Mental Health Visits Up, Suicidal Behavior Down for Vets Given iPads During Pandemic, Study Finds

Demonstration of the Department of Veterans Affairs' telehealth programs.
Representatives from the Department of Veterans Affairs meet with Veteran Service Organizations at the Washington D.C. VA Medical Center for a demonstration about VA’s telehealth programs, October 23, 2014. (VA/Robert Turtil)

A program that put iPads in the hands of veterans with mental health conditions at the start of the COVID-19 pandemic resulted in increased therapy sessions and reduced suicidal behaviors, according to a new study.

At the start of the pandemic in 2020, the Department of Veterans Affairs distributed nearly 99,000 of the tablet computers to veterans for telehealth appointments, with more than one-third issued to rural veterans without computers or who faced long drives for medical care.

Among rural veterans receiving treatment for mental health conditions, those with tablets engaged in mental health appointments and psychotherapy visits at higher rates than those who didn't have the devices, and they also had fewer emergency visits and less suicidal behavior, a study published Wednesday in JAMA Network Open found.

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Suicide rates in the U.S. have risen disproportionately in rural counties in the past decade, with residents at even higher risk during the pandemic when mental health providers were forced to close their doors and move their services online.

The veteran suicide rate is 1.5 times that of non-veterans, and vets in rural areas are more likely to die by suicide, according to data kept by the VA.

The department, which began distributing iPad tablets to veterans in 2016 through its Offices of Rural Health and Connected Care, ramped up its efforts at the start of the pandemic to ensure that veterans could continue accessing treatment.

The investment appeared to pay off, according to the study led by VA Palo Alto researcher Kritee Gujral. The group of vets with the devices saw a 36% drop in emergency room visits linked to suicidal behavior, a 22% decline in the likelihood of suicide behavior and a 20% reduction in overall emergency department visits, although researchers noted that there were limitations to that data, given that COVID-19 kept many away from hospitals.

The veterans also increased their attendance at therapy sessions, up nearly four visits per year, according to the study.

The encouraging findings also were seen in veterans deemed as high risk for suicide by the VA, with even higher results in one measure -- that group accessed nearly six more therapy sessions per year, according to the study.

Gujral wrote that although telehealth has had the potential to improve access to mental health care, little research has been done on its effectiveness on suicide prevention and outcomes.

"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," Gujral wrote.

During the COVID-19 pandemic, the VA ramped up its telehealth capabilities for care across departments and specialties. VA telehealth appointments and messages to providers surged 3,147%, from 294,847 in fiscal 2019, to 9,575,958 in fiscal 2021.

For many veterans, telehealth provides accessible health care, and the VA plans to keep offering remote services moving into the future, according to VA Secretary Denis McDonough.

"We want to maintain it, because it's ease of access for vets who don't need to be seen in person," McDonough said during a hearing before a Senate Appropriations Committee on June 23, 2021. "There is going to continue to need to be things that are done in person. … But I think as a system we recognize the huge efficiency gains and huge satisfaction gains which come from vets spending less time traveling to our facilities while getting good care."

Veterans were eligible to receive a tablet with a data plan if they didn't have their own with connectivity via broadband or cell service and they lived far from a VA medical facility or had transportation issues.

Their doctors ensured that they were able to physically and mentally operate the devices.

The researchers said their study had several limitations, noting that in general veterans received tablets because they were selected by the VA in order to facilitate health treatment and already were more likely to engage in mental health services.

They added that future studies should look at the broader range of medical treatments tablets can help address, as well as consider program and use costs.

But, they added, the results were encouraging.

"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," they wrote.

The Veterans Crisis Line can be reached 24 hours a day, 7 days a week by calling 1-800-273-8255 and pressing 1, or by texting 838-255 or engaging via the Crisis Line's website.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime

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