United States Department of Veterans Affairs
 Health Care
Telemental Health Extends Meaningful Treatment Across the Miles
A group of Veterans sit around a table with a web camera and video screen in the background.
Veterans in the aftercare recovery group can discuss anything on their mind during group time. Their psychiatrist joins in via a web camera and video screen.

A group of Veterans gather in one room for a therapy session. Ninety miles away, a therapist moderates their discussion. Another 120 miles away, a few more Veterans join in.

This is a telemental health session. As part of VA's telehealth program, this kind of telemental health service allows Veterans to receive counseling without a long drive to meet a therapist. The service has been offered by the VA for about 15 years, extending help to Veterans who live far from VA mental health clinicians.

"I think telehealth is great. We get a perspective from somebody out of town, get to meet new people and get to open up to each other and offer perspectives that others don't think about," said Dwayne, a Vietnam Veteran, in Helena, Montana.

Dwayne is part of an aftercare recovery group that meets weekly. The group is a mix of Veterans based in Helena, Missoula and Great Falls, where their psychiatrist is based.

Group participants meet at their local medical center or outpatient clinic and gather in a room equipped with videoconferencing technology. VA technicians and nurses are on hand locally if any problem arises with the video connection, but the session is primarily run by the therapist tuned in on the video screen.

"The ability to communicate from Vet to Vet works well," said Terry, another Vietnam Veteran in the Helena therapy group. "The staff have been great about making this available to Veterans."

The aftercare recovery group functions as an extension of VA's Intensive Outpatient Program, a support group for Veterans overcoming drug and alcohol addictions.

Minimized Driving Time Means Maximized Therapy Time

Montana is one of the largest states in the country and its residents are widely dispersed. The state's limited amount of interstates highways and mountainous terrain makes getting from one town to another a time-consuming journey.

"Some Veterans have to drive four to five hours to get to a mental health clinician," said Dr. Rosa Merino, a psychiatrist at the Fort Harrison VA Medical Center in Montana.

With telemental health, Veterans in the most rural parts of Montana now only need to drive one to two hours, and VA is working on decreasing that distance even more. There are 13 VA clinics in Montana which use telemental health and two telehealth facilities will open later this year.

Telehealth services are available for convenience and Veterans are always given a choice if they would prefer to meet their therapist in-person. "Some Veterans are ill-at-ease with the thought of a camera watching them, but when it comes to using telehealth versus driving across the state, most choose telehealth," said Merino.

"There is a little difference with using video instead of in-person counseling. I think body language is difficult to read and it is a little weird talking to the therapist on the screen - it's like talking to the TV. But you get over that and it's a lot like talking on the phone," said Aaron, an OIF Veteran in the Intensive Outpatient Program (IOP).

Aaron's group meets in Helena three days a week. His therapist comes to town once a month to meet in person, but most sessions he spends the time speaking via video screen from Great Falls, Montana.

Telemental therapy sessions are offered both individually and in groups. Aaron has designated times when he speaks one-on-one with his therapist in Great Falls, and other nights where he meets with a group.

"I'm learning a lot about myself. It's difficult just like anything else, but the therapists are good, both in the room and on the computer. They're knowledgeable and want to help," said Aaron.

A map of Montana shows that its size is comparable to 14 states, Virginia to Maine, in the northeast.
Commutes across Montana are comparable in distance to a drive through 14 of the country's northeastern states. With such vast distances, telehealth allows Veterans to seek care with shorter driving times.

5,000 Veterans in Rocky Mountain Region Using the Service

Using telecommunication technologies for therapy sessions has been considerably well-received, according to Dr. Merino. In VA's Rocky Mountain Network, which spans Montana, Wisconsin, Colorado and Utah, more than 5,000 Veterans made use of telemental health services in 2009.

"It's exciting to see where telemental health care is going," said Jeff Lowe, Special Projects Manager for the Office of Telehealth. "Last quarter, 3,200 Veterans used the service and we plan to see more usage up and coming."

Two additional telehealth clinics are slated to open in Montana this year. Both will provide rooms specifically for mental health telecommunication.

Terry considers telemental health an "effective way to communicate. We are fortunate to have the access to care."

"I have good support from the others in the group and we have grown closer," said Dwayne. "I believe I have benefitted from this program."

Editor's note: For privacy purposes, Veterans' last names were excluded from this article.

By Megan Tyson, VA Staff Writer