Tablets, Teletherapy, and Rural Veteran Health

Suicide in the United States is increasing. For veterans, suicide completion occurs at 1.5 times the rate of the general population. Rural communities also experience higher suicide rates than urban settings, largely due to barriers to accessing mental health care, putting veterans who live in these areas at particularly high risk.

The U.S. Department of Veteran Affairs (VA) has identified veteran suicide prevention as its top clinical priority. Since 2016, the VA has been distributing cellular-enabled tablets to veterans for easier access to VA health care providers and services. Tablet users are able to access VA mental health services such as psychotherapy, medication management, and comprehensive suicide risk evaluations remotely.

Extensive research exists on the effectiveness of teletherapy vs. in-person therapy, but there is little research on how well teletherapy services treat suicidal ideation and behavior. This VA intervention paired with the increased teletherapy use due to the pandemic allowed researchers to assess how the improved access to remote mental health services influenced suicidal behavior among veterans in rural areas.

Gujral and colleagues conducted a retrospective cohort study of 471,791 U.S. veterans living in rural areas. They compared the differences between mental health service use between 13,180 veterans who received tablets between March 16, 2020 and April 30, 2021 and 458,611 veterans who did not.

As the graph shows, the researchers found the likelihood of going to the emergency department for a suicide-related event decreased by 36% in the month after receiving the tablet and remained lower when compared to have no tablet-access to care. Psychotherapy visits across all modalities also rose considerably by 33% compared to the baseline in the month after getting the tablet.

These government-issued tablets provide veterans in rural areas easy access to mental health services that may be otherwise very difficult to receive in-person. For a population that experiences disproportionate rates of mental health crises, having a free electronic device and service providers ready to help, could be an important means of reducing otherwise untreated suffering.

Databyte via , Kritee Gujral, James Van Campen, Josephine Jacobs, Rachel Kimerling, Dan Blonigen, Donna M. Zulman, Mental Health Service Use, Suicide Behavior, and Emergency Department Visits Among Rural US Veterans Who Received Video-Enabled Tablets During the COVID-19 Pandemic, JAMA Network Open, 2022.