Rural Mental Health Services Need Reliable Telemedicine More than Most

Rural mental health is one of the most pressing areas in healthcare today. Telemedicine technology can make a huge difference in helping rural populations with mental health services, but only if video chat reliability is improved.

First, the problem.

Roughly one in five people in the U.S. suffer from a diagnosable mental health condition, according to the National Institute of Mental Health, and it costs the U.S. an estimated $467 billion in lost productivity and medical expenses each year. This is not just a U.S. issue, either; globally, the cost of depression is estimated to stand around $2.5 trillion annually.

Rural populations are particularly hard hit, the result of insufficient numbers of mental health specialists practicing in these areas. There is an average of only 43 specialists available for every 100,000 rural patients in need of care, according to the National Rural Health Association. In the state of Wisconsin, for instance, there are 130 licensed child psychologists but more than half are in Milwaukee and a couple of neighboring counties. Fifty-one counties in the state don’t have a single child psychologist.

Mental health techniques such as cognitive behavioral therapy (CBT) and exposure therapy (ET) are highly effective treatments for mental health conditions such as anxiety, which affects 40 million people in the U.S. each year including many of my friends. But such therapeutic techniques only work if the right mental health specialists are available, something often lacking in rural areas.

Telemedicine: Helping Rural Mental Health

The solution to this problem of inadequate rural mental health services in telemedicine technology.

If rural areas cannot attract a sufficient number of mental health specialists, telemedicine can bridge the gap by bringing these rural patients to the specialists virtually. And since mental health services revolve around talk therapy most of the time, this area of healthcare is particularly well-suited for telemedicine. Many psychologists and specialty therapists already use technologies such as Skype for virtual mental health practices, and this can be expanded as a mainstream solution for rural populations.

“Telemedicine is part of the future,” Dr. Jonathan Gilbert, clinical director for the Billings, Montana area of the Indian Health Service, told the Billings Gazette recently. “It’s a fantastic way to bring board-certified specialists to a frontier community and to raise the bar.”

States such as South Carolina are starting to use video chat for virtual psychiatry visits, and mental health studies such as those conducted by the American Academy of Child and Adolescent Psychiatry have shown that telepsychiatry is just as effective as in-person treatment.

But Reliability Matters

The challenge with video chat for mental health is reliable network transmission. You can’t have connection problems in the middle of a session with a mental health patient. Abridging a video chat with your girlfriend is one thing, but stopping a mental health video chat session while a patient is sharing a trauma or having an emotional breakdown is another thing entirely. Video chat must be reliable if it is to be used in a clinical setting.

The problem is that most video chat technology is not reliable because it relies on the public Internet and is poorly optimized. Cellular 3G and 4G connectivity greatly challenge real-time communications, and network congestion often can delay video packet transmission and lead to poor quality of experience or dropped connections entirely. Rural mental health is particularly susceptible to these problems because of poor infrastructure.

Many telemedicine advocates talk about the necessity of laying a good communications infrastructure in rural communities, but we at think that people who suffer from mental health issues shouldn’t have to wait until new major infrastructure projects are completed—if they even get completed.

“If Internet connections are not always strong, as is the case with mobile Internet and rural environments, you need to make the video connection adapt, not the user,” our founder and CEO, Tony Zhao, has noted in the past. “Good connectivity in the future is important, of course, but we also have the technology to make it work today.”

That technology, of course, is’s global virtual real-time communications network for assured quality of experience. makes video chat work even in rural environments by pairing proprietary, optimized audio and video codecs with real-time network monitoring and more than 70 global data centers that ensure that video streaming quality and live video chat is smooth and uninterrupted. The connection adjusts if there are bottlenecks or cellular connectivity issues, delivering the mission-critical quality of assurance for applications such as telemedicine for mental health.

Telemedicine technology is ideally placed to alleviate the shortage of mental health professionals in rural areas. For the technology to work, however, it must have solid reliability. And we can help with that.