Telepsychiatry: The Mental Health of Tomorrow?

By: Nikhil Jaisinghani

 

Nearly a quarter of American internet users had tried videocalls or chats according to a Pew Research poll conducted in 2010. Videocalling apps and programs, such as Skype, Google Talk, and Apple FaceTime, three of the most common ones, have steadily pervaded both our personal lives and our workplaces, as videochatting and teleconferencing have become increasingly more common forms of communication and accepted business practices. Additionally, the increasing purchase and proliferation of smartphones with built-in cameras means that more people have an opportunity to participate in videochats­—wherever they are. What relevance does this have to psychiatry, however? And how will this affect the future of the field? These are some of the questions I will attempt to answer in this post.

Telepsychiatry is defined as the process of providing psychiatric care and assessment through the medium of telecommunications technology and is becoming an increasingly more common and accepted mode of providing mental health services. This practice has some great benefits, compared to traditional, office-based, therapy which requires both patient and provider to be physically present together in the same space. Telepsychiatry can reduce the impact of space in the availability of care by extending the range of a provider’s services to areas that would be difficult or impractical to serve in-person.

There are 4 common varieties of telepsychiatry:

  1. Home-based: treatment of patients in a private setting, such as their homes. Useful for the elderly, disabled, or otherwise motor-challenged.
  2. Forensic: provides mental health services to imprisoned populations.
  3. On-demand: for emergency populations
  4. Scheduled: long-term, increased care.

There are, however, still some challenges that telepsychiatry has to overcome before it can become a ubiquitous service offered by mental health service providers. Probably chief among these is the question of billing. Because it is such a relatively new practice compared to traditional psychiatry, questions about its effectiveness might be a cause in the comparatively limited coverage it enjoys. Things are changing, however, and Medicaid does reimburse for some telepsychiatry services in 48 states, and as for private insurance, the Affordable Care Act is leading many insurance carriers to begin covering telepsychiatric services. Several states are also passing laws which make it mandatory for private insurers to provide coverage for them.

The American Psychiatric Association is involved in developing a standardized “Telepsychiatry Toolkit”, which is an evolving resource designed to help centralize information about this growing field and features articles on a wide range of topics related to telepsychiatry, including the history and background of this practice, training, legal issues, questions about reimbursement, the technology involved, how to practice it, and potential clinical issues that may arise. The article “History of Telepsychiatry” reveals that this practice has actually been going on since the 50s and that the Nebraska Psychiatric Institute had been using videoconferencing to provide therapy (including for groups), psychiatric consultation, and training for medical students as early as 1959.

Ultimately, despite its relative novelty compared to traditional healthcare, telepsychiatry will probably continue growing as populations do and percentage of patients to psychiatrists continues to rise in the future. This technological innovation in the field of mental health will probably go a long way to reduce the impact of geographic boundaries to access to necessary mental health services

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