Telepsychiatry

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. As of 2011 it has been the most successful of all the telemedical applications to date, as it typically only needs adequate videotelephony service between the patient and the psychiatrist, especially for follow-up treatments.

One of the drivers behind telepsychiatry's growth in the United States is a national shortage of psychiatrists, particularly in speciality areas like child and adolescent psychiatry. There has been a national rise in psychiatric consumer needs but few facilities have the staff to properly treat all patients. Thus telepsychiatry services have become an alternative.

Telepsychiatry has a variety of sub-specialties based on different applications of service delivery.

For example, forensic telepsychiatry is when an inmate is connected to a remote psychiatrist or nurse practioner for psychiatric evaluations, medication consultations, suicide watch, required pre-parole evaluations and more. Forensic telepsychiatry significantly cuts down correctional facilities costs because inmates no longer need to be escorted and transported to distant off site appointments and psychiatric interventions. , Home-based telepsychiatry, is another sub-specialty where the patient is in his or her own home (or office), accessing the physician by a webcam and high-speed Internet service. This sub-speciality raises questions of security and possibly HIPPA violations, so while an increased number of individual psychiatrists are adopting this method with willing, interested patients , larger telepsychiatry service providers focus on delivering telepsychiatry to formal facilities where secure video links can be established thus avoiding legal privacy issues.

Another common application is its use for patients in rural or under served areas. As of 2010 there were a number of grassroot telepsychiatry programs being created in the United States and other countries to address such problems. In the U.S., Medicare and the various state Medicaids, as well as nearly all private health insurance providers, provide payments for telepsychiatry as for face-to-face psychiatric medication management visits.

A quickly expanding sub-specialty of telepsychiatry is "emergency psychiatry." Research is currently on-going to develop the guidelines required to provide consultation for emergency psychiatric patients such as the evaluation of suicidal, homicidal, violent, psychotic, depressed, manic, and acutely anxious patients. however, emergency telepsychiatry services are being provided to hospital emergency departments, jails, community mental health centers, substance abuse treatment facilities, and schools. Emergency telepsychiatry solves the problem of understaff and over worked hospital emergency departments and increases patient throughput and emergency room disposition. Rather then employing, expensive, short term locus tenens doctors or having emergency rooms physicians evaluate the psychiatric stability of their patients, telepsychiatry can be used to decrease hospital costs and increase patient access to behavioral health evaluations done by actual psychiatric specialists.

Another type of telepsychiatric evaluation is called urgent evaluations. While emergency evaluations are typically conducted within one hour of the remote telepsychiatry service being contacted, urgent evaluations are conducted within four. Urgent evaluations might be used in cases of required psychiatric evaluations before certain surgeries, for example.

The application of telepsychiatry services are expanding into other areas such as military bases, cruise ships, nursing homes, med/surg floors, crisis centers and disaster sites.

Further reading

• Frueh BC, Monnier J, Elhai JD, Grubaugh AL, Knapp RG (2004). "Telepsychiatry Treatment Outcome Research Methodology: Efficacy Versus Effectiveness". Telemedicine Journal and E-health 10 (4): 455–8. doi:10.1089/tmj.2004.10.455. PMID 15689650. 
• Hilty DM, Marks SL, Urness D, Yellowlees PM, Nesbitt TS (January 2004). "Clinical And Educational Telepsychiatry Applications: A Review". Canadian Journal of Psychiatry 49 (1): 12–23. PMID 14763673. 
• Frueh BC, Monnier J, Elhai JD, Grubaugh AL, Knapp RG (2004). "Telepsychiatry Treatment Outcome Research Methodology: Efficacy Versus Effectiveness". Telemedicine Journal and E-health 10 (4): 455–8. doi:10.1089/tmj.2004.10.455. PMID 15689650. 
• Monnier J, Knapp RG, Frueh BC (December 2003). "Recent Advances In Telepsychiatry: An Updated Review". Psychiatric Services 54 (12): 1604–9. doi:10.1176/appi.ps.54.12.1604. PMID 14645799. 

External links

• http://www.cpa-apc.org/publications/archives/Bulletin/2003/october/hilty.asp A review on the effectiveness
• A feasibility study
• American Association for Emergency Psychiatry