Gaba
Telepsychiatry

Telepsychiatry Research

More Telepsychiatry research is being published, demonstrating that telepsychiatry can be as useful as an office visit when practiced the correct way. Telepsychiatry research is relatively new, and we expect to see more trials emerging, focusing on the effectiveness of telepsychiatry for different treatment modalities.

Published Telepsychiatry Research

Online resources for assessment and evaluation

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Objective: The Accreditation Council for Graduate Medical Education and the Liaison Committee on Medical Education have mandated the transition from written global evaluation methods to competency-based assessments in resident and medical student training. Assessment of competency requires analysis of performance data from numerous sources. This article reviews characteristics of Web-based evaluation and assessment systems and recommends areas for further development.

Method: The authors review functions common to a variety of online evaluation and curriculum management systems with attention to their adaptation for competency documentation and assessment. Details of online global assessments, examination methods, electronic portfolios, procedure/case logs, and survey systems are provided along with a list of Internet resources.

Results: Online evaluation and assessment systems not only provide data on trainee competence but can provide valuable feedback on faculty teaching, curriculum quality, and the learning environment. Suggestions for future development, legal ambiguities that could become obstacles, and the need to clarify the responsibility for funding this work are discussed. Web-based performance assessment and evaluation are seen in the larger context of moving toward competency assessment of practicing physicians.

Conclusions: Online assessment systems offer advantages over paper systems in allowing robust data analysis, reporting, and flexibility. A national online procedure/case log tracking system would facilitate gathering data that could provide one type of experiential benchmark for determining competency.

Telepsychiatry: learning from the pandemic

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient’s clinical needs and social context, as well as by service-level socio-technical and logistical factors.

U.S. Emergency Department Telepsychiatry Use in 2019

 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Introduction: Although many emergency departments (EDs) receive telehealth services for psychiatry, or telepsychiatry, to manage acute psychiatric emergencies, national research on the usage of ED telepsychiatry is limited. To investigate ED telepsychiatry usage in the pre-COVID-19 era, we surveyed a sample of EDs receiving telepsychiatry in 2019, as a follow-up to a survey targeted to similar EDs in 2017


METHOD: All U.S. EDs open in 2019 (n = 5,563) were surveyed to characterize emergency care. A more in-depth second survey on telepsychiatry use (2019 ED Telepsychiatry Survey) was then sent to 235 EDs. Of these EDs, 130 were randomly selected from those that reported telepsychiatry receipt in 2019, and 105 were selected based on their participation in a similar survey in 2017 (2017 ED Telepsychiatry Survey).


RESULTS: Of the 235 EDs receiving the 2019 Telepsychiatry Survey, 192 (82%) responded and 172 (90% of responding EDs) confirmed 2019 telepsychiatry receipt. Of these, five were excluded for missing data (analytic sample n = 167). Telepsychiatry was the only form of emergency psychiatric services for 92 (55%) EDs. The most common usage of telepsychiatry was for admission or discharge decisions (82%) and transfer coordination (70%). The most commonly reported telepsychiatry mental health consultants were psychiatrists or other physician-level mental health professionals (74%).


Discussion: With telepsychiatry as the only form of psychiatric services for most telepsychiatry-receiving EDs, this innovation fills a critical gap in access to emergency psychiatric care. Further research is needed to investigate the impact of the COVID-19 pandemic on usage of ED telepsychiatry.

The future of mental health care: peer-to-peer support and social media

 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Aims: People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group.

Methods: In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing.

Results: People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one’s health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks.

Conclusion: Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.

Definitions and terminology regarding child alignments, estrangement, and alienation: A survey of custody evaluators

 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Parental alienation (PA) is a highly consequential family dynamic that causes harm to children and parents. While many mental health and legal professionals agree that PA is common and potentially very harmful to children, there is still the appearance that there is controversy and discord in the field. The purpose of this study was to test the extent of consensus in the field regarding the basic tenets of PA theory. Specifically, 11 key terms related to PA were identified through expert input and preliminary field-testing. An on-line survey was created specifically for the study to assess level of agreement with these key terms among custody evaluators. This profession was selected because of their high degree of training and experience with a variety of family conflict situations; 119 child custody evaluators selected as members of a professional custody evaluator listing (88% response rate) rated their endorsement of these 11 key definitions with response options including: strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree. Results revealed that roughly 80% of respondents agreed or strongly agreed with each of the 11 definitions. These results demonstrate a high degree of consensus and should guide future trainings of legal and mental health professionals to ensure a common language and understanding of this phenomenon.

It’s a Battle and a Blessing: The Experience and Needs of Custodial Grandparents of Children with Autism Spectrum Disorder

 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

We know little about custodial grandparents of children with autism spectrum disorder (ASD) who offer a vital social safety net. 117 custodial grandparents of children with ASD from 37 states completed an online survey with open-ended questions about their “greatest challenges and joys” as grandparent. Grounded theory analysis revealed four categories of experience (Issues with Adult Children, Caregiving Burden, Coping, & Wisdom) explained by 15 themes. Grandparents’ stressors encompassed custody issues, ASD problem behaviors like tantrums and eloping, insufficient ASD services, financial burden, 24/7 caregiving demands, social isolation, and fears for the future. Grandparents’ coping included celebrations of progress, unconditional love, faith, and a positive focus. Grandparents’ wisdom included patience and insight. Recommendations to support these caregivers are provided.

Forensic mental telehealth assessment (FMTA) in the context of COVID-19

 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Due to the present COVID-19 pandemic, forensic mental telehealth assessment (FMTA) is an increasingly utilized means of conducting court-sanctioned psychiatric and psychological evaluations. FMTA is not a novel development, and studies have been published during the past two decades that opine on the positive and negative implications of conducting testing and interview procedures online, in forensic and traditionally clinical matters alike. The present article examines prospects for eventual legal challenges to FMTA, describes considerations for conducting FMTA in both institutional and residential settings, and concludes that FMTA is now-due to predicted accommodations on the part of courts, attorneys, institutions, and professional guilds-a permanent part of the forensic evaluation landscape, even once the present COVID-19 pandemic has subsided.

Preparation for court testimony in child abuse cases

 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Medical expert testimony in child abuse cases is a socially essential task if children are to be protected from abuse. Accomplishing this task in an excellent way is an important challenge requiring attention to its ethical, legal, and administrative aspects as well as to technical medical considerations. As the field of child protection matures as a medical specialty, expertise in child abuse becomes increasingly definable; it is now sufficiently definable to allow courts to begin to separate those physicians who are specialists in the field from those who are not.

The virtual courtroom: a view of justice. Project to prepare witnesses or victims with learning disabilities to give evidence

 
 

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

Purpose: With the advent of ‘The Youth Justice and Criminal Evidence Act 1999’ passed by Parliament in August 1999, vulnerable witnesses can for the first time give evidence to the court with the support of ‘special measures’. People with a learning disability fall into the category of vulnerable witnesses, and the purpose of this paper is to describe the development of the virtual courtroom, a virtual reality (VR) and multimedia based training platform to prepare this group of people for such an eventuality.

Method: A user-centred design methodology was adopted, with a user group being formed of students and adults with learning disabilities. This group, working together with facilitators, experts on the new act, and experienced designers of VR based training systems, designed and implemented the virtual courtroom.

Results: The virtual courtroom model has been produced using the Realimation Virtual Reality software tool. The next stage of the project is to design and develop three multimedia-based scenarios showing a variety of situations in which a person with a learning disability could give evidence in court.

Conclusion: One of the recommendations in the ‘Speaking up for justice’ report, suggested that the Home Office develop further material to assist vulnerable witnesses to prepare for their attendance at court. The virtual courtroom provides one of the first and most innovative of such solutions.

Treatment Outcomes in Depression: Comparison of Remote Treatment Through Telepsychiatry to In-Person Treatment

Paul E. Ruskin, M.D., Michele Silver-Aylaian, Ph.D., Mitchel A. Kling, M.D., Susan A. Reed, C.R.N.P., C.N.S., Douglas D. Bradham, Dr.P.H., J. Richard Hebel, Ph.D., David Barrett, M.D., Frederick Knowles, III, M.D., and Peter Hauser, M.D.

Published online: August 01, 2004
American Journal of Psychiatry

Abstract

OBJECTIVE: Telepsychiatry is an increasingly common method of providing psychiatric care, but randomized trials of telepsychiatric treatment compared to in-person treatment have not been done. The primary objective of this study was to compare treatment outcomes of patients with depressive disorders treated remotely by means of telepsychiatry to outcomes of depressed patients treated in person. Secondary objectives were to determine if patients’ rates of adherence to and satisfaction with treatment were as high with telepsychiatric as with in-person treatment and to compare costs of telepsychiatric treatment to costs of in-person treatment.

METHOD: In this randomized, controlled trial, 119 depressed veterans referred for outpatient treatment were randomly assigned to either remote treatment by means of telepsychiatry or in-person treatment. Psychiatric treatment lasted 6 months and consisted of psychotropic medication, psychoeducation, and brief supportive counseling. Patients’ treatment outcomes, satisfaction, and adherence and the costs of treatment were compared between the two conditions.

RESULTS: Hamilton Depression Rating Scale and Beck Depression Inventory scores improved over the treatment period and did not differ between treatment groups. The two groups were equally adherent to appointments and medication treatment. No between-group differences in dropout rates or patients’ ratings of satisfaction with treatment were found. Telepsychiatry was more expensive per treatment session, but this difference disappeared if the costs of psychiatrists’ travel to remote clinics more than 22 miles away from the medical center were considered. Telepsychiatry did not increase the overall health care resource consumption of the patients during the study period.

CONCLUSIONS: Remote treatment of depression by means of telepsychiatry and in-person treatment of depression have comparable outcomes and equivalent levels of patient adherence, patient satisfaction, and health care cost.

Telepsychiatry: Videoconferencing in the Delivery of Psychiatric Care


Published online: March 01, 2013
American Journal of Psychiatry

Abstract

This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient’s clinical needs and social context, as well as by service-level socio-technical and logistical factors.

How Mental Health Has Become a Hot Topic in Telemedicine

Steven Chan M.D., M.B.A. Arshya Vahabzadeh M.D.
Published online: March 17, 2015
American Journal of Psychiatry

Abstract

Could the era of Internet technologies and consumer electronics boost access to mental health care? Dr. Phil McGraw and numerous other exhibitors at the 2015 Consumer Electronics Show (CES) believe so. At the CES Digital Health Summit, television talk-show host and Doctor on Demand cofounder McGraw presented his vision of how wireless and communications technology will boost wellness and mental health. McGraw highlighted how telemedicine must play a greater role in providing mental health care, or “tele-mental” health.

Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches

World J Psychiatry.
2015 September 22; 5(3): 286–304.
Published online: 2015 September 22
doi:  10.5498/wjp.v5.i3.286
PMCID: PMC4582305

Abstract

Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.

CONCLUSION Is telepsychiatry an idea whose time has come? There is no doubt videoconferencing-based telepsychiatry facilitates effective service-provision in a large number of areas, where access to high-quality services is difficult. Consequently, it promotes an equality of access, a sense of empowerment among patients, and high levels of satisfaction among them. The evidence to date is highly suggestive that it is comparable to face-to-face care on several aspects of what is traditionally considered effectiveness. However, by the present stringent standards, the quality of the evidence is, perhaps, not adequate. Additionally, there are several barriers to telepsychiatry’s wider implementation such as cost-effectiveness, uncertain ethical and legal implications, and concerns about sustainability of programmes. These continue to thwart its integration into the routine network of mental health services. Accordingly, at present telepsychiatric services can only serve as an adjunct to the more traditional modes of service-delivery, but can never replace them. Therefore, the way forward would be to develop hybrid models, which incorporate both forms of service-delivery[84,172]. If telepsychiatry settles into this niche, it has the potential to enhance the overall efficiency of mental health services by removing the many obstacles, which afflict conventional systems of service-delivery. This model may also work for low- and middle-income countries, provided that effective, needs-based forms of telepsychiatric services are developed in these countries as well.

Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is a seminal event that is precipitating radical transformative change to our society and health care systems. Social distancing, isolation, and deployment of suppression and mitigation strategies are directly influencing the morbidity and mortality rates of the pandemic. Remote communication technologies are being broadly deployed in all spheres of medicine to support these strategies while still delivering effective health care. Telepsychiatry, in the form of videoconferencing and other technologies, was uniquely positioned to push the field of psychiatry to the forefront of these efforts. Prior to the pandemic, telepsychiatry had built a strong scientific foundation and real-world evidence base, demonstrating its effectiveness across a range of psychiatric treatments, populations, and settings. Although previously leveraged temporarily in disaster response, telepsychiatry’s use in the COVID-19 pandemic has been distinctive and will have long-lasting and wide-ranging effects on the field of psychiatry, including mental health care delivery and configuration and patient experience and expectations.

Mobilization of Telepsychiatry in Response to COVID-19—Moving Toward 21st Century Access to Care

Abstract

The COVID-19 pandemic threatens to disrupt the provision of mental health services. In response, policymakers, administrators, and providers have taken bold steps toward enabling telepsychiatry to bridge this sudden gap in care for our most vulnerable populations. With rapid deregulation and adoption of this modality of care, careful consideration of issues related to policy and implementation is essential to maximize its effectiveness and mitigate unintended consequences. Though the crisis places the healthcare system under strain, it sets the stage for a lasting shift in not only how care is delivered, but also our beliefs around the system’s capacity for rapid, innovative change.

The urge to implement and expand telepsychiatry during the COVID-19 crisis: Early career psychiatrists’ perspective

Abstract

Currently, there are millions of cases and hundreds of thousands of deaths confirmed worldwide with coronavirus disease 2019 (COVID-19), an illness classified by the World Health Organization as a global pandemic. Because effective treatments or vaccines for the SARS-CoV-2 are still nonexistent, social distancing and isolation remain the most successful strategies to prevent countries from humanitarian disasters and collapse of their national health systems.