Virtual treatments in an integrated primary care-behavioral health practice: an overview of synchronous telehealth services to address rural-urban disparities in mental health care

A quiet revolution underway is leading to changes in healthcare for many countries of the world. The sentinels of health have always been physicians; the medical model, representing the research, education, and experience of medical doctors, has worked well for treating acute conditions of injury and physical illness and been very successful in reducing disease-producing morbidity and mortality. But pressing contemporary issues, such as spiraling healthcare costs, population aging and the need to manage chronic conditions, and recognition that mental health care is necessary for societies to be physically healthy, are forcing a reevaluation of existing conceptualizations of care. In response, physicians are increasingly working in integrated practices with other specialists to broaden care coverage to include social and behavioral conditions empirically demonstrated to influence medical care outcomes. Aiding the development of these new, more inclusive models of healthcare are advances in communication technologies. Practitioners are now using synchronous and asynchronous forms of communication to deliver physical and mental health services beyond the boundaries of traditional brick-and-mortar practices, into communities where clients live and work. This brief review of the potential of telehealth to address disparities in healthcare has two purposes: 1) examine an innovative model of comprehensive, integrated biopsychosocial services useful in single- and multiple-location practices; and, 2) identify challenges of using synchronous, virtual technologies for client-centered, mental health care service provision in rural, underserved areas.