The evolution and history of telepsychiatry and its impact on psychiatric care: Current implications for psychiatrists and psychiatric organizations

Abstract

We have reached a critical convergence in psychiatry between the changing systems of health care structure and funding, our evolution into a technology-based society, and growth in the science and delivery of psychiatric treatments. Fostered by this convergence is the maturation over the past two decades of telepsychiatry, in the form of live interactive video conferencing, as a critical tool to improve access, increase quality and reduce costs of psychiatric treatment. This article reviews the history and evolution of telepsychiatry including implications for the field in order to provide individual psychiatrists and psychiatric organizations guidance on how to formulate current and strategic directions. This article begins with a broad overview of the history of medicine providing contextualization of the development of the field of telepsychiatry. It concludes with projected trends and recommendations.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…90 Fortunately, as the technology advances rapidly, technical problems become less substantial. 8,12,47,91 The same telepsychiatry interventions with better technologies may even improve the present results. 91,92 Unfortunately, previous studies abound with examples of technical difficulties such as sessions unable to start, spontaneous disconnections, or poor audio/visual quality, and audio/visual lag.…”

“…20,38,46 Like patients, clinicians also report improved attitudes toward telepsychiatry after trying it, suggesting that increased exposure for clinicians may be important to alleviate their concerns about rapport. 35,[47][48][49][50] Where organization level barriers have been eliminated, the most frequent barrier…”

“…19,106 In addition, the understanding of how technology affects patient-doctor relationships, practice, and clinical outcomes has not kept pace with the rapidly changing technologies. 12,47 Additional studies to address these concerns would strengthen the literature and mitigate clinician skepticism.…”

Telepsychiatry and social psychiatry

“…Shore (2015) reminds us that video-conferencing and the use of technology dates back to the 1950s. Technical advances since then have led to the development of telemedicine, teleradiology and telepathology.…”

“…This is particularly of interest to rural areas (Brown, 1998) where access to services and investigations may be problematic. Shore (2015) points out that telepsychiatry can do several things. It can improve healthcare for individuals, advance public health (especially public mental health) and help reduce costs through quality improvement (Richardson et al, 2001).…”