Evidence-Based Reviews

Telepsychiatry: What you need to know

Current Psychiatry. 2020 June;19(6):16-23 | doi:10.12788/cp.0001

Bradford Frank, MD, MPH, MBA

Thomas Peterson, MD

Sanjay Gupta, MD

Timothy Peterson, MD

Evidence suggests that this tool is effective, cost-efficient, and well-accepted.

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References

1. Spivak S, Spivak A, Cullen B, et al. Telepsychiatry use in U.S. mental health facilities, 2010-2017. Psychiatr Serv. 2019;71(2):appips201900261. doi: 10.1176/appi.ps.201900261.
2. Reliford A, Adebanjo B. Use of telepsychiatry in pediatric emergency room to decrease length of stay for psychiatric patients, improve resident on-call burden, and reduce factors related to physician burnout. Telemed J E Health. 2019;25(9):828-832.
3. Mathiasen K, Riper H, Andersen TE, et al. Guided internet-based cognitive behavioral therapy for adult depression and anxiety in routine secondary care: observational study. J Med Internet Res. 2018;20(11):e10927. doi: 10.2196/10927.
4. Waugh M, Calderone J, Brown Levey S, et al. Using telepsychiatry to enrich existing integrated primary care. Telemed J E Health. 2019;25(8):762-768.
5. Swanson CL, Trestman RL. Rural assertive community treatment and telepsychiatry. J Psychiatr Pract. 2018;24(4):269-273.
6. Gentry MT, Lapid MI, Rummans TA. Geriatric telepsychiatry: systematic review and policy considerations. Am J Geriatr Psychiatry. 2019;27(2):109-127.
7. Christensen LF, Moller AM, Hansen JP, et al. Patients’ and providers’ experiences with video consultations used in the treatment of older patients with unipolar depression: a systematic review. J Psychiatr Ment Health Nurs. 2020;27(3):258-271.
8. Marcus S, Malas N, Dopp R, et al. The Michigan Child Collaborative Care program: building a telepsychiatry consultation service. Psychiatr Serv. 2019;70(9):849-852.
9. Kaye DL, Fornari V, Scharf M, et al. Description of a multi-university education and collaborative care child psychiatry access program: New York State’s CAP PC. Gen Hosp Psychiatry. 2017;48:32-36.
10. Larson JL, Rosen AB, Wilson FA. The effect of telehealth interventions on quality of life of cancer patients: a systematic review and meta-analysis. Telemed J E Health. 2018;24(6):397-405.
11. Peter L, Reindl R, Zauter S, et al. Effectiveness of an online CBT-I intervention and a face-to-face treatment for shift work sleep disorder: a comparison of sleep diary data. Int J Environ Res Public Health. 2019;16(17):E3081. doi: 10.3390/ijerph16173081.
12. LaBelle B, Franklyn AM, Pkh Nguyen V, et al. Characterizing the use of telepsychiatry for patients with opioid use disorder and cooccurring mental health disorders in Ontario, Canada. Int J Telemed Appl. 2018;2018(3):1-7.
13. Fortney JC, Heagerty PJ, Bauer AM, et al. Study to promote innovation in rural integrated telepsychiatry (SPIRIT): rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics. Contemp Clin Trials. 2020;90:105873. doi: 10.1016/j.cct.2019.105873.
14. Weiner S. Addressing the escalating psychiatrist shortage. AAMC. https://www.aamc.org/news-insights/addressing-escalating-psychiatrist-shortage. Published February 12, 2018. Accessed May 14, 2020.
15. American Psychiatric Association. What is telepsychiatry? https://www.psychiatry.org/patients-families/what-is-telepsychiatry. Published 2017. Accessed May 14, 2020.
16. Yilmaz SK, Horn BP, Fore C, et al. An economic cost analysis of an expanding, multi-state behavioural telehealth intervention. J Telemed Telecare. 2019;25(6):353-364.
17. Bashshur RL, Shannon GW, Bashshur N, et al. The empirical evidence for telemedicine interventions in mental disorders. Telemed J E Health. 2016;22(2):87-113.
18. Lopez A, Schwenk S, Schneck CD, et al. Technology-based mental health treatment and the impact on the therapeutic alliance. Curr Psychiatry Rep. 2019;21(8):76.
19. Schubert NJ, Backman PJ, Bhatla R, et al. Telepsychiatry and patient-provider concordance. Can J Rural Med. 2019;24(3):75-82.
20. Hubley S, Lynch SB, Schneck C, et al. Review of key telepsychiatry outcomes. World J Psychiatry. 2016;6(2):269-282.
21. Mayworm AM, Lever N, Gloff N, et al. School-based telepsychiatry in an urban setting: efficiency and satisfaction with care. Telemed J E Health. 2020;26(4):446-454.
22. Christensen LF, Gildberg FA, Sibbersen C, et al. Videoconferences and treatment of depression: satisfaction score correlated with number of sessions attended but not with age [published online October 31, 2019]. Telemed J E Health. 2019. doi: 10.1089/tmj.2019.0129.
23. Christensen LF, Gildberg FA, Sibbersen C, et al. Disagreement in satisfaction between patients and providers in the use of videoconferences by depressed adults. Telemed J E Health. 2020;26(5):614-620.
24. Hantke N, Lajoy M, Gould CE, et al. Patient satisfaction with geriatric psychiatry services via video teleconference. Am J Geriatr Psychiatry. 2020;28(4):491-494.
25. Goetter EM, Blackburn AM, Bui E, et al. Veterans’ prospective attitudes about mental health treatment using telehealth. J Psychosoc Nurs Ment Health Serv. 2019;57(9):38-43.
26. Vanderpool D. Top 10 myths about telepsychiatry. Innov Clin Neurosci. 2017;14(9-10):13-15.
27. Butterfield A. Telepsychiatric evaluation and consultation in emergency care settings. Child Adolesc Psychiatr Clin N Am. 2018;27(3):467-478.
28. Medicare.gov. Telehealth. https://www.medicare.gov/coverage/telehealth. Accessed May 14, 2020.
29. Centers for Medicare & Medicaid Services. Behavioral Health Services. https://www.medicaid.gov/medicaid/benefits/bhs/index.html. Accessed May 14, 2020.
30. New York Pub Health Law §2999-cc (2017).

The need for mental health services has never been greater. Unfortunately, many patients have limited access to psychiatric treatment, especially those who live in rural areas. Telepsychiatry—the delivery of psychiatric services through telecommunications technology, usually video conferencing—may help address this problem. Even before the onset of the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry was becoming increasingly common. A survey of US mental health facilities found that the proportion of facilities offering telepsychiatry nearly doubled from 2010 to 2017, from 15.2% to 29.2%.¹

In this article, we describe examples of where and how telepsychiatry is being used successfully, and its potential advantages. We discuss concerns about its use, its impact on the therapeutic alliance, and patients’ and clinicians’ perceptions of it. We also discuss the legal, technological, and financial aspects of using telepsychiatry. With an increased understanding of these issues, psychiatric clinicians will be better able to integrate telepsychiatry into their practices.

How and where is telepsychiatry being used

In addition to being used to provide psychotherapy, telepsychiatry is being employed for diagnosis and evaluation; clinical consultations; research; supervision, mentoring, and education of trainees; development of treatment programs; and public health. Telepsychiatry is an excellent mechanism to provide high-level second opinions to primary care physicians and psychiatrists on complex cases for both diagnostic purposes and treatment.

Evidence suggests that telepsychiatry can play a beneficial role in a variety of settings, and for a range of patient populations.

Emergency departments (EDs). Using telepsychiatry for psychiatric consultations in EDs could result in a quicker disposition of patients and reduced crowding and wait times. A survey of on-call clinicians in a pediatric ED found that using telepsychiatry for on-site psychiatric consultations decreased patients’ length of stay, improved resident on-call burden, and reduced factors related to physician burnout.² In this study, telepsychiatry use reduced travel for face-to-face evaluations by 75% and saved more than 2 hours per call day.²

Medical clinics. Using telepsychiatry to deliver cognitive-behavioral therapy significantly reduced symptoms of depression or anxiety among 203 primary care patients.³ Incorporating telepsychiatry into existing integrated primary care settings is becoming more common. For example, an integrated-care model that includes telepsychiatry is serving the needs of complex patients in a high-volume, urban primary care clinic in Colorado.⁴

Assertive Community Treatment (ACT) teams. Telepsychiatry is being used by ACT teams for crisis intervention and to reduce inpatient hospitalizations.⁵

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Telepsychiatry: What you need to know

References

How and where is telepsychiatry being used

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