Telemedicine, often referred to as telehealth, has become an increasingly beneficial option for providing and receiving care. The convenience and flexibility provided by virtual care allows both patients and physicians to thrive. While telemedicine has applications that range all fields of health care, psychiatry was one of its earliest adopters. In the late 1950s, Norfolk State Hospital in Nebraska and the Nebraska Psychiatric Institute used closed-circuit television to provide consultations, support educational endeavors, and conduct research and training between the two institutions.1
This was one of the earliest forms of telemedicine services or telehealth services and laid the groundwork for much of telehealth as we know it today. Learn more about telemedicine in psychiatry and its main benefits below.
Telepsychiatry is a subset of telehealth that involves providing psychiatric care to patients via any form of telecommunication, usually in the form of videoconferencing. Otherwise, psychiatrists can use telemedicine to provide many of the same services that they would normally provide, including:
- Psychiatric evaluations
- Therapy, including individual therapy, group therapy, and family therapy
- Patient education
- Medication management2
While telepsychiatry will mainly involve interactions between a psychiatrist and a patient, it may also be used as a means of supporting primary care providers with consultation regarding mental health care.2
Virtual psychiatry allows patients access to mental health and is offered in synchronous and asynchronous forms. Synchronous telepsychiatry involves live video conferencing through a telehealth platform between the patient and psychiatrist. A patient can have an online visit in the comfort of their home or at a doctor’s office. In the doctor’s office, the session may include help from an assistant or telepresenter, who can measure blood pressure, perform tests, and provide other forms of hands-on support. Asynchronous telemedicine, often referred to as “store and forward”, works much like email and allows the patient or psychiatrist to capture and send data for telepsychiatry consultation.
The Benefits of Telemedicine in Psychiatry
The benefits of this emerging technology are wide in range for to providers and patients alike.
1. Improved Access to Care
Much like telemedicine writ large, virtual psychiatry offers greater access to care. This particularly benefits those in smaller rural communities and other underserved communities that may lack specialists. A Merritt Hawkins report from 2017 found that 77 percent of counties in the United States reported a severe shortage of psychiatrists.3 At the same time, about 1 in 5 Americans will experience some form of mental illness in any given year.4 However, in most states, providers are more often found in the more densely populated metropolitan areas.5
Telepsychiatry provides a convenient and viable option for those looking for access to psychiatric care and for behavioral health providers to give it to them. Instead of forcing patients or providers to travel long distances, this innovative technology allows for comprehensive mental health care much like a face to face visit in the comfort of their home.
Telepsychiatry is also a boon in terms of financial accessibility. Quality psychiatric care can be financially burdensome for many people, even those outside of underserved rural communities. Health insurance coverage for telepsychiatry can vary from plan to plan, provider to provider, and there are various costs involved that insurance will not cover.5
For example, psychiatric care may mean travel costs, meaning hours on the road or even plane trips to see a specialist. For patients who have to receive care over several days, this may also mean added costs for room and board. Bad weather, delays, and other disruptions can cause further burdens on treatment.5
Furthermore, traveling for psychiatric care may require days off from school or work, which puts an even greater burden on families in need. That means a loss of income and added childcare costs for children at home.5
Telepsychiatry can also be cost-effective for providers. Subspecialists may be required to travel to multiple sites in one day, which can put added financial and time constraints on them. Telepsychiatry allows the provider to conduct all of their business from their home or office and may choose their own hours.
Telepsychiatry essentially prevents patients from having to choose between finances and their own mental health. Telepsychiatry sessions can be done in the comfort of home or in a primary care provider’s office. Patients can also usually make virtual psychiatry appointments outside of usual business hours, ensuring that they do not have to miss days of work for their sessions.
3. It’s Effective
Ample evidence shows that telepsychiatry is effective and has outcomes that are equivalent to in-person care in terms of diagnostic accuracy, treatment effectiveness, and overall quality of care. Patient privacy and confidentiality of virtual psychiatry were also on par with in-person psychiatric care. Satisfaction remains high among patients, psychiatrists, and other professionals.2
Research shows that overall experiences with this innovative technology have been good among all age groups. This evidence shows good outcomes for kids, adolescents, and adults involved with assessment and treatment, which includes both medication and forms of therapy.2 Preliminary studies also show positive results among geriatric patients and patients from across cultures. This suggests that telepsychiatry may provide better options for facilitating cultural, ethnic, and language matching between patients and providers.6
Some research even suggests that telepsychiatry may be preferred by or more effective than in-person care with certain individuals. This includes:
- Children and adolescents on the autism spectrum6
- Adults with disabling anxiety disorders, including those with panic disorder or post-traumatic stress disorder (often combined with other telephone and email options for care)6
- Those with depression disorders and attention deficit hyperactivity disorder (ADHD)2
Furthermore, while online psychiatry may be used on its own, it can also be used in conjunction with in-person visits and integrated with behavioral health care and primary care to provide better outcomes.
4. Returns on Investment
For providers, integrating this lucrative technology presents some significant returns on investment. Used with an emergency department, telepsychiatry can provide more efficient connectivity with outpatient mental health services. This can help to close referral loops between ER and other departments. Studies show that telepsychiatry can also benefit ER settings by reducing transportation costs and inpatient and emergency department utilization.7
In primary care and specialty care clinics, telepsychiatry could provide significant cost savings to medical groups and delivery systems while improving the health status of patients. Telepsychiatry may also reduce costs in correctional facilities and nursing homes, including transportation, labor, and general care-oriented factors.7
5. Flexibility of Use
Telepsychiatry naturally incorporates greater flexibility that can be applied to nearly all medical departments. Telepsychiatry could help to bring more quality psychiatric care to emergency rooms where an estimated 1 in 8 visits are related to mental health or substance abuse. Unfortunately, most emergency rooms do not have the personnel or equipment to assess or treat those with mental health emergencies. With virtual psychiatry, emergency rooms have a viable and effective option for helping those with serious mental health issues.2
In nursing homes, telepsychiatry is being applied as a means of providing ongoing psychiatric care and evaluation, but it may also be used in emergency care intervention when meeting with a psychiatrist in person may not be feasible.2
Ultimately, the biggest hurdle for patients is access to technology and reliable internet. For providers, reimbursement and regulatory issues tend to be the main barriers for providing telepsychiatry services.
Still, the telepsychiatry benefits far outweigh any drawbacks. Studies show that good outcomes are a matter of combining excellent clinicians, program fitness, and reliable technology that allows for clarity and engagement.8