Evidence-Based Reviews

Telepsychiatry: What you need to know

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

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).

Correctional facilities. With the downsizing and closure of many state psychiatric hospitals across the United States over the last several decades, jails and prisons have become de facto mental health hospitals. This situation presents many challenges, including access to mental health care and the need to avoid medications with the potential for abuse. Using telepsychiatry for psychiatric consultations in correctional facilities can improve access to mental health care.

Geriatric patients. A systematic review of 76 studies evaluating telepsychiatry for older patients found this approach was well-accepted for inpatient and nursing home consultation, cognitive testing, dementia diagnosis and treatment, depression in integrated and collaborative care models, and psychotherapy.⁶ Another review of telepsychiatry for geriatric patients found that it supports mental health practice, especially when face-to-face therapy is not possible.⁷ The main drawbacks were technical problems and lack of support from staff.

Children and adolescents. The Michigan Child Collaborative Care (MC3) program is a telepsychiatry consultation service that has been able to provide cost-effective, timely, remote consultation to primary care clinicians who care for youth and perinatal women.⁸ New York has a pediatric collaborative care program, the Child and Adolescent Psychiatry for Primary Care (CAP PC), that incorporates telepsychiatry consultations for families who live >1 hour away from one of the program’s treatment sites.⁹

Patients with cancer. A literature review that included 9 studies found no statistically significant differences between standard face-to-face interventions and telepsychiatry for improving quality-of-life scores among patients receiving treatment for cancer.¹⁰

Patients with insomnia. Cognitive-behavioral therapy for insomnia (CBT-I) is often recommended as a first-line treatment, but is not available for many patients. A recent study showed that CBT-I provided via telepsychiatry for patients with shift work sleep disorder was as effective as face-to-face therapy.¹¹ Increasing the availability of this treatment could decrease reliance on pharmacotherapy for sleep.

Patients with opioid use disorder (OUD). Treatment for patients with OUD is limited by access to, and availability of, psychiatric clinicians. Telepsychiatry can help bridge this gap. One example of such use is in Ontario, Canada, where more than 10,000 patients with concurrent opiate abuse and other mental health disorders have received care via telepsychiatry since 2008.¹²

Continue to: Increasing access to cost-effective care where it is needed most

Telepsychiatry: What you need to know

References

Pages

Recommended Reading