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.[3] The growth in home-based telepsychiatry is attributed to a shortage of psychiatrists and the ability to reach people in rural areas.[4] 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 in order to protect the patient's privacy and provide the same standard of care as in a traditional office.[4] Telepsychiatry produces similar treatment outcomes and has similar reliability of diagnosis compared to face-to-face therapy.[5][6] Patient satisfaction with telepsychiatry is generally high, although providers report lower levels of satisfaction than patients.[5] Despite a higher up-front cost, telepsychiatry is more cost-effective in the long run due to savings in travel expenses.[5]

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.[7]

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.[8] 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.[9]

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.[10] With the increased throughput offered by telepsychiatry, psychiatric consumers enjoy reduced wait times and faster access to care.

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.[11][12][13]

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;[14] telepsychiatry can allow fewer doctors to serve more patients by improving utilization of the psychiatrist's time. 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.

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]

According to a Kaiser Family Foundation and Epic Research database of electronic health records, 40% of mental health and substance abuse visits in the United States were conducted by telehealth in 2021 (as compared with only 5% of all other outpatient care visits and virtually no mental health and substance abuse visits being conducted by telehealth prior to the COVID-19 pandemic), while more than 150 million Americans lived in designated healthcare shortage areas for mental health professionals by the Health Resources and Services Administration in 2022.[16][17]

Since the passage of the Infrastructure Investment and Jobs Act in November 2021, the telehealth industry in the United States has expanded due to its $65 billion appropriation for broadband internet access expansion,[18][19] and online mental health start-up companies saw a $4.8 billion increase in investment in 2022 according to Rock Health.[17]

Digital advertising spending by telehealth companies increased from approximately $10 million in 2020 to $100 million in 2021 (while $23 million in telehealth digital advertising was spent on TikTok alone from January to November 2022). In December 2022, The Wall Street Journal published an analysis it conducted in October and November of that year of telehealth digital advertisements that found that 20 companies ran more than 2,100 advertisements on Facebook and Instagram that described prescription drug benefits without citing risks (including for ketamine and testosterone), that promoted unapproved usages of drugs, or that featured testimonials without disclosing the speaker's relationship with the company, while 15 telehealth companies ran more than 1,800 other social media advertisements without prescription drug warnings or risks (including at least 800 that promoted controlled substances).[20]

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[21] and the Schizophrenia Research Foundation in Chennai.[22]

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.