Telepsychiatry refers to the use of telehealth tools in providing mental health assistance to patients. Recently a panel of psychiatrists from fifteen different countries developed a practical and clinically useful protocol to assist mental health providers when dealing with telemental health.
The American Psychiatric Association (APA) updated its toolkit with guidance on clinical considerations, administrative and technical requirements for software issues, and reimbursement related to telepsychiatry.
Mental Health care is a sensitive subject. It has to be adequately monitored for the psychiatric standard of care to stay high and for patients and public health to benefit from these new means of delivering psychiatric services.
History of telepsychiatry
Remote psychiatric care is far from new. In the late 1950s, the Nebraska clinic already used video conferencing for group therapy and trained students remotely. In 1969, when telemedicine started, the Massachusetts General Hospital (MGH) offered psychiatric consultations to patients from a Logan International Airport healthcare clinic.
To ease access to care in rural areas or remote regions is where Telehealth shines. Undoubtedly, with the development of the Internet, remote primary care and mental health appointments increased dramatically in Australia during the 1990s.
Even though the APA was a slow adopter of telepsychiatry, the 2000s saw Best Practices in Videoconferencing-Based Telemental Health adopted by both the APA and the American Telemedicine Association (ATA), with the latest version being adopted in the spring of 2018.
Telemedicine to treat mental illnesses proved beneficial in increasing access to appropriate mental health care, significantly decreasing costs. Concerns about reimbursement, licensure, privacy, security, patient safety, and interoperability are part of the challenges that must be overcome to provide efficient patient care.
Covid-19 imposed constraints on the healthcare system and paved the way for the widespread use of Telehealth. What were the lessons learned in 2020, and how do they apply to the future of remote mental care?
Telepsychiatry during Covid-19 times
During the Covid-19 pandemic, numerous regulations were loosened in response to a mounting surge in mental and behavioral health care needs. The APA requires the Centers for Medicare and Medicaid Services (CMS) to relax the video requirement for telepsychiatry delivery.
CMS has loosened requirements so that individuals receiving Medicaid and Medicare can use telemedicine to link health care; however, vulnerable individuals, particularly the elderly and those with serious mental illness, continue to face technological obstacles to access care. They include the lack of required video technology or living in areas without reliable broadband access.
According to a survey conducted in the United-States by the Bio-Pharmaceutical company Alkermes, 27% of respondents used telepsychiatry to access mental health care. Further, 74% of current telepsychiatry users expressed interest in continuing these services after the pandemic in favor of face to face consultation. This impressive ratio shows high patient satisfaction.
Many of the regulation constraints were lifted, such as the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. This act placed restrictions on the delivery of controlled substance prescriptions via videoconferencing or the need for psychiatrists to be licensed in the state of the telepsychiatry appointment.
Is there a future for telepsychiatry after the pandemic?
The recent changes in Telehealth regulations in response to COVID-19 have been groundbreaking. The unknown element relies on the sustainability of the changes relative to prescription, licensure, and reimbursement once the COVID-19 emergency declaration end.
More than a replacement, remote mental consultations may integrate into a more global framework combining in-person and digital Telehealth consultations. The existing guidelines do not explicitly cover the use of such a hybrid model.
Furthermore, models predict that the COVID Pandemic Could Lead to 75,000 Additional Deaths from Alcohol and Drug Misuse and Suicide. Virtual mental care proved safe and comparable to in-person visits. Psychological or psychiatric disorders are highly private hence the need for HIPAA compliant platforms.
Telehealth services such as Healthsapiens offer unlimited counseling solutions that could be an excellent first step before consulting more clinical services. Always, what we need is a helping ear to go through the day and just provide advice rather than treatments,
The need for mental consultation has never been so pregnant, and policymakers will have to manage the current conditions and the future ones for Telehealth in general and telepsychiatry, in particular, to fit its right place in an integrated model of care.