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?

Mental health problems as well as behavioral problems like anxiety, depression and drug use, are reported to be one of the primary drivers when it comes to disability worldwide, causing over 40 million years of disability in those in the 20-29-year-old age range.[2]

Research also indicates that one out of every six people in the past week experienced some type of common mental health problem, with major depression surmised to be the second leading cause of disability across the world and a significant contributor to the burden and risk of suicide as well as ischemic heart disease.[3][4]

When it comes to mood, personality, behavioral, and psychotic disorders, then, poor treatment accessibility is a significant concern for healthcare practitioners.

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[5]:

  • Internet-based CBT
  • Structured clinical interviews
  • Medical evaluations
  • Psychiatric evaluation
  • e-therapy sessions
  • Individual or group therapy
  • Patient education
  • Review of medical images or similar type of information
  • 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.[6]

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

Types of Telepsychiatry

There are different types of telepsychiatry.

Some of these include:

  1. In-home telepsychiatry
  2. Crisis telepsychiatry
  3. Forensic telepsychiatry, and
  4. Routine telepsychiatry.

In-home telepsychiatry is most likely what you think of when you hear this term. This involves offering psychiatric services and mental health care for those at home, via video chat, or other methods.

Most of the time, the only equipment needed on the patient’s end is a computer, a webcam, and an Internet connection.

Crisis telepsychiatry involves immediate service and responses when it comes to handling a mental health crisis.

This might involve individuals in need of immediate care, those who are suicidal, violent, manic, or severely anxious. This could also be helpful for anyone suffering from an acute panic attack.

Forensic telepsychiatry involves providing mental health care services for those in prison or those in correctional facilities. A psychiatrist could utilize this type of platform for performing regular psychiatric assessments; evaluations for parole, and for providing psychiatric care to inmates in a safe manner. Another benefit to this type of service is the reduced cost and the advantage of not having to transport a prisoner off-site.

Routine solutions are most likely the most significant piece of this type of service. Routine solutions might involve a mental health facility merely wanting to increase their volume or providing a way to outsource mental health services. This could also be beneficial for places where mental health is understaffed.

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[7] 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[8] 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.[9]
  • Anxiety – Telepsychiatric treatments have also demonstrated positive impacts when used to treat anxiety-related disorders such as panic disorder.[10] 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[11], 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.[12] 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.[12]
  • 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.[13]
  • 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.[14]
  • 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.[12]
  • Reduced burden on in-person mental health providers with fewer emergency or hospital trips through continued treatment and early diagnosis.[15]
  • Like e-counseling or online therapy, telepsychiatry can result in fewer delays when providing mental health services, as well as improved continuity of care for follow-up work.
  • Some people don’t feel comfortable seeking mental health care or visiting a formal office, and certain client groups may also be more inclined to express themselves when compared to a more traditional setting openly. By removing the need for patients to turn up in person at a surgery, it can decrease the perceived stigma around receiving mental health care.
  • Some providers may struggle to incorporate telepsychiatry into their existing practices – studies suggest one key barrier is difficulties with finding the right technology.[16][17]
  • 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.[18]
  • 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.

Telepsychiatry and Improved Access

The issue of improved access may be one of the best benefits overall when compared to other methods.

There is strong evidence to suggest this a growing trend as this type of practice can help overcome many of the barriers to accessibility, including:

  1. Economics:  Modalities like telepsychiatry and telemedicine significantly reduce the overall cost burden for mental healthcare services by offering an affordable option when it comes to delivering service. As increasingly more insurance plans begin covering this modality, telepsychiatry is becoming both affordable and accessible.
  2. Geography: As noted, telepsychiatry reduces the additional time and expenses associated with both standard treatment and crisis intervention. Getting psychiatric care to those who need it remains one of the biggest roadblocks in the healthcare system, so providing a secure platform for people to access and utilize can quickly solve this problem.
  3. Stigma: The stigma that surrounds mental health is a big obstacle for many to overcome. This stigma, whether imagined or not, discourages people from seeking proper care. As practitioners continue looking for ways to improve service and delivery, telepsychiatry is a highly viable solution.

In a Nutshell

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 is 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.[19]
  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.[20] 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.[19]
  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.[21][22]

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

Many telepsychiatry platforms are multi-functional. They offer features supporting interactions between psychiatrists, primary care providers, and other healthcare providers, as well as medical and practice management functions.

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/

App

Details

eVisit TelehepsychiatryThis HIPAA-compliant platform connects mental health providers with patients to provide high-quality remote care.

It has an intuitive, user-friendly interface, allowing physicians to review a patient’s personal information, history, pharmacy preferences, insurance details, and health records.

Average visits are estimated to save 30-45 minutes per visit, a significant cost saving overall.

NameeVisit
Price$600+ monthly
Good ForClient Communications, EMR/EHR integration, Practice Management, e-Prescriptions
Websitehttps://evisit.com/

App

Details

Mend TelepsychiatryThe Mend platform is another HIPAA-secure telemedicine platform. It has robust reporting as well as patient management features.

It offers SMS appointment reminders, digital intake and other forms, integrated patient self-scheduling, and a 99% connection rate. There are no downloads to connect to the platform, and the software is easy to install.

The software is compatible with all top devices as well.

NameMend
Price$49+ monthly per practitioner
Good ForClient Communications, EMR/EHR integration, Practice Management
Websitehttps://www.mendfamily.com/leading-telemedicine-lp/

App

Details

OnCall TelepsychiatryThe OnCall Health Platform is a cloud-based virtual care solution. It is also HIPAA-compliant, providing one-on-one and group video, instant messaging, and a practice automation tool.

OnCall also provides an appointment calendar, a patient roster, digital files, analytics dashboard, and booking software.

This software is ideal for solo practitioners, and offers a comprehensive white label option, which can be added to your web, Android, and IOS devices.

NameOnCall
Price$49+ monthly
Good ForClient Communications, EMR/EHR integration, Medical Billing, Practice Management
Websitehttps://get.oncallhealth.ca/

App

Details

ContinuousCare TelepsychiatryThe ContinuousCare app provides a white-label platform, utilizable under your own brand.

The software includes a mobile app, telemedicine, and remote care plans for those with chronic conditions.

Also included are practice management, a branded patient portal, and the ability to create a website with a unique domain name.

NameContinuousCare
Price$5+ monthly
Good ForClient Communications, EMR/EHR integration, e-Prescriptions, Practice Management
Websitehttps://www.continuouscare.io/telemedicine-software/

App

Details

WiCis TelepsychiatryThe WiCis CareFlows platform is a HIPAA compliant telehealth platform designed for hospitals, surgery centers as well as solo practices. The platform offers solutions for those with chronic conditions and provides psychiatric evaluations.

The platform is a fully configurable white label telemedicine solution that allows you to brand it as your own.

Some of the features offered include widgets for scheduling, videoconferencing, and remote vital sign monitoring.

NameWiCis CareFlows
Price$100 monthly per user
Good ForClient Communications, EMR/EHR, Medical Billing, e-Prescriptions, Practice Management
Websitehttp://unbouncepages.com/wicis-telehealth-solutions/

App

Details

PatientClick TelepsychiatryPatientClick is a telemedicine platform that provides easy to use, secure televisits.

Features offered include an integrated EMR, eRx, patient scheduling, patient portal, push notifications, and more. You can also customize your PatientClick with unlimited encounter note templates, forms, and reports.

NamePatientClick
PriceAvailable on request
Good ForClient Communications, EMR/EHR, e-Prescriptions, Practice Management
Websitehttp://patient-click.com/telemedicine-software/

App

Details

InSync EMR TelepsychiatryThe InSync EMR software has many benefits, including EMR practice management, revenue cycle management, and a fully integrated cloud-based healthcare IT solution.

The platform is specially designed for behavioral health practices, and it offers group therapy, constructs care plans, and a wide selection of assessment tools.

NameInSync EMR
PriceAvailable on request
Good ForClient Communications, e-Prescriptions, Practice Management, EMR/EHR,
Websitehttps://www.insynchcs.com/

App

Details

Secure Telehealth TelepsychiatrySecure Telehealth is another good solution. The software provides video conferencing on Mac’s and PC’s as well as mobile devices and is HIPAA-compliant.

Features and benefits include a virtual meeting room, which can be used in any number of facilities, a virtual waiting room and facilitates workflow between doctors and patient locations.

NameSecure Telehealth
PriceAvailable on request
Good ForClient Communications
Websitehttps://securetelehealth.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. ^ Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., ... & Aboyans, V. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2095.
  3. ^ McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.
  4. ^ Whiteford, H. A. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575.
  5. ^ American Psychiatric Association. (2020). What is Telepsychiatry? Retrieved from https://www.psychiatry.org/patients-families/what-is-telepsychiatry
  6. ^ Chakrabarti, S. (2015). Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World Journal of Psychiatry, 5(3), 286.
  7. ^ 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.
  8. ^ Nelson, E. L., Barnard, M., & Cain, S. (2003). Treating childhood depression over videoconferencing. Telemedicine Journal and E-health, 9(1), 49.
  9. ^ 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.
  10. ^ 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.
  11. ^ 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.
  12. ^ Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telepsychiatry outcomes. World Journal of Psychiatry, 6(2), 269.
  13. ^ 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.
  14. ^ 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
  15. ^ Davies, S. F. (2012). A hospital driven telepsychiatry initiative to improve patient care and reduce costs. Mental Health, 73(3), 228.
  16. ^ 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.
  17. ^ 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.
  18. ^ APA. (2013). Telepsychology 50-state Review. Retrieved from https://www.apaservices.org/practice/advocacy/state/telehealth-slides.pdf
  19. ^ 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.
  20. ^ American Psychiatric Association. (2020). What is Telepsychiatry?. Retrieved from https://www.psychiatry.org/patients-families/what-is-telepsychiatry
  21. ^ King, A., & Hoppe, R. B. (2013). “Best practice” for patient-centered communication: a narrative review. Journal of Graduate Medical Education, 5(3), 385.
  22. ^ 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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