Telepsychiatry: Promise, potential, and challenges

Abstract

Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called ‘Mental Health Gap’. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store–forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.

How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations

“…Thus, a large variety of interventions are designated alternatively by the terms eHealth and e-support or mHealth and m-support when online technologies are reached via mobile or smartphone. Research has stressed the fact that this emerging kind of support is a cost-effective and ongoing resource that defies geographical, timely, and social barriers (the “mental health gap”) [12,13] without replacing the traditional system [14,15]. While there has been an increase in the number of people using the Internet for information and support relating to mental health disorders, available resources—from psychoeducation to self-help therapy, peer-to-peer support forums, and e-counseling—focus mainly on depression, anxiety, and bipolar disorder, with a particular interest in the monitoring of signs and symptoms by smartphone or digital application [10], together with psychoeducational programs [9] and not so much on schizophrenia spectrum disorders or other psychotic disorders.…”

Asynchronous Telepsychiatry in Maharashtra, India: Study of Feasibility and Referral Pattern

“…The chief objectives of the National Mental Health Program[67] are to ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population and to apply mental health knowledge in general health care and in social development. Telepsychiatry holds promise to further such objectives.…”

Telepsychiatry and comprehensive mental health India

“…In the discussion room, communication proceeds between a psychiatrist, the patient, and caregivers through flat screen TVs and state‐of‐the‐art high‐definition cameras using a wireless internet connection. Subsequently a teleconsultation, like a medicine, is recommended by the psychiatrist to the telepsychiatry clinic organizer in the bus and distributed through the on‐board pharmacy …”

“…Subsequently a teleconsultation, like a medicine, is recommended by the psychiatrist to the telepsychiatry clinic organizer in the bus and distributed through the on-board pharmacy. 21 At present, the service focuses only on those with serious mental disorders. Currently, about 1500 patients have availed of the services offered under the SCARF Telepsychiatry in Pudukkottai (STEP) Program.…”