Telepsychiatry has existed in some capacity for more than 60 years, a surprising fact—even to medical professionals. Telepsychiatry was first utilized in the 1960s, and officially became the dominant treatment modality in mental healthcare with the onset of the COVID-19 pandemic.
What Is Telepsychiatry?
Psychiatric services conducted via telecommunications technology is known as telepsychiatry, a subspecialty of telemedicine. Remote consultation conducted between a psychiatrist and a patient in the outpatient setting is the most popular form of telepsychiatry.
Telepsychiatry programs can offer diagnosis and assessment, medication management, as well as individual and group psychotherapy sessions. Platforms for telepsychiatry are utilized for interactions between psychiatrists and other healthcare professionals and patient-psychiatrist interactions.
A psychiatrist and a patient may communicate directly during telepsychiatry. Psychiatrists who offer consultation to primary care doctors regarding psychiatric patients can also occur in a collaborative care model. Mental health care can be provided to patients through real-time, interactive conversation.
Furthermore, telemedicine allows for exchange of medical data, such as videos or images, or lab results between the patient and provider.
Telepsychiatry: A timeline
The range of telepsychiatry services grew significantly in recent years. Psychiatrists previously used telephone calls to offer remote care for emergent situations to speak with a referring physician, or to address a patient’s concerns outside of scheduled visits.
More psychiatrists are now providing remote visits to patients as a practical treatment option, thanks to the advent of telepsychiatry software that enables video communication. The patient demand for telepsychiatry services is experiencing rapid growth. Let’s dive into its history.
- Between 1957 And 1959: To provide group therapy, long-term therapy, consultation-liaison psychiatry, and to instruct medical students, the Nebraska Psychiatric Institute developed and started deploying early video conferencing.
- In the 1990s: Telepsychiatry became more often utilized all around the world, but it was especially popular in Australia. To prove the effectiveness of telepsychiatry care and recognize its capacity to overcome political and geographical barriers, researchers worldwide started conducting studies.
- In the 2000s: Early 2000s, studies proved that telemedicine increases access to care in a safe way. Regulatory bodies and healthcare organizations developed practice guidelines for telemedicine and telepsychiatry.
Telepsychiatry may provide a reasonable alternative to in-person visits while providing similar diagnostic accuracy, treatment effectiveness, and patient satisfaction—while saving time, money, and effort.
The Past Five Years
Organizations like the American Psychiatric Association and other national medical organizations released guidelines during the past five years regarding the use, research, and policy implications of telepsychiatry and telemedicine.
The APA Committee on Telepsychiatry is currently provides guidelines and recommendations for use of telepsychiatry services. Check here for the official statement from APA.
The Interstate Medical Licensure Compact (IMLC) has shortened the wait time for medical doctors to obtain medical licenses in several participating states.
With governmental and medical organization support for its quick expansion and facilitation, telepsychiatry is now a well-established and approved avenue for psychiatric care.
Telepsychiatry Services for Patients
Asynchronous real-time audio-visual platforms can provide mental health treatment in various settings.
In-Home Telepsychiatry
In-home telepsychiatry entails providing mental health care to patients in their homes; telepsychiatry software can be utilized requires a computer, webcam, and internet connection. It is a practical approach for patients with restricted mobility or who reside in rural places to receive mental healthcare from the comfort of their homes. This technology has increased access to care for many patients in a significant way.
Crisis Telepsychiatry (Emergency Services)
Telepsychiatry is utilized for situations involving mental health crises. Crisis telepsychiatry provides urgent mental health consultation for patients with acute mental health conditions such as those who present to an emergency room or even in disaster settings.
Many emergency departments and mental health facilities are outsourcing emergency mental health care through telepsychiatry solutions due to a shortage of available psychiatrists in the United States.
Telepsychiatry solutions may provide less expensive, high-quality, easily accessible care.
Forensic Telepsychiatry
In forensic telepsychiatry, patients in jail or detention centers may receive mental health care through video visits. Using a telepsychiatry service, a psychiatrist might provide psychiatric examinations, followup visits, evaluations for parole, capacity evaluations, and more to prisoners.
As with any telemedicine, forensic telepsychiatry services can reduce medical expenses because inmates do not have to be transported to medical offices for psychiatric visits.
Efficacy of Telepsychiatry
Looking at the telepsychiatry studies, there is proof that it is effective for at least a few different conditions. Let us look at some data proving that telepsychiatry improves health outcomes.
PTSD (post-traumatic stress disorder): Frueh and colleagues tested the effectiveness of in-person (same-room) psychiatric therapies to telepsychiatric treatment for 14 weeks. When assessing progress at the 3-month point, they discovered no clinical variations between the two groups. Findings also revealed that patients in both groups had high satisfaction levels, and attendance and drop-out rates were identical.
Depression: Nelson and colleagues studied the effect of telepsychiatry on Child Depression Inventory scores for childhood depression. When comparing pre- and post-treatment scores, the results were encouraging, demonstrating a considerable overall reduction in symptoms.
Fortney and colleagues looked into an adult sample. They discovered that after a year, telepsychiatry patients in a tiered care model had better chances of being eligible for remission than same-room patients.
Anxiety: When used to treat anxiety-related diseases like panic disorder, telepsychiatric therapies have also shown promising results. An online self-help program combined with email-based therapy advice was found to have a modest to significant influence on improving anxiety symptoms in a randomized experiment involving 22 participants.
Applications
It is now efficiently employed for clinical services and educational initiatives. The growing shortage of board-certified psychiatrists and the deteriorating mental health crisis makes the use of telepsychiatry vital. Mental health facilities serve patients in urgent need of care and reduce wait times.
Telepsychiatry is practical;
- It increases access to care
- Facilitates specialty consultation
- Generates positive outcomes
- Enables trustworthy evaluation
- It has few negative interactional features
- Typically meets the needs of both patients and providers
- Improves education
A patient in a psychiatric crisis needs immediate medical attention and treatment to avoid risking their life. Consider the following scenarios, for instance:
- Acute Psychoses
- Mood disorders
- Severe Anxiety
- Panic Attacks
- Substance Abuse
- Or Withdrawal
- Suicidal Thoughts
Telepsychiatry Improved Access
Compared to alternative approaches, improved access can be one of the main advantages.
Strong evidence points to this as a developing trend because it can assist in removing various accessibility obstacles, such as:
Cost-Effective Choice: By providing a more cost-effective choice for service delivery, telepsychiatry and telemedicine significantly lower the overall cost burden for mental healthcare services. Telepsychiatry is becoming both more cost-effective and more widely available as more insurance companies start to cover this modality.
Quick And Secure Platform For Those In Need: Geographically, telepsychiatry reduces the time and expenses contributed to both regular therapy and crisis intervention, as was previously stated. The issue of getting psychiatric care to those in need, which continues to be one of the main obstacles in the healthcare system, can be quickly resolved by offering a secure platform for people to access and use
Reduces Stigma: Many people find it challenging to overcome the stigma associated with mental health. People are deterred from obtaining appropriate care by this shame, whether real or not. Telepsychiatry is an efficient answer as practitioners continue exploring methods to enhance service and delivery.
Myths And Facts About Telepsychiatry
Myth #1: Telemedicine’s purpose is to take the place of in-person care.
Actual fact: Remote consultations are not meant to take the place of traditional in-person care; rather, they are meant to augment it. Physical examination is usually necessary for some conditions. Digital consultations, however, can provide additional clinical capacity in cases where a GP practice has limited resources, and face-to-face appointments are few.
Additionally, remote appointments can free up face-to-face time for patients who truly need it, allowing them to receive the proper care in the appropriate setting. This is actually the truth for patients who have medical issues that do not require a physical appointment.
Myth #2: A positive doctor-patient connection cannot be established via telemedicine.
Actual Fact: The truth is that some patients reside in areas with poor GP-to-patient ratios or where there is a prolonged waiting time for an appointment. These patients appreciate the convenient service and high standard of treatment, and they have given positive feedback. Patients can also visit doctors with whom they have already communicated. Consequently, it is totally conceivable to develop a long-lasting doctor-patient relationship.
Myth #3: Patients who are treated remotely are subjected to a different level of care than those who are seen in person.
Actual Fact: The standard of care for telepsychiatry patients is the same as the standard of care for patients treated face-to-face, according to every state that has addressed the subject.
The Medical Board of California states that the same standard of care is provided whether a patient receives in-person care, telemedicine, or other forms of electronically enabled healthcare.
In conclusion, regardless of how communication is carried out, the law rules the practice of medicine, and the standard of care is the same in both cases.
Myth #4: The same medications can be prescribed when a patient is seen in person or through telepsychiatry.
Actual Fact: In reality, telepsychiatry prescriptions for controlled medications must adhere to strict guidelines. The Ryan Haight Act modified the federal Controlled Substance Act to require at least one in-person visit before prescribing controlled substances, with very few exceptions. The laws of several states are in line with those of the federal government.
For instance, the Rhode Island medical board is explicit and “particularly stresses that prescription restricted drugs without an established in-person physician-patient relationship is illegal.
Challenges in Telepsychiatry
Applications for telepsychiatry have encountered several serious obstacles, the most prominent of which are legal and ethical concerns around care responsibility, involvement in emergencies, confidentiality, confidentiality, and data protection.
One of the significant difficulties is in defining the obligations and responsibilities of the expert consultant who works at a location far from the patient.
The responsibility of care is a serious ethical issue that could be resolved using telepsychiatry using consulting services rather than therapy. Tasks that would be challenging to complete, including those in emergencies, are not directly accepted by the consultant. While doing so, they support the specialists who deliver primary care.
Clinicians highly advise protecting electronic data from unauthorized disclosure, whether stored, transferred, received, or destroyed. The information is stored, sent, received, or destroyed, all of which must be done safely.
An additional degree of defense against unauthorized monitoring, reading, and altering of electronic communications is offered by using software that encrypts email messages.
Final Words
Like other telemedicine specialties, telepsychiatry is quickly gaining internet popularity. Telepsychiatry is assisting an increasing number of people because it can help patients who are more challenging to reach or who would ordinarily be unable to pay for such services.
Telepsychiatry, according to research, is equally beneficial as in-person therapy and, for certain patients, may even be preferable. So, use telepsychiatry apps to get mental health services like counseling sessions, medication management, and condition diagnosis.
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