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Telepsychiatry: What is It and What Does it Do

Outline: Telepsychiatry is the application of telemedicine to the specialty field of psychiatry.

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Telepsychiatry is currently one of the most effective ways to increase access to psychiatric care for individuals living in underserved areas.

Telepsychiatry typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing.

Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups.

Most commonly, telepsychiatry encounters take place at medical facilities under the supervision of onsite staff, though at-home models are becoming accepted as long as they are in compliance with HIPAA standards. In many regions, qualified professionals are scarce, insurance coverage varies, wait times are long, and appointments are frequently scheduled during work or school hours. Only about 20% of adults with mental health disorders see mental health specialists. Others go untreated or see general practitioners for help. Increasingly, mental health organizations are addressing these challenges by using telehealth tools to treat patients with emotional and psychological disorders.

Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations. The term eHealth is often used, particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology.

The most common means of insurance coverage for telehealth services among the United States is to incorporate coverage into the Medicare program. Reimbursement for Medicare-covered services must satisfy federal requirements of efficiency, economy and quality of care. Since 1999, Medicare and Medicaid reimbursement for all kinds of telehealth services have expanded, requirements of providers have been reduced, and grants have been given to support telehealth program adoption. For 2014, the Center for Medicare (CMS) services does cover telemedicine services, including telepsychiatry in many areas.

Telepsychiatry includes a variety of sub-specialties based on different contexts of service delivery:

Routine Telepsychiatry - A consistent provider or small group of providers serve a regular caseload of consumers in previously scheduled blocks of time. Remote providers can be consulted for medication management, treatment team meetings, supervision, or to offer traditional psychiatric assessment and consultations.

Forensic telepsychiatry - The use of a remote psychiatrist or nurse practitioner for psychiatry in a prison or correctional facility, including psychiatric assessment, medication consultation, suicide watch, pre-parole evaluations and more.

Crisis telepsychiatry - Guidelines are being developed for the provision of tele-psychiatric consultation for emergency psychiatric patients, such as the evaluation of suicidal, homicidal, violent, psychotic, depressed, manic, and acutely anxious patients.

In-home Telepsychiatry - Psychiatric treatment of patients who are at home or in another private setting is called home-based telepsychiatry, and it can require only a webcam and high-speed internet service.

Overall, telepsychiatry provides increased access to services and has helped enhance the provision of services to families with children and other patients who are homebound. Patients participating in telepsychiatry say they are satisfied with the care they are receiving and that they feel telepsychiatry is a reliable form of practice. However, the technology is not appropriate for every situation. Just as telehealth cannot address all physical ailments, telepsychiatry is not right for all mental conditions. "Psychiatrists should be careful when providing care in an in-home setting and choose carefully which patients are right for telepsychiatry treatment," e-Psychiatry said in a blog post.

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