Exploring needs and perceptions about telemental healthcare among Veterans with spinal cord injuries, a qualitative study

Mental health (MH) is essential for self-efficacy and self-care, both of which affect health outcomes and care costs for Veterans with disabilities. Co-occurring mobility impairment and MH disorder are strongly linked to reduced daily function and lower life satisfaction. Veterans with spinal cord injuries (SCI) are a high-priority group for VA and are frequent, high-cost healthcare users. MH disorders are common in Veterans with SCI, but are often underdiagnosed and undertreated due to medical complexity, limited clinician familiarity with post-injury adjustment, and insufficient evidence for effective MH treatments in this population. Telehealth can increase access to MH care but requires supports such as accessible applications, adaptive equipment, and electronic health literacy. This qualitative study presents interview findings on how Veterans with SCI experience and perceive telemental healthcare. We conducted semi-structured interviews with 24 Veterans diagnosed with SCI to learn about their needs, experiences, and perceptions of telemental healthcare. Interviews were thematically analyzed. Participants described diverse experiences with telemental healthcare, with most finding video telehealth helpful for improving access to care. Veterans emphasized three key findings: the value of virtual care in overcoming distance and SCI-related challenges; the need for providers to have comprehensive knowledge of available resources and to deliver disability-competent care; and the importance of flexible telehealth options tailored to individual needs. Four primary themes emerged: (1) Telemental health addresses distance and SCI related Access Challenges, (2) Unintended Consequences Impact Access and Accessibility of Telemental Health, (3) Adaptive Strategies May Help Mitigate Telemental Health Barriers, and (4) Flexible Use of Telehealth Can Match Care Modalities to Individual Needs. Telehealth is an important tool for Veterans with SCI when seeking MH care. However, individualized support is needed to address barriers and facilitate positive experiences, thereby maximizing therapeutic benefit.