cross-sectional survey of telemental health care and suicide prevention practices at a nationally representative sample of all U.S. EDs associated with acute care general medical hospitals. We used proportionate allocation and nonresponse weighting to generate national estimates. We used weighted adjusted logistic regression models to measure associations between an ED's access to telemental health care and use of six recommended suicide-prevention practices.

Results: A total of 606 of 977 eligible EDs completed the survey (62% response rate), weighted to represent 4321 EDs nationally. Telemental health care was used in 68% of EDs, and rural, smaller-volume, and critical-access EDs were more likely to use telemental health care. Critical-access hospitals were more likely to use telemental health care 24/7 and less likely to have access to a telehealth psychiatrist or electronic health record (EHR)-based information sharing. With structural differences being adjusted for, EDs with telemental health care were more likely to assess patients' suicidal intent or plans (adjusted risk ratio [ARR] 1.07, 95% confidence interval [CI] 1.10-1.14) and access to lethal means (ARR 1.13, 95% CI 1.01-1.26). Critical-access EDs with telemental health care were also more likely to provide lethal means safety counseling (ARR 2.11, 95% CI 1.14-3.89).

Conclusions: Telemental health care is widely used across all types of EDs, and EDs with telemental health care are more likely to use suicide prevention practices. Critical-access hospitals rely on telemental health care to a great extent and need better access to telehealth psychiatry and EHR information sharing.