Providing video-enabled tablets to rural veterans decreased emergency department visits and suicide behaviors, and increased both in-person and virtual mental health visits, according to a study published in JAMA Network Open. 

"These findings suggest that video-enabled tablets may provide access to critical services for rural patients with mental health needs and reduce instances of suicide behavior and ED visits among them," the authors wrote. 

TOP-LINE DATA

Researchers found that receiving a video-enabled tablet with a data plan was associated with an overall 20% reduction in the likelihood of an emergency department visit, a 36% decrease in likelihood of a suicide-related visit and a 22% reduction in the likelihood of suicide behavior among U.S. veterans living in rural areas. These findings persisted for vets who were considered high-risk for suicide by the Department of Veterans Affairs.

The tablets were also associated with an increase of 1.8 psychotherapy visits per year, 3.5 video psychotherapy visits, 0.7 video-based medication management appointments and 0.02 video-based comprehensive suicide risk evaluations. 

HOW IT WAS DONE

The study was made up of 13,180 tablet recipients and 458,611 nonrecipients, all veterans living in rural areas who had at least one VA mental health visit in 2019. 

Recipients received their tablets between March 2020 and April 2021, and data was pulled 10 months before their baseline month. The vets were followed until the end of June 2021, and the researchers attempted to follow data for most veterans for 10 months after the tablets were received.

They also included a sub-cohort considered at high risk for suicide by a VA predictive model that analyzes health record information.

BACKGROUND

Mental and behavioral healthcare is a booming sector for virtual care. According to a report by CB Insights, mental health-tech startups raised $5.5 billion worldwide in 2021. Though U.S. digital health funding slowed in the first quarter this year, Rock Health found mental health was still the leading clinical area by investment dollars. 

Telehealth use soared during the COVID-19 pandemic, but there are concerns some marginalized groups could have less access to virtual care. An issue brief released by the Department of Health and Human Services found rates of video-enabled telehealth use was lower among people with lower incomes; adults without a high school degree; Black, Latinx and Asian respondents; and those without health insurance.

CONCLUSION

Researchers noted the study did have some limitations. For one, they were evaluating a health system initiative by the VA, so they couldn't randomize who received a tablet. It also took place during COVID-19, so it was difficult to remove the effects of the pandemic from associations related to the tablet alone. 

The study also didn't analyze all the potential ways the tablet could have contributed to improved mental health outcomes, like care convenience or social connectivity. Future studies could examine these other tablet influences as well as how tablets could affect mental health in non-VA care settings. 

"These findings suggest that the VA and other health systems should consider leveraging video-enabled tablets for improving access to mental health care via telehealth and for preventing suicides among rural residents," the authors wrote.