Telepsychiatry

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing.[1] Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. Most commonly, telepsychiatry encounters take place at medical facilities under the supervision of onsite staff, though at-home models are becoming accepted[2] as long as they are in compliance with HIPAA standards.

One of the drivers behind telepsychiatry's growth in the United States has been a national shortage of psychiatrists, particularly in specialty areas such as child and adolescent psychiatry;[3] telepsychiatry can allow fewer doctors to serve more patients by improving utilization of the psychiatrist's time. Telepsychiatry can also make it easier for psychiatrists to treat patients in rural or under-served areas by eliminating the need for either party to travel. The most common means of insurance coverage for telehealth services among the United States is to incorporate coverage into the Medicare program. Reimbursement for Medicare-covered services must satisfy federal requirements of efficiency, economy and quality of care. Since 1999, Medicare and Medicaid reimbursement for all kinds of telehealth services have expanded, requirements of providers have been reduced, and grants have been given to support telehealth program adoption. For 2014, the Center for Medicare (CMS) services does cover telemedicine services, including telepsychiatry in many areas.

Sub-specialties

Telepsychiatry includes a variety of sub-specialties based on different contexts of service delivery.

Home-based telepsychiatry

Psychiatric treatment of patients who are at home or in another private setting is called home-based telepsychiatry or direct-to-consumer telepsychiatry, and it can require only a webcam and high-speed internet service.[4] The growth in home-based telepsychiatry is attributed to a shortage of psychiatrists and the ability to reach people in rural areas.[5] The telepsychiatrist needs to consider several factors before starting treatment. They must receive informed consent and guarantee that the use of telepsychiatry is safe for the patient, use secure videoconferencing platforms compliant with HIPAA in order to protect the patient's privacy and provide the same standard of care as in a traditional office.[5] Telepsychiatry produces similar treatment outcomes and has similar reliability of diagnosis compared to face-to-face therapy.[6][7] Patient satisfaction with telepsychiatry is generally high, although providers report lower levels of satisfaction than patients.[6] Despite a higher up-front cost, telepsychiatry is more cost-effective in the long run due to savings in travel expenses.[6]

Forensic telepsychiatry

Forensic telepsychiatry is the use of a remote psychiatrist or nurse practitioner for psychiatry in a prison or correctional facility, including psychiatric assessment, medication consultation, suicide watch, pre-parole evaluations and more. Telepsychiatry can deliver significant cost savings to correctional facilities by eliminating the need for prisoners to be escorted to off-site appointments and psychiatric interventions.[8]

On-demand telepsychiatry

As of 2008, guidelines are being developed for the provision of telepsychiatric consultation for emergency psychiatric patients, such as the evaluation of suicidal, homicidal, violent, psychotic, depressed, manic, and acutely anxious patients.[9] However, emergency telepsychiatry services are already being provided to hospital emergency departments, jails, community mental health centers, substance abuse treatment facilities, and schools. Emergency telepsychiatry can ease staff shortages in overworked hospital emergency departments and increase patient throughput and ED disposition. Rather than employ expensive, short-term locum tenens doctors or have emergency department physicians evaluate the psychiatric stability of their patients, hospitals can use telepsychiatry to decrease costs and increase patient access to behavioral health evaluations by psychiatric specialists.[10]

Crisis telepsychiatry is also an efficient means of reducing the need for psychiatric boarding. Psychiatric boarding is when a mentally ill resident is detained, often in a hospital emergency department, while waiting for proper psychiatric treatment.[11] With the increased throughput offered by telepsychiatry, psychiatric consumers enjoy reduced wait times and faster access to care.

Scheduled Telepsychiatry

Many facilities that offer behavioral health care are turning to telepsychiatry providers to allow for an increased care capacity. With routine telepsychiatry, a consistent provider or small group of providers serve a regular caseload of consumers in previously scheduled blocks of time. Remote providers can be consulted for medication management, treatment team meetings, supervision, or to offer traditional psychiatric assessment and consultations.

Having access to remote providers allows facilities, especially those in rural areas that struggle to recruit and maintain providers, access to a greater variety of speciality care to offer their consumers. For example behavioural therapy is an effective treatment for tics in children but many can not access this service due to a lack of professionals. Offering an online, self-guided but therapist-supported intervention can be effective in reducing tics and could allow more people to receive care.[12][13][14]

Facilities that use routine telepsychiatry include:

Community Mental Health Centers (CMHCs) Outpatient clinics Federally Qualified Health Centers (FQHCs) Universities and Schools Residential Programs Nursing Homes Accountable Care Organizations (ACOs) Substance Use Treatment Centers Military Bases

HIPAA compliance in the United States

HIPAA (the Health Insurance Portability and Accountability Act) is a United States federal law that establishes security and privacy standards for electronic medical information exchange, including telemental health services. In order to comply with HIPAA guidelines, many providers develop their own specialized videoconferencing services, since common third-party consumer solutions do not include sufficient security and privacy safeguards. There are also a growing number of HIPAA-compliant technologies available for telepsychiatry.[15]

In India

India's large population and relatively small number of psychiatrists makes telepsychiatric service a good option for expanding access to mental health care. Telepsychiatry in India is still a young industry, but it is gradually growing, led by institutes such as the Post Graduate Institute of Medical Education and Research in Chandigarh[16] and the Schizophrenia Research Foundation in Chennai.[17]

In the UK

The NHS has been slow at recognising the merits of telepsychiatry, perhaps because the regional set up of the NHS makes the provision non-location based virtual service difficult for the bureaucracy of a state owned model to implement, though there are now some NHS Mental Health Trusts such as Oxford NHS Foundation Trust who are starting to see the cost benefits and to set up services. There is a UK based group of consultant psychiatrists, Psychiatry-UK LLP, working in a chamber model, providing a national telepsychiatry service. They are registered with the Care Quality Commission as a qualified provider of medical services to the NHS and can be found on the NHS Choices website. they are now seeing NHS patients as well as patients who self fund or who have suitable health insurance.

See also

References
  1. "Telepsychiatry". American Psychiatric Association. Retrieved 7 August 2013.
  2. Hoffman, Jan (23 September 2011). "When Your Therapist Is Only a Click Away". New York Times. Retrieved 7 August 2013.
  3. Lieberman, Jeffrey A. (2 September 2010). "Psychiatric Care Shortage: What the Future Holds". Medscape. Retrieved 7 August 2013.
  4. Ikelheimer, Douglas M. (2008). "Treatment of Opioid Dependence via Home-Based Telepsychiatry". Psychiatric Services. 59 (10): 1218. doi:10.1176/appi.ps.59.10.1218-a. Retrieved 7 August 2013.
  5. Kristen Lambert; Moira Wertheimer (2016-02-01). "Telepsychiatry: Who, What, Where, and How". Psychiatric News. doi:10.1176/appi.pn.2016.2a13.
  6. Hubley, Sam; Lynch, Sarah B; Schneck, Christopher; Thomas, Marshall; Shore, Jay (2016). "Review of key telepsychiatry outcomes". World Journal of Psychiatry. 6 (2): 269. doi:10.5498/wjp.v6.i2.269. ISSN 2220-3206. PMC 4919267. PMID 27354970.
  7. Hilty, Donald M.; Sunderji, Nadiya; Suo, Shannon; Chan, Steven; McCarron, Robert M. (2018-11-02). "Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies". International Review of Psychiatry. 30 (6): 292–309. doi:10.1080/09540261.2019.1571483. ISSN 0954-0261. PMID 30821540.
  8. Miller, T. W.; Burton, D. C.; Hill, K.; Luftman, G; Veltkempf, L. J.; Swope, M. (2005). "Telepsychiatry: critical dimensions for forensic services". Journal of the American Academy of Psychiatry and the Law. 33 (4): 539–546. PMID 16394233.
  9. Shore JH; Hilty, D.M.; Yellowlees, P. (2007). "Emergency Management Guidelines For Telepsychiatry". General Hospital Psychiatry. 29 (3): 199–206. doi:10.1016/j.genhosppsych.2007.01.013. PMC 1986661. PMID 17484936.
  10. Williams, Mike; Pfeffer, Michael; Boyle, Juliana; Hilty, Donald M. (December 2009). "Telepsychiatry in the Emergency Department: Overview and Case Studies" (PDF). California HealthCare Foundation. Archived from the original (PDF) on 1 November 2013. Retrieved 7 August 2013.
  11. title=Alleviate Psychiatric Boarding in Washington with Telepsychiatry | author=James Varrell, MD| source=Insight Bulletin http://insightbulletin.com/alleviate-psychiatric-boarding-in-washington-with-telepsychiatry/
  12. "Children with tics can be helped by a new online treatment". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2022-03-04. doi:10.3310/alert_49151.
  13. Hollis C, Hall CL, Jones R, Marston L, Novere ML, Hunter R, et al. (October 2021). "Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial". The Lancet. Psychiatry. 8 (10): 871–882. doi:10.1016/S2215-0366(21)00235-2. PMC 8460453. PMID 34480868.
  14. Khan K, Hollis C, Hall CL, Davies EB, Murray E, Andrén P, et al. (31 August 2022). "Factors influencing the efficacy of an online behavioural intervention for children and young people with tics: Process evaluation of a randomised controlled trial". Journal of Behavioral and Cognitive Therapy. 32 (3): 197–206. doi:10.1016/j.jbct.2022.02.005.
  15. Comparison of Telemental Health Technologies
  16. "Telemedicine Centre". PGIMER, Chandigarh. Retrieved 10 November 2013.
  17. "Tele Medicine". Scarf India. Retrieved 10 November 2013.

Further reading
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