Virtual crisis care: How real-time telemedicine counseling can improve outcomes and conserve resources

The nation’s mental health crisis is taking a serious toll on first responders. Real-time access to a virtual behavioral health professional can aid de-escalation efforts, avoid involuntary committals and save law enforcement resources.

Estimates show that up to 20 percent of police calls involve a mental health or substance use crisis, and that number appears to be growing over time. With the ongoing opioid epidemic and the COVID-19 pandemic contributing to an increase in mental health crises across the country, law enforcement agencies are feeling the pressure since they are often the first responder to these crises.

When law enforcement is called to respond, the mental health situations they encounter vary each time. Depression rates have tripled since the start of the pandemic, public health researchers state, while suicidal ideation is also on the rise. At the same time, access to consistent, affordable mental health care is only available to a small proportion of Americans, leaving law enforcement to close the gaps in an unsustainable system.

According to a recent survey, more than 80 percent of long-term law enforcement veterans said they have seen an increase in mental health issues over the course of their careers. A similar number reported that the total amount of time spent on mental health-related calls has risen significantly over time, due in part to the fact that these calls often take much longer than traffic calls, larceny reports, domestic disputes and other common situations.

The need for more mental health intervention training is well documented, but agency resources are scarce, and officers cannot be expected to act as fully qualified clinicians in addition to performing their other duties. A result is often a high number of involuntary committals that consume an extraordinary amount of time, peoplepower and money.

While law enforcement agencies should be commended for doing whatever it takes to ensure individuals get immediate access to mental health care, they need a better way to solve the problem. This is where telemedicine is starting to close the gap.

With telemedicine mental health crisis management, law enforcement officers can use a telemedicine tablet to connect with a trained counselor, who can thoroughly assess the situation and make informed recommendations about the next steps. This approach has been proven to avoid unnecessary involuntary committals—improving the outcomes for the individual in crisis—while significantly reducing time and effort for law enforcement staff.

In 2020, South Dakota launched a telemedicine pilot in partnership with Avel eCare and a private donor. The virtual crisis care (VCC) program equips sheriff agencies with iPads to support on-demand, 24/7 access to a behavioral health care team.

VCC is another tool for law enforcement to serve their communities better and help those in mental health crises. Telemedicine has become an important technology to connect people with high-qualified health care providers on demand. It’s time we extend its value to law enforcement agencies, who play a critical role in handling behavioral health crises in the community.

Virtual mental health care access is not limited to rural areas, but the impacts it can have on these regions are especially noticeable.

For example, in South Dakota, where only a few facilities offer inpatient mental health care, transport for an involuntary committal can take up to seven hours of driving, as the available facilities are located in the extreme geographic corners of the state, which is arduous for both the officers responsible and the person being transported.

With VCC, law enforcement officers on-site can request a video safety assessment before beginning an hours-long journey. The telemedicine call can take between 15 minutes and an hour, depending on the person’s health status and ability to engage with the mental health professional.

The mental health professional who documents the encounter then speaks with the on-site officers to recommend a course of action. If the mental health professional determines that the individual is safe to stay at home, they connect the person to a community health resource for follow-up. The officer has the ultimate decision on what course of action to take based on their direct knowledge of the situation.

The results of this strategy are extremely encouraging. Out of 181 encounters during the pilot predicted to result in an involuntary committal, just 19 ended up with a person needing immediate inpatient care. More than half of the 181 calls involved suicidal ideation, and 15 percent involved aggressive behavior.

“By utilizing VCC through Avel eCare, we’ve noticed significantly different outcomes than what we usually see,” commented Butte County Sheriff Fred Lamphere. “It’s less disruptive for the subject of the call, less stressful for the officers and less costly for the agency. We need all the help we can get to maximize our resources and treat those experiencing mental health crises. Telemedicine is a simple, effective way to accomplish that goal.”

The Avel eCare pilot is looking to expand to more counties in South Dakota in 2022 and potentially to other states soon. Whether operating in rural or urban areas, law enforcement agencies have the potential to use telemedicine technology as a cost-effective, highly impactful way to diffuse tense situations, conserve their resources, and improve outcomes for individuals in crisis.

Brian Erickson is vice president and general manager of behavioral health and specialty clinic at Avel eCare, one of the first and largest telemedicine care providers in the nation to start offering provider-to-provider services via telemedicine. Since 1993, Avel physicians and clinicians have delivered exceptional virtual care impacting millions of patients in rural and underserved communities across the United States.