Telehealth Counseling Makes PTSD Treatment Accessible For Veterans
After an hour-long commute from Yuma, Ruben Moreno Garcia arrives at his El Centro apartment and immediately boots up his laptop. First thing: he checks his inbox for the two emails he receives every Monday.
One email is a reminder for his weekly counseling session; The Army veteran was diagnosed with post-traumatic stress disorder after serving three tours in combat. The other email has a username and password for that he needs in order to connect to those weekly counseling sessions.
He logs into Jabber, a Skype-like service, and inputs the newly-generated credentials. A few rings later and he's connected to Kathryn Williams, a psychologist located more than 100 miles away at the San Diego VA.
It's called telemental health — virtually connecting patient with psychologist. Nearly a quarter of veterans return home with post-traumatic stress disorder, but only a few actually seek treatment. Hectic schedules, transportation challenges and the persistent stigma regarding mental health may prevent those in need from seeking help. The telehealth program helps to break those barriers, and the San Diego VA is its West Coast leader.
According to the program's administrator, psychologist Nilesh Shah, the program got its start as a way to monitor chronic disease among patients who lived far away.
"For example, we would have a diabetic patient who would submit daily their blood sugars or their blood pressure," he said.
The information would go to a secure website monitored by a nurse.
Since then, the program expanded to new areas, like psychiatry.
However, the question is: Does it really work? At first, even Garcia said it was weird.
"There was some sense of kind of being distant, you couldn't really feel like trusting the person because there was no physical interaction," he said.
San Diego VA psychologist Steven Thorp agrees.
"And you do miss out on some things you would get face to face, so you can't touch the client like sometimes we shake a veteran's hand and you can tell if they seem anxious, if their palm is warm or cool, things like that" he said.
Despite the lack of physical contact, Thorp said the video conferencing is just as effective as face-to-face counseling.
In fact, he was part of a team that just finished one of the largest studies on the matter. Researchers compared the mental health experiences of more than 200 veterans. About half did face-to-face counseling and the other did video conferencing.
"Right after the 12 sessions were done, after 12 weeks, the people who did face-to-face did a little bit better," Thorp said.
Months later, something interesting happened.
"And then we asked them again six months later how they were doing in terms of their PTSD symptoms and found that the folks who went through video conferencing psychotherapy kept improving over the course of those six months until they were at the same level as the face-to-face folks," he said.
That was the case for Garcia. He was in a bad place just more than a year ago.
"I was trying to do a swan dive from the roof onto concrete," he said.
He didn't jump. His dog actually prevented him from jumping until his mother came home, but he said he wanted to, and it wasn't the last time he tried something like that. After serving overseas as an Army mechanic, he brought home a lot of memories he wished he never had.
On his last tour, he was assigned to retrieve parts from damaged vehicles and sometimes rescue troops still stuck inside.
"If you were lucky, it would blow up far enough that only (there) will be vehicle damage," he said. "Sometimes you weren't that lucky. Sometimes the vehicle actually gets blown upside down, or sideways, and then, well, since the vehicles are made to keep people out, they're just locked inside," Garcia said.
Recoveries weren't very successful, he said.
When he got back to the U.S., he started the telehealth program twice a week from the satellite clinic in El Centro, but working in Yuma it made it difficult to get to the clinic before closing time.
Around the same time, a federal grant came through to fund the in-home conferences he uses now. Garcia is actually the first of only about 50 people in San Diego to try it.
For him, reaching only 50 people through the program isn't enough.
"And that's why I don't mind doing this, so the word gets out and actually some speed— so some dust gets picked up," he said.
Garcia said he hopes funding continues for the tech workers, server space and psychologists that make the program possible so eventually all of his fellow vets can get the chance to recover in the privacy of their own home.