Telepsychiatry has its roots in Europe. In the 1920s and into the 1940s radio consultations were performed between European countries and sailors onboard ships or people on isolated islands who were ill. In the 1950s, radiology images were being transmitted.1 In 1959, the Nebraska Psychiatric Institute was using early videoconferencing to provide group therapy, long-term therapy, and consultation-liaison psychiatry.2 By the 1980s, telepsychiatry was increasingly common.
The New Freedom Commission on Mental Health emphasized the need for prevention and treatment of mental illness so that patients with mental health conditions can receive the care they need and become functional participants in the community.3 The Commission discussed videoconferencing and telehealth as a means of access to care. In 2015, approximately 60 million people in the US were living in rural areas.4 The popularization of telemedicine has been secondary to a direct need to serve these areas.
Benefits and effectiveness of telepsychiatry
The use of telepsychiatry to provide mental health services has the potential to solve the provider shortage problem that directly affects access to care. Telepsychiatry is not only effective and well accepted; it can also increase administrative efficiency while providing positive outcomes in most clinical settings. Hilty and colleagues5 reviewed the published literature on effectiveness of telemental health compared to services provided face-to-face. Their findings suggest that telemental health is not only effective for diagnosis and assessment across many populations and disorders in many settings, but it appears to be comparable to face-to-face care. Telepsychiatry has also been found to be effective in providing access to care for inmates and veteran populations.6,7
In a study that compared telepsychiatry with standard care, participants who received treatment via telepsychiatry had greater response and remission rates.8 Positive results were also seen in a study undertaken in a skilled nursing facility.9 The findings indicate that telepsychiatry provided efficient access to care compared with regular visits by a provider who would need to travel to the nursing home multiple times. A study by De Las Cuevas and colleagues10 also demonstrated the effectiveness of telepsychiatry and how it is equivalent to in-person evaluation. In a literature review of child and adolescent psychiatry articles, Diamond and Bloch11 found telepsychiatry to be equivalent to in-person consultations and no negative outcomes were reported. As evidence continues to emerge in support of telepsychiatry as a means to reach underserved patients, we hope to see it continue to evolve into a widely available method for delivering mental health services.
Despite empirical evidence for the effectiveness of telepsychiatry when compared with in-person care many psychiatrists are still not at ease with telepsychiatry. Including telepsychiatry in residency training curriculum can help increase the number of psychiatrists who will likely use it in caring for patients.
Dr Saeed is Professor and Chairman, Dr Pastis is Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
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