Barriers and Facilitators to Implementing a U.S. Department of Veterans Affairs Telemental Health (TMH) Program for Rural Veterans

Telemental health refers to the use of information and technology to provide mental health services when providers and patients are separated geographically. The U.S. Department of Veterans Affairs' (VA) Telemental Health Hub (TMH) initiative started in 2002 to address the mental health needs of rural Veterans and has been increasingly used since that time. Services are typically provided from a VA medical center (VAMC) to a VA community-based outpatient clinic, as well as to Veterans' homes. The VA NY Harbor Health Care System TMH Hub (VA NYH TMH Hub) was established in 2016 through funding from VA's Office of Rural Health. Since March 2017, the VA NYH TMH Hub has provided individual, couples, and group therapy, as well as neuropsychological and psychodiagnostic testing to Veterans in rural New York and Iowa. As the TMH initiative continues to grow, it is increasingly important to understand program development, particularly barriers and facilitators to support ongoing growth. The present article examines factors that enhance and challenge the provision of psychotherapy via TMH, as experienced by TMH psychologists. Reflections are based on discussions among nine TMH psychologists regarding their experiences providing TMH treatment, generated and categorized during weekly staff and peer supervision meetings. Administrative, technical, and clinical barriers and facilitators are discussed. Unique considerations are also discussed, related to the structure of the VA NYH TMH Hub and the ways in which the therapeutic relationship may be impacted by TMH. Current considerations highlight strategies to improve telehealth processes and provide practical guidance to support TMH growth.