Table 2.

Descriptions of mental health facilities and Telemental health (TMH) adoption among mental health facilities in the United States.

	All facilities		Facilities with TMH
Total	N 11,883	Column % 100.0	N 3082	% 25.9
Level-1: Facility characteristics
Type of facility
Care setting
Psychiatric inpatient	1804	15.2	356	19.7
Residential	1633	13.7	174	10.7
VAMC	377	3.2	349	92.6
CMHC	2587	21.8	1079	41.7
Outpatient	5088	42.8	1030	20.2
Multi-setting	394	3.3	94	23.9
Ownership
Private-for-profit	2069	17.4	380	18.4
Private-non-profit	7,601	64.0	1,714	22.5
Public	2213	18.6	988	44.6
Religious affiliation
Yes	763	6.4	105	13.8
No	11,091	93.3	2965	26.7
Not reported	29	0.2	12	41.4
Annual mental health admissions
0–100	3323	28.0	549	16.5
100–250	1472	12.4	329	22.4
250–500	1474	12.4	395	26.8
500–1000	3684	31.0	1192	32.4
>1000	1930	16.2	617	32.0
Daily volume of patientsa
1–100	5398	45.4	938	17.4
100–250	4340	36.5	1320	30.4
250–500	1311	11.0	488	37.2
500–1000	388	3.3	123	31.7
>1000	446	3.8	213	47.8
Comprehensiveness of mental health treatments
Treatment focus
Mental health only	8019	67.5	1662	20.7
Mental health & Substance Abuse	3499	29.4	1217	34.8
General health	365	3.1	203	55.6
# of mental health treatment approachesb
0–3	1967	16.6	237	12.0
4–5	9916	83.4	2845	28.7
# of mental health servicesc,l
0–4	6668	56.1	1128	16.9
≥5	5212	43.9	1954	37.5
# of special mental care programsd
0–3	10,541	88.7	2538	24.1
4–5	1342	11.3	544	40.5
Non-English services
Yes	7197	60.6	2064	28.7
No	4685	39.4	1018	21.7
Quality improvement practicee
0–3	3377	28.4	696	20.6
4	3708	31.2	915	24.7
5	4757	40.0	1462	30.7
IT capabilityyf,l
Low	2509	21.1	310	12.4
Moderate	9006	75.8	2577	28.6
High	342	2.9	188	55.0
Payer mix
Medicaid
Yes	10,515	88.5	2635	25.1
No	1155	9.7	334	28.9
Not reported	213	1.8	113	53.1
Medicare
Yes	8120	68.3	2339	28.8
No	3454	29.1	630	18.2
Not reported	309	2.6	113	36.6
Veteran Health Administration
Yes	2613	22.0	1131	43.3
No	6770	57.0	1350	19.9
Not reported	2500	21.0	601	24.0
Any private insurance
Yes	9501	80.0	2694	28.4
No	2158	18.2	306	14.2
Not reported	224	1.9	82	36.6
Case mix
Any elderlya
Yes	7714	64.9	2372	30.7
No	4169	35.1	710	17.0
% Femalesa
0–10%	567	4.8	199	35.1
11–50%	5872	49.4	1399	23.8
>50%	5444	45.8	1484	27.3
% African Americana
0–20%	9068	76.3	2520	27.8
>20%	2815	23.7	562	20.0
Any Hispanic/Latino patientsa
Yes	5993	50.4	1617	27.0
No	5890	49.6	1465	24.9
Any minority patientsa
Yes	11,308	95.2	2895	25.6
No	575	4.8	187	32.5
% Mental health & substance abuse patientsa
0–20%	4327	36.4	933	21.6
20–40%	2127	17.9	611	28.7
40–60%	1256	10.6	344	27.4
60–80%	1536	12.9	354	23.0
Not reported	2637	22.2	840	31.9
Annual % of veteran patients
0–50%	9209	77.5	2,030	22.0
>50%	302	2.5	265	87.7
Not reported	2,372	20.0	787	33.2
Level-2 variables: Policy characteristicsg
ATA telehealth coverage & reimbursement gradingh
A	1362	11.5	427	31.4
B	8425	70.9	2098	24.9
C	2096	17.6	557	26.6
Patient consenti
Yes	8127	68.4	2058	25.3
No	3756	31.6	1024	27.3
Licensurei
Individual state	1398	11.8	447	32.0
FSMB Compact	2670	22.5	707	26.5
Special telehealth	1450	12.2	485	33.4
With exemptions	1900	16.0	641	33.7
Not required/defined	4465	37.6	802	18.0
Level-2 variables: Market characteristicsh
Provider shortagej
Low	3779	31.8	298	9.7
Moderate	3566	30.0	1170	38.0
High	4538	38.2	1614	52.4
% rural countiesj
0–10%	6114	51.5	1097	17.9
10–20%	3510	29.5	1172	33.4
≥20%	2259	19.0	813	36.0
Level-2 variables: Environmental resourcesh
% counties with broadband accessk
0–10%	6112	51.4	1082	17.7
10–20%	4391	37.0	1419	32.3
≥20%	1380	11.6	581	42.1

Note: The study population included mental health facilities located in the 50 states and the District of Columbia that responded to the query about telemedicine use and patient characteristics in the 2016 N-MHSS. Facilities in American Samoa, Guam, Puerto Rico, and Virgin Island were excluded due to insufficient information on telehealth policies.

^aN-MHSS measured total number of patients and patient mix of a facility on a specific day (April 29, 2016).

^bMental health treatment approaches evaluated in N-MHSS included individual psychotherapy, couples/family/group therapy, cognitive behavioural/dialectical behavioural therapy/behaviour modification, integrated dual disorders treatment, trauma therapy, activity therapy, electroconvulsive therapy, and psychotropic medication.

^cMental health services evaluated in N-MHSS included intensive case/case management/chronic disease/illness management, integrated primary care services, any counselling, family psychoeducation, education services, psychosocial rehabilitation services, psychiatric emergency walk-in services, suicide prevention services, peer support services, screening for tobacco use, smoking cessation services.

^dSpecial mental health programmes included mental health programmes that is dedicated or designed exclusively for serious mental illnesses, co-occurring mental and substance abuse disorders, post-traumatic stress disorder, senior/elderly patients or veterans.

^eQuality improvement practice evaluated in N-MHSS included continuing education, case review, outcome follow-up after discharge, utilization review, and satisfaction surveys.

^fThe IT capacity was defined as the level of technology involvement in 14 routine facility activities, including mental health intake, scheduling appointments, assessment/evaluation, treatment planning, client progress monitoring, discharge, referral, issue/receive lab results, prescribing/dispensing medications, checking medication interactions, health records, provider collaboration, billing, and satisfaction surveys. The level of technology involvement was measured by the mean score of all activities rated on a 3-point scale, where ‘1’ denotes no technology involvement (i.e. rely on paper), ‘2’ indicates partial involvement (i.e. both electronic and paper), and ‘3’ represents fully involvement (i.e. only electronic).

^genvironmental-, policy-, and market characteristics were measured for the state where the facility was located.

^hthe American Telemedicine Association (ATA) has given each state a grade (A, B, C, or F) for the coverage and reimbursement policies for telehealth, basing on health plan parity and Medicaid conditions of payment.

ⁱthe patient consent policy that requires informed consent before telehealth services and the licensure policy that requires licence for interstate telehealth practice were obtained from the Centers for Connected Health Policy’s (CCHP) annual State Telehealth Laws and Reimbursement Policies Report.

^jThe percentage counties with primary care physician (PCP) shortage, mental health professional (MHP) shortage, and the percentage of rural counties were obtained from the Area Health Resources File (AHRF).

^kBroadband access was defined as having access to 25Mbps/3 Mbps service; % counties with broadband access in the locating state were derived from the 2016 Broadband Progress Report.

^lMissing data category is not presented due to small sample size (n<10).