Telepsychiatry

What is Telepsychiatry?

Telemedicine is the process of providing health care from a distance through technology, often using videoconferencing. Telepsychiatry, a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.

Telepsychiatry can involve direct interaction between a psychiatrist and the patient. It also encompasses psychiatrists supporting primary care providers with mental health care consultation and expertise. Mental health care can be delivered in a live, interactive communication. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review.

Benefits

Video-based telepsychiatry helps meet patients’ needs for convenient, affordable and readily-accessible mental health services. It can benefit patients in a number of ways, such as:

  • Improve access to mental health specialty care that might not otherwise be available (e.g., in rural areas)
  • Bring care to the patient’s location
  • Help integrate behavioral health care and primary care, leading to better outcomes
  • Reduce the need for trips to the emergency room
  • Reduce delays in care
  • Improve continuity of care and follow-up
  • Reduce the need for time off work, childcare services, etc. to access appointments far away
  • Reduce potential transportation barriers, such as lack of transportation or the need for long drives
  • Reduce the barrier of stigma

While some people may be reluctant or feel awkward talking to person in a screen, experience shows most people are comfortable with it. Some people may be more relaxed and willing to open up from the comfort of their home or a convenient local facility. Also, this will likely be less of a problem as people become more familiar and comfortable with video communication in everyday life.

Telepsychiatry allows psychiatrists to treat more patients in distant locations. Psychiatrists and other clinicians need to be licensed in the state(s) where the patient they are working with is located. State licensing boards and legislatures view the location of the patient as the place where “the practice of medicine” occurs.

Although telepsychiatry has the disadvantage of the patient and psychiatrist not being in the same room, it can create enhanced feelings of safety, security and privacy for many patients.

Evidence for Effectiveness

There is substantial evidence of the effectiveness of telepsychiatry and research has found satisfaction to be high among patients, psychiatrists and other professionals. Telepsychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, quality of care and patient satisfaction. Patient privacy and confidentiality are equivalent to in-person care.

Research has also found that overall experiences among all age groups have been good. There is evidence for children, adolescents and adults regarding assessment and treatment (medication and therapy). There are even people for which telemedicine may be preferable to in-person care, for example people with autism or severe anxiety disorders and patients with physical limitations may find the remote treatment particularly useful.

Telepsychiatry has been found especially effective with respect to the treatment of PTSD, depression, and ADHD. See more on the evidence base for telepsychiatry.

Used in a Variety of Settings

Telepsychiatry is used in a variety of different settings, including private practice, outpatient clinics, hospitals, correctional facilities, schools, nursing homes, and military treatment facilities.

Patients can schedule appointments individually with a psychiatrist or therapist for a live video appointment. This can be with a regular provider if they offer the service or through one of a number of companies offering access to mental health clinicians for video appointments. Patients should plan ahead and prepare the just as for an in-person appointment. Have any relevant records and information, including prescriptions, and have a list of questions to address.

Telepsychiatry is helping bring more timely psychiatric care to emergency rooms. An estimated one in eight emergency room visits involves a mental health and/or substance use condition, according to the Agency for Healthcare Research and Quality. Many emergency rooms are not equipped to handle people with serious mental health issues and do not have psychiatrists or other mental health clinicians on staff to assess and treat mental health problems. A 2016 poll of emergency room physicians found only 17 percent reported having a psychiatrist on call to respond to psychiatric emergencies.

Telepsychiatry is being used in nursing homes to provide both ongoing psychiatric evaluation and care and emergency crisis intervention when it may be difficult to find local psychiatrist to assist. Many states use telepsychiatry in corrections facilities where inmates frequently require ongoing mental health care.

Cost and Insurance

telemedicine-coverage-map
Click to view larger image

Thirty-two states have legislated that private insurance cover telemedicine, according to the American Telemedicine Association (as of July 2016, see map).

Medicaid programs in 48 states reimburse for some telepsychiatry services. State Medicaid policies, rules, and laws are continuing to evolve. Medicare will reimburse for telepsychiatry services if the community is considered rural.

Definition of Terms

APA Position Statement on Telemedicine in Psychiatry

Telemedicine in psychiatry, using video conferencing, is a validated and effective practice of medicine that increases access to care. The American Psychiatric Association supports the use of telemedicine as a legitimate component of a mental health delivery system to the extent that its use is in the best interest of the patient and is in compliance with the APA policies on medical ethics and confidentiality. 2015

Asynchronous or "Store and Forward": Capture and then transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation.

Distant Site: Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system. eHealth: Health care practice supported by electronic processes and communication.

Electronic Health Record (EHR): A systematic collection of electronic health information about individual patients or populations that is recorded in digital format and capable of being shared across health care settings via information networks or exchanges. EHRs generally include patient demographics, medical history, medication, allergies, immunization status, laboratory test results, radiology and other medical images, vital signs, characteristics such as age and weight, and billing information.

e-Prescribing: The electronic generation, transmission and filling of medical prescriptions, as opposed to traditional paper and faxed prescriptions. E-prescribing allows qualified health care personnel to send new prescriptions or renewals to community or mail-order pharmacies.

HIPAA: Acronym for Health Information Portability and Accountability Act. HIPAA protects the privacy of individually identifiable health information, sets national standards for the security of electronic protected health information, and protects identifiable information being used to analyze patient safety events and improve patient safety. More about HIPAA

Originating Site: Location of the patient at the time the service is provided via a telecommunications system.

Synchronous: Interactive video connections that transmit information in both directions during the same time period.

Teleconferencing: Interactive electronic communication (voice, video, and/or data transmission) between multiple users at two or more sites.

Teleconsultation: Consultation between a provider and specialist located at a distance using either store and forward telemedicine or real time videoconferencing.

Telehealth and Telemedicine: Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote health care that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs and nursing call centers are all considered part of telemedicine and telehealth. Telemedicine is not a separate medical specialty. Telemedicine encompasses different types of programs and services provided for the patient.

Videoconferencing: Real-time transmission of digital video images between multiple locations.

(Glossary sources: American Telemedicine Association, Centers for Medicare and Medicaid Services – Telemedicine, National Center for Telehealth and Technology)

Resources/References

Physician Review By:

Jay H. Shore, M.D., M.P.H.
Associate Professor, University of Colorado Anschutz Medical Campus
Chair, APA Committee on Telepsychiatry
January, 2017

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