Telepsychiatry Fills Gaps in PTSD Care

by Candi Helseth

Telehealth reaches veterans unlikely to get help anywhere else, said Dr. Jay Shore, a psychiatrist with the VA Office of Rural Health Veterans Rural Health Resource Center. For the last 10 years, Dr. Shore and his team have been using telemedicine to treat PTSD in American Indian veterans living in remote areas on reservations in the Midwest.

Through regional VA partnerships and the use of live interactive videoconferencing, the treatment team works from the VA Denver office. Veterans travel to the nearest reservation clinic where a VA tribal outreach worker (TOW) coordinates the videoconferencing session.

“Native Americans serve at the highest rate per capita of any ethnic minority and are the most rural of all veterans,” Dr. Shore said. “They also proportionately have higher rates of PTSD and other deployment-related issues. The geographic isolation, access barriers, poverty levels and cultural attitudes create challenges for getting help, especially if it requires traveling outside the reservation.

The VA bridges cultural diversities by partnering with local Indian Health Services and tribal councils. The TOWs also work as liaisons to help VA staff better understand issues relative to reservation lifestyles.

“Native Americans have a complex historical relationship with the United States government that may or may not be positive, so building trust is important,” Shore explained. “Their family and community concepts differ from other non-Native rural vets so transcending cultural barriers is essential to success.”

Many patients Shore has treated are Vietnam veterans still struggling with untreated PTSD and depression. A former Vietnam veteran is maintaining his sobriety and employment after PTSD teletherapy, and ongoing participation in a telehealth support group has helped him break over three decades of alcohol abuse, job instability, broken relationships and self-imposed isolation. According to his case report, he says he never realized how his war experiences—including the deaths of all his team members—continued to negatively impact his life until he received PTSD treatment.

Indiana, too, is turning to telemedicine as the means to provide rural veterans with more timely assistance. The Indiana Veterans Behavioral Health Network (IVBHN) connects rural community mental health centers in five Indiana counties to the Roudebush Veterans Administration Medical Center telebehavioral health hub in Indianapolis. Using funding from a $536,660 three-year Health Resources and Services Administration (HRSA) planning grant, IVBHN began operation in December and should be fully on-line by June.

“Large numbers of our veterans are not getting care during those critical first months when timely interventions can best prevent unnecessary suffering and worsening of symptoms,” Project Director Bob Strange said. “Telebehavioral health prevents emotional deterioration while maintaining access to medications.”

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