Mental illness affects 18% of American adults and 8.0% of American children. Untreated mental illness can increase mortality, influence treatment of other conditions, and impose unnecessary burdens on individuals, families, and communities. Despite the prevalence and burdens of untreated mental illness, there are still numerous financial, social, and organizational barriers to the availability, utilization and quality of mental health services. In the last two decades, many efforts have been made to improve healthcare access through legal and regulatory overhauls, health insurance reform, electronic health system infrastructure expansion, and development of new models of care. These efforts are perhaps most easily observed through the implementation of telehealth and telemedicine. Telehealth is an umbrella term indicating the use of technology for the provision of healthcare, health administration, and health education while telemedicine is a more specific term referring to the use of technology for the delivery of healthcare across distances. While telemedicine is used in almost all subspecialties, implementation and research are more developed in some specialties than in others. Research on telepsychiatry shows that 1) telepsychiatry can be used to effectively diagnose and treat a variety of mental illnesses in a number of populations in many locations; 2) telepsychiatry has the potential to be a cost effective alternative to treatment as usual for patients, providers, and communities; 3) telemental health can function successfully within the legal and regulatory landscape in United States; 4) the technology for telemental health is already available and continually improving; 5) There are resources available to facilitate the use of telemental health by patients, providers and healthcare organizations. Telepsychiatry has the potential to improve access to mental health services by connecting patients with the right providers, reducing the costs of receiving and providing mental healthcare, lowering social barriers that prevent individuals from seeking and providers from offering care, and facilitating organizational practices and goals. This paper summarizes published data concerning the clinical, financial, legal and regulatory, and technological aspects of telepsychiatry and explores how telepsychiatry might be used to improve the availability, utilization, and quality of mental health services in the United States.

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Master of Science / Industrial & Manufacturing Systems Engineering / David H. Ben-Arieh / Telemental health systems, a form of telemedicine, use electronic communication media to provide patients in remote locations access to psychological and psychiatric specialists. The structure of telemental health systems has a major impact on their performance. Discrete-event simulations offer useful results concerning capacities and utilization of specific resources. Simulation, however, cannot provide theoretical properties of analyzed systems. Petri net representations of systems can overcome this shortfall, offering a wide range of easily-analyzed and useful properties. Their ability to model resource conflict, parallel activities, and failure modes fits nicely with the reality of telemental health systems. Analysis of behavioral properties of Petri nets can provide meaningful information for system analysts. The most useful properties include net boundedness, liveness, and non-reachability of certain undesirable states. The thesis discusses methods to find all these properties. Specifically, it provides property-preserving net reductions to facilitate analysis of boundedness and liveness and describes an integer programming model to solve reachability and coverability problems. Moreover, this thesis outlines a simulation analysis of synchronous and asynchronous telemental health systems. The paper then describes a Petri net model of a generic telemental health delivery system. The paper subjects the model to an integer programming model and net reduction. The integer programming model indicated that the number of resources in the system remains static, full utilization of resources at a given time is possible, conflict over resources is possible, and improper work prioritization is possible within the model. Net reduction and analysis with open-source software showed that the model is bounded and live. These results can aid telemedicine system architects in diagnosing potential process issues. Additionally, the methods described in the paper provide an excellent tool for further, more granular analysis of telemedicine systems.

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