Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care

Abstract

The coronavirus disease 2019 pandemic is a seminal event that is precipitating radical transformative change to our society and health care systems. Social distancing, isolation, and deployment of suppression and mitigation strategies are directly influencing the morbidity and mortality rates of the pandemic. 1 Remote communication technologies are being broadly deployed in all spheres of medicine to support these strategies while still delivering effective health care. Telepsychiatry, in the form of videoconferencing and other technologies, was uniquely positioned to push the field of psychiatry to the forefront of these efforts. Prior to the pandemic, telepsychiatry had built a strong scientific foundation and real-world evidence base, demonstrating its effectiveness across a range of psychiatric treatments, populations, and settings. 2-5 Although previously leveraged temporarily in disaster response, 6 telepsychiatry's use in the COVID-19 pandemic has been distinctive and will have long-lasting and wide-ranging effects on the field of psychiatry, including mental health care delivery and configuration and patient experience and expectations.Globally, health care systems, psychiatric organizations, and individual clinicians have been rapidly virtualizing their operations. These activities have included the extensive use of videoconferencing, either expanding or initiating direct clinician-home to patient-home services, and partially or fully virtualizing administrative operations. Implementation has occurred at a pace never experienced in telemedicine, with many large organizations fully virtualizing in a matter of days. Historically, full implementation of telepsychiatry, especially in large organizations, could take months to years. Rapid virtualization has shown that clinicians, patients, and systems can quickly adapt to telepsychiatry, although not without challenges and lessons learned. Previous barriers including regulatory constraints, system inertia, and general resistance to telepsychiatry have disappeared, at least temporarily; technical innovations abound as clinicians and organizations work to best configure telepsychiatry to current clinical needs and environments.Historically, telepsychiatry has experienced a substantial evolutionary period with the expansion of the internet and the use of other technologies and peripheral devices that are ubiquitous to consumers and based largely on commercial uses and applications. Currently, in response to the COVID-19 emergency, there has been an unprecedented revolution in the telehealth landscape with the lifting of federal and state regulatory barriers to telemedicine and telepsychiatry. Such changes include the suspension of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which placed VIEWPOINT

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“…On the other hand, access to direct emergency and outpatient psychiatric care was reduced ( Hao et al, 2020 ). Consequently, mental health practitioners and policymakers called for research on regulations and implementations of alternative clinical interventions, such as telepsychiatry ( Kannarkat et al, 2020 ; Shore et al, 2020 ).…”

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“…44 Another compensatory measure that has been adopted in psychiatry as well as in many medical specialties is a transition to telemedicine with out-patient tele-visits (via telephone, chat or video call). 45 Mental health seems a good candidate for telemedicine as a physical examination is not always required. 46 So far, during the pandemic, it has been a practical alternative and many problems have been solved this way, especially for patients who have been followed-up for some time already and who are able to maintain a close relationship with their therapists this way.…”

Psychotherapie in Zeiten der Covid-19-Pandemie – Eine kurze Reflexion

“…Dieses telemedizinische Angebot wurde von Überweisern und Patienten dankbar angenommen; die Skepsis, dass dies nicht als gleichwertiger Ambulanztermin wahrgenommen würde, war auf Behandlerseite in der Rückschau größer als bei den Patienten. Unter dem Stichwort der "Telepsychiatry" wird diese Entwicklung derzeit auch international sehr gefördert [7] und wir wiesen bereits vor der Covid-19-Pandemie darauf hin, dass Digitalisierung und Psychotherapie keinen Widerspruch bedeuten muss [8]. Eine besondere Herausforderung an den psychotherapeutischen Ambulanzbetrieb stellt aber derzeit die vorsichtige Öffnung seit dem 4.…”