Telepsychiatry is one specialized form of telemedicine that uses a range of advanced technologies to diagnose and treat a range of mental health illnesses.

As technology advances, it is becoming an increasingly accepted means of directly managing clinical cases, conducting consultations, educating patients, and supervising those suffering from clinical mental issues.[1]

So, what counts, and what doesn’t count as telepsychiatry? Does it work? Is it private, safe, or practical? Keep reading to find out.

What is Telepsychiatry?

When it comes to mood, personality, behavioral, and psychotic disorders, many segments of the world’s population still face obstacles to professional care. These include, but aren’t limited to:

  • Scarcity of local psychiatric care providers;
  • Limited government resources to fund education, outreach programs, and mental initiatives;
  • Individual differences in the proclivity to seek treatment – often stemming from perceived social stigma, concerns around cost, and a lack of awareness around treatment options.

This is where telepsychiatry can play a hugely promising role for both patients and practitioners. With the ability to deliver remote, high-quality professional care for psychiatric issues, telepsychiatry (or telemental health) provides a great advantage for struggling mental health systems around the world.

A Definition

Telepsychiatry can be broadly defined as “the use of ICT to provide or support psychiatric services across distances”.[1]

From a patient perspective, it can involve a range of established medically-based treatments for mental illnesses, such as[2]:

  • Internet-based CBT
  • Structured clinical interviews
  • Medical evaluations
  • Group, relationship, and family therapies, and
  • Medication management

As a form of blended care, it covers a range of different synchronous and asynchronous modalities; providers can interact with patients in real-time or through non-live media such as email and text.

Perhaps the longest-standing form of telepsychiatry is telephone therapy, while more modern advances include videoconferencing, instant messaging, and internet-based care.[3]

Looking at the research, there is evidence in support of telepsychiatry’s efficacy for at least a few different conditions.

Is It Effective?

Looking at the research on telepsychiatry, there is evidence in support of its efficacy for at least a few different conditions. Let’s consider some of the evidence in support of telepsychiatry’s impact on health outcomes.

Reducing Symptoms

  • PTSD – Frueh and colleagues[4] compared the efficacy of in-person (same-room) psychiatric treatments against telepsychiatric therapy for 97 veterans, over the course of 14 weeks. They found no clinical differences between the two groups when comparing improvement at the-3 month mark. Findings also showed similarly strong satisfaction ratings between patients in both groups, with no difference in drop-out or attendance rates, either.
  • Depression – A study by Nelson and colleagues[5] examined the impact of telepsychiatry on childhood depression scores as measured by the Child Depression Inventory. Findings were promising, showing a significant overall reduction in symptoms when comparing pre- and post-treatment scores. Investigating an adult sample, Fortney and fellow researchers found that telepsychiatry patients within a stepped care model had higher odds of qualifying for remission compared to same-room patients after one year.[6]
  • Anxiety – Telepsychiatric treatments have also demonstrated positive impacts when used to treat anxiety-related disorders such as panic disorder.[7] In a randomized trial of 22 participants, a combination of internet-based self-help treatments and email-based therapist guidance were found to have a moderate to large impact on the improvement of anxiety symptoms.

Elsewhere in the literature, we can expect to see more results emerging as researchers begin to look into further into telepsychiatry – it’s efficacy, diagnostic reliability, and cost-effectiveness.

For now, it’s safe to say that there is at least a good amount of encouraging evidence regarding its ability to improve at least some symptoms of those suffering from diagnosed, mental health disorders.

Engagement and Satisfaction

Frueh et al.’s PTSD study[8], described above, also compared patient satisfaction while looking at the efficacy of telepsychiatry for PTSD.

Encouragingly, findings also showed similarly strong satisfaction ratings between patients in both groups, with no difference in drop-out or attendance rates, either. There was one notable drawback, however. This is that when interviewed, PTSD veterans who underwent face-to-face therapy for their condition did report feeling more comfortable discussing their issue with a therapist who was in the same room.

Elsewhere, meta-analytic data supports this.[9] While telepsychiatrists and patients both reported overall satisfaction with the treatment delivered and received, practitioners voiced concerns that it compromised the quality of therapeutic rapport. Clients, on the other hand, were less likely to vocalize such engagement concerns.

Telepsychiatry Pros and Cons

Curious about whether telepsychiatry is the solution that you’re looking for? Whether it’s cost-efficiency, flexible working hours, or greater practitioner reach, there are a few significant benefits that make it worth considering.

Compare these with the evidence-based downsides of telepsychiatry for an idea of whether it’s for you.

Pros

Cons

  • Telepsychiatry is more cost-effective than in-person treatment, according to data from over 450 studies.[9]
  • It may thus be a realistic option on a budget for both independent and state-funded providers to implement while providing a more financially viable treatment option for patients.[10]
  • As a flexible form of blended care, telepsychiatry gives practitioners location- and time-independence – sessions can be adapted to suit the convenience of both users and providers.[11]
  • Telepsychiatry enables patients to access evidence-based, specialized medical care for specific diagnoses and treatments that may not be otherwise accessible or available in their locale.[1]
  • As such, it can tackle or reduce mental health disparities by broadening the reach of mental health solutions to people in remote or rural areas, as well as those who to those living in less developed regions or those with otherwise limited access to treatment.[9]
  • Reduced burden on in-person mental health providers with fewer emergency or hospital trips through continued treatment and early diagnosis.[12]
  • Some providers may struggle to incorporate telepsychiatry into their existing practices – studies suggest one key barrier is difficulties with finding the right technology.[13][14]
  • On the whole, the serious nature of psychiatric treatments means practitioners must be somewhere reasonably close to the patient. Many providers may not be licensed to practice across state boundaries.[15]
  • Concerns with the security of medical data can arise when patient-practitioner communications take place over the internet – however, some of these can be mitigated by the use of HIPAA-compliant platforms, 3rd party-verified EMRs and EHRs, and regulated providers.

With growing demand for telehealth from the younger population and the rapidly increasing ubiquity of connected devices, it’s little wonder many clinical practitioners are looking to expand into telepsychiatry.

Before you expand your practice, here’s what we know to date about starting up with telepsychiatry.

Starting a Telepsychiatry Practice: Practitioner Advice

Starting a practice that totally or partially online offers all the flexibility and freedom of remote work, from flexible hours to helping patients from the privacy of home.

However, as with any telehealth practice, it involves considering a few key elements.

  1. Different telepsychiatry platforms offer different functionalities. These can range from basic telephone-based capacities to advanced, live, video conferencing platforms that support screen- and file-sharing with patients. You’ll need to consider how you plan to practice, what you’re willing to invest, and the learning curve involved in familiarizing yourself with the technology at hand.
  2. Different states have different laws regarding telemedicine and telehealth practices. This means, as a provider, you’ll need to check with a malpractice lawyer before offering any psychiatric services either within your state or across boundaries.[16]
  3. Not all telepsychiatry services are covered by Medicaid. Recent counts showed 48 states currently reimbursing patients for some telepsychiatry treatments, however, policies and regulations change regularly.[17] If your intention is to provide more cost-effective services to more patients, it is essential to find out which services you offer are covered by insurance and state funding.
  4. Mental health technologies provide different levels of personal interaction. What is your psychiatric specialty, and will your chosen platform ensure the necessary quality of contact, supervision, and care? Certain health services, such as prescriptions and medication management, are only supported by a limited number of platforms.[16]
  5. Are you comfortable with the idea of a remote therapeutic alliance? Strong therapeutic alliances develop when patients and physicians the latter can tailor their services to individual needs. If you are not comfortable with the idea of foregoing some non-verbal communication or with asynchronous modes of telepsychiatry, you may need to do a little more research before finding, downloading, or investing in a platform.[18][19]

For those after a more in-depth insider’s perspective, you may find this a useful article by one telepsychiatrist Dr. Knoedler: Telepsychiatry Basics: Setup, Sessions, and Pros and Cons.

Telepsychiatry Software To Consider

The following services and mental health software solutions offer different options for applying telepsychiatry.

ServiceDetails
On Call TelepsychiatryOnCall is a HIPAA-compliant virtual solution for healthcare providers, including individual practitioners and organizations.

It provides you with the tools to offer both video and instant messaging services for your online appointments and is Cloud-based to save you space.

OnCall allows you to Health system is easy for both patient and therapists to use and ensures all your sessions are carefully organized. Stay in charge of session scheduling, or let clients book. Opt for additional data for patient notes and information, and use the synced calendar system and appointment reminders for better office management of your telepsychiatry practice.

NameOnCall People
PriceOn Request
Good forPractice Management
Websitehttps://oncallpeople.com/
ServiceDetails
TheraNest TelepsychiatryEnter, edit, and store your telepsychiatry notes with HIPAA-compliant TheraNest, which also keeps your client information securely and lets you upload multimedia to client files.

As a practitioner with administrator access, you’ll also benefit from customer support, treatment plans, and more – this is a well-rated platform with a host of convenient search features.

Designed for psychologists, psychiatrists, and mental health practitioners, this e-clinic software offers all the essentials such as client scheduling and secure private messaging.

NameTheraNest
Price$38+ monthly
Good forClient Conferencing, Practice Management, Treatment Plans
Websitehttps://theranest.com/

App

Details

OnCallOnCall is a HIPAA-compliant virtual solution for healthcare providers, including individual practitioners and organizations.

It provides you with the tools to offer both video and instant messaging services for your online appointments and is Cloud-based to save you space.

OnCall allows you to Health system is easy for both patient and therapists to use and ensures all your sessions are carefully organized. Stay in charge of appointment scheduling, or let clients book. Opt for additional data for patient notes and information, and use the synced calendar system and appointment reminders for better office management of your telepsychiatry practice.

NameOnCall
PriceOn Request
Good ForPractice Management
Websitehttps://oncallhealth.us/

App

Details

TheraNestEnter, edit, and store your telepsychiatry notes with HIPAA-compliant TheraNest, which also keeps your client information securely and lets you upload multimedia to client files.

As a practitioner with administrator access, you’ll also benefit from customer support, treatment plans, and more – this is a well-rated platform with a host of convenient search features.

Designed for psychologists, psychiatrists, and mental health practitioners, it offers all the essentials such as client scheduling and secure private messaging.

NameTheraNest
Price$38+ monthly
Good ForClient Conferencing, Practice Management, Treatment Plans
Websitehttps://theranest.com/try-theranest/

App

Details

SimplePracticeGreat video is one of SimplePractice’s best features, and you’ll also find the invoicing, scheduling, and note management features highly useful.

Make appointments in a click, and stay in touch with teammates as well as clients with secure, HIPAA-compliant interactions.

SimplePractice boasts bank-level data encryption and makes it highly simple to add new clients with straightforward forms. The same applies to patient notes, saving you time and helping you streamline your work.

NameSimplePractice
Price$39+ monthly
Good ForPractice Management, Client Communications
Websitehttps://www.simplepractice.com/

App

Details

DrEHR TelepsychiatryDrChrono is a powerful practice management tool that allows simple online scheduling and private, HIPAA-compliant video calls.

Appointment notifications, dedicated patient portals, clinical workflows, and built-in invoicing are a few of the convenient practitioner features.

You’ll also find specialized clinical tools such as medical forms, custom vital tracking, and more, such as a paperless, self-check-in kiosk and digital consent forms.

NameDrChrono EHR
Price$199+ monthly
Good ForPractice Management, Client Communications
Websitehttps://www.drchrono.com/

Final Thoughts

Telepsychiatry, like other areas of telemedicine, is rapidly becoming hugely popular online. With the ability to provide aid to those more out of the way patients, or those who would normally be unable to afford such services, telepsychiatry is helping an ever-greater number of people.

However, there’s a lot to be considered before starting a remote psychiatric practice or even incorporating telepsychiatry into your existing services. So, as you begin your research for the right platform, keep in mind all the issues that can arise. Find yourself a top-quality software program to use and make sure to abide by any state laws to protect, not only your clients but yourself as well.

What are your experiences with telepsychiatry? Have you looked into the research, or even delivered consultations, diagnoses, or treatments as part of your blended care practice? Why not leave us a comment and tell us about it below?

References

  1. ^ Malhotra, S., Chakrabarti, S., & Shah, R. (2013). Telepsychiatry: Promise, potential, and challenges. Indian Journal of Psychiatry, 55(1), 3.
  2. ^ American Psychiatric Association. (2020). What is Telepsychiatry? Retrieved from https://www.psychiatry.org/patients-families/what-is-telepsychiatry
  3. ^ Chakrabarti, S. (2015). Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World Journal of Psychiatry, 5(3), 286.
  4. ^ Frueh, B. C., Monnier, J., Yim, E., Grubaugh, A. L., Hamner, M. B., & Knapp, R. G. (2007). A randomized trial of telepsychiatry for post-traumatic stress disorder. Journal of Telemedicine and Telecare, 13(3), 142-147.
  5. ^ Nelson, E. L., Barnard, M., & Cain, S. (2003). Treating childhood depression over videoconferencing. Telemedicine Journal and E-health, 9(1), 49.
  6. ^ Fortney, J. C., Pyne, J. M., Mouden, S. B., Mittal, D., Hudson, T. J., Schroeder, G. W., & Rost, K. M. (2013). Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. American Journal of Psychiatry, 170(4), 414.
  7. ^ Carlbring, P., Ekselius, L., & Andersson, G. (2003). Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy and Experimental Psychiatry, 34(2), 129.
  8. ^ Frueh, B. C., Monnier, J., Yim, E., Grubaugh, A. L., Hamner, M. B., & Knapp, R. G. (2007). A randomized trial of telepsychiatry for post-traumatic stress disorder. Journal of Telemedicine and Telecare, 13(3), 142.
  9. ^ Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telepsychiatry outcomes. World Journal of Psychiatry, 6(2), 269.
  10. ^ Butler, T. N., & Yellowlees, P. (2012). Cost analysis of store-and-forward telepsychiatry as a consultation model for primary care. Telemedicine and e-Health, 18(1), 74.
  11. ^ Knoedler, D. (2014). Telepsychiatry Basics: Setup, Sessions, and Pros and Cons. Retrieved from https://www.psychiatrictimes.com/couch-crisis/telepsychiatry-basics-setup-sessions-and-pros-and-cons/page/0/1
  12. ^ Davies, S. F. (2012). A hospital driven telepsychiatry initiative to improve patient care and reduce costs. Mental Health, 73(3), 228.
  13. ^ Sinclair, C., Holloway, K., Riley, G., & Auret, K. (2013). Online mental health resources in rural Australia: clinician perceptions of acceptability. Journal of Medical Internet Research, 15(9), e193.
  14. ^ Gillis, G. (2015). Exploring the views of emergency department staff on the use of videoconferencing for mental health emergencies in southwestern Ontario. Global Telehealth 2015: Integrating Technology and Information for Better Healthcare, 209, 114.
  15. ^ APA. (2013). Telepsychology 50-state Review. Retrieved from https://www.apaservices.org/practice/advocacy/state/telehealth-slides.pdf
  16. ^ Deslich, S., Stec, B., Tomblin, S., & Coustasse, A. (2013). Telepsychiatry in the 21st century: transforming healthcare with technology. Perspectives in Health Information Management/AHIMA, 10(Summer), 1.
  17. ^ American Psychiatric Association. (2020). What is Telepsychiatry?. Retrieved from https://www.psychiatry.org/patients-families/what-is-telepsychiatry
  18. ^ King, A., & Hoppe, R. B. (2013). “Best practice” for patient-centered communication: a narrative review. Journal of Graduate Medical Education, 5(3), 385.
  19. ^ Toh, N., Pawlovich, J., & Grzybowski, S. (2016). Telehealth and patient-doctor relationships in rural and remote communities. Canadian Family Physician, 62(12), 961.

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