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COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future
Open accessAbstract
The COVID-19 pandemic has dramatically transformed the U.S. healthcare landscape. Within psychiatry, a sudden relaxing of insurance and regulatory barriers during the month of March 2020 enabled clinicians practicing in a wide range of settings to quickly adopt virtual care in order to provide critical ongoing mental health supports to both existing and new patients struggling with the pandemic's impact. In this article, we briefly review the extensive literature supporting the effectiveness of telepsychiatry relative to in-person mental health care, and describe how payment and regulatory challenges were the primary barriers preventing more widespread adoption of this treatment modality prior to COVID-19. We then review key changes that were implemented at the federal, state, professional, and insurance levels over a one-month period that helped usher in an unprecedented transformation in psychiatric care delivery, from mostly in-person to mostly virtual. Early quality improvement data regarding virtual visit volumes and clinical insights from our outpatient psychiatry department located within a large, urban, tertiary care academic medical center reflect both the opportunities and challenges of virtual care for patients and providers. Notable benefits have included robust clinical volumes despite social distancing mandates, reduced logistical barrieres to care for many patients, and decreased no-show rates. Finally, we provide clinical suggestions for optimizing telepsychiatry based on our experience, make a call for advocacy to continue the reduced insurance and regulatory restrictions affecting telepsychiatry even once this public health crisis has passed, and pose research questions that can help guide optimal utilization of telepsychiatry as mainstay or adjunct of outpatient psychiatric treatment now and in the future.
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“The COVID-19 pandemic imposed the sudden conversion of in-person to telehealth visits in healthcare systems throughout the world (Chen et al., 2020; Torales et al., 2022).”
From Online Mindfulness-Based Cognitive Therapy for People with Parkinson’s Disease and Their Caregivers: a Pilot Study (2022) · cites this paper as Chen et al., 2020
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The Role of Telehealth in Reducing the Mental Health Burden from COVID-19
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Covid-19 and Health Care’s Digital Revolution
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The Effectiveness of Telemental Health: A 2013 Review
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“More frequent disruptions, difficulty reading nonverbal communications, and increased effort required to establish rapport have all been previously reported [5,8] and are anecdotally confirmed by our clinicians.”
InfluentialUsefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches
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“While the “pot” of mental health in the United States had already been close to boiling in 2019 [7], the COVID-19 pandemic was the tipping point that drove home gaps in access to mental health treatment and led to more widespread adoption of telemedicine [8-10].”
Metadata
- Authors
- Chen, J. A., Chung, W.-J., Young, S. K., Tuttle, M. C., Collins, M. B., Darghouth, S. L., Longley, R., Levy, R., Razafsha, M., Kerner, J. C., Wozniak, J., & Huffman, J. C.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Chen, Justin A.
- ORCID
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 66
- Pages
- 89-95
- ISSN
- 0163-8343 (ISSN-L)
- PMC
- PMC7347331
- OpenAlex
- W3040928965
- Cited by
- 227
- References
- 28
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 24 · 2023: 40 · 2022: 52 · 2021: 85 · 2020: 8
- FWCI
- 7.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Patient-Centered Outcomes Research Institute
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Keywords
- telepsychiatry, COVID-19 pandemic, virtual care, outpatient psychiatric care, mental health service delivery, insurance coverage barriers, regulatory challenges, no-show rates, quality improvement, social distancing
- MeSH terms
- COVID-19, Ambulatory Care, Mental Disorders, Humans, Mental Health Services, Pneumonia, Viral, Psychiatry, Telemedicine, Coronavirus Infections, Pandemics
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