Telepsychiatry during the COVID-19 pandemic

Abstract

The US possesses the infrastructure and the technology to successfully offer digital care, and healthcare providers from different specialties have claimed that “healing at a distance” improves patient outcomes and captures the needs of vulnerable populations.1-3 Efforts to limit the spread of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the implementation of lockdown measures have created an opportunity for mental health clinics to employ telemedicine—or, in the field of psychiatry and mental health—telepsychiatry.4 Telepsychiatry, also referred to as “telepsych,” is a subset of telemedicine that includes remote services, such as psychiatric evaluations, therapy (individual, group, and family), patient education, and pharmacologic and nonpharmacologic management.5 The Nebraska Psychiatric Institute first introduced telepsych in mental health practices in 1959, and this approach has since addressed several psychiatric disorders and problems.3,5,6 The adaptations necessitated by the COVID-19 pandemic, characterized by remote communications and services, are transforming mental health practices globally by expanding the availability of telepsych.7 Advanced practice registered nurses (APRNs) are equipped to contribute to the healthcare needs of the populations they serve. There are two types of APRN specialties that are trained specifically in psychopharmacology and psychotherapy to help patients across the lifespan: psychiatric-mental health nurse practitioners and psychiatric-mental health clinical nurse specialists. Both of these APRN specialties are qualified to provide telepsychiatry effectively and in many states have full-practice authority (FPA). There is increased accessibility to mental health services provided by a psychiatrist or APRN in states where APRNs have FPA.8 Telemedicine in psychiatry has observable efficacy in diagnostic and management decisions. Virtual platforms are achieving greater popularity among mainstream healthcare services, and studies show that telepsych can overcome barriers to care associated with patient difficulty in attending in-person sessions.2,5 However, while providers recognize the benefits of telepsych, they may be unaware of potential liability concerns as well as the clinical, technological, and ethical issues associated with this method. The purpose of this article is to describe the considerations impacting the use of telepsych in mental health and to enhance provider understanding of telepsych to enable more efficient and cost-effective care amid this pandemic and beyond. Telepsych users Using the internet and its applications can significantly expand the reach of quality mental healthcare by limiting geographic, economic, and human resource barriers.1 Because of COVID-19 containment efforts (including social distancing, quarantine, and isolation), healthcare providers face significant challenges in delivering care while complying with the rules, including scheduling patients and providing follow-up care.7 Because of these issues, telepsych services are expanding as in-office visits are declining globally.7 In lieu of potentially exposing patients and families to SARS-CoV-2 in the public arena, telepsych offers patients the ability to see their providers remotely, which may reduce patient anxiety, limit disease transmission, and allow providers to manage chronic mental health disorders.9 However, telepsych must be adapted to maintain a form of human contact while engaging in and maintaining continuity of care.1,9 Advantages. Telepsych can offer cost-effective care that benefits both patients and providers.10 This technology gives providers access to a larger number of patients, expands patient access to physicians and effective psychotherapies, and mitigates patient fear of privacy breaches and stigmatization because they are allowed to access healthcare from their home rather than in public.11 Patients who have limited mobility, lack transportation, or have insufficient economic resources may benefit from telepsych's accessibility in their homes. In addition, telepsych's cost-effectiveness and access to a larger pool of psychiatric providers is an attractive option for situations such as psychological treatment of children and adolescents in different settings.12 The implementation of telepsych is also creating new ways to ease workforce problems in attaining mental health care.11 Disadvantages. Despite its many advantages, the remote connection of telepsych can limit treatment efficacy.10 Concerns regarding stable access to video conferencing and the security of software can affect its use.10 With remote care, direct eye contact is often lacking, and providers may miss patients' lower and upper limb gestures due to the limited view.13 Providers need to observe these objective findings to formulate a comprehensive and accurate mental status examination. Distortion in communication may also alt