Evolution of Telepsychiatry: From Alternative Back-up Modality to Mainstream Necessity
The COVID-19 pandemic has transformed Telepsychiatry from an alternative back up model of care reserved for rural and underserved settings to mainstream necessity utilized across the field.
What is Telepsychiatry?
Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. It is used to deliver psychiatric assessments and care through telecommunications technology, most often in the form of videoconferencing. Despite its relatively newfound wide scale exposure, forms of telepsychiatry have been used since as early as 1959, when the Nebraska Psychiatric Institute used a 2-way television circuit for group therapy, consultation-liaison psychiatry, and medical student training at the Nebraska State Hospital in Norfolk. Throughout the following decades, the use of the videoconferencing model expanded so that by the 2000s, telepsychiatry was validated as an equivalent modality to the in-person model of care in diagnostic reliability, effectiveness of treatment, and patient satisfaction. However, despite convincing data supporting its use, telepsychiatry remained to be viewed as an alternative option for psychiatric care delivery limited to underserved and academic grant-based settings.
So, how did a modality that was primarily used as an alternative option reserved for underserved, rural geographic areas become a mainstream component of psychiatric care delivery? Enter March 2020.
The Impact of COVID-19 on Mental Health
The impact that the COVID-19 pandemic had on the healthcare industry cannot be understated. For months, hospital waiting rooms and emergency departments were lined with people afflicted by the virus. The effects of the pandemic took a physical toll on millions of individuals, but mentally there was a completely different challenge rearing its head. The stresses of physical isolation and fear led to a meteoric rise in mental health needs. Surveys collected by the CDC in 2021 showed increases in the following behavioral health symptoms that nearly doubled the rates expected prior to the pandemic:
- 31% reported symptoms of anxiety and depression
- 26% reported stress related symptoms
- 13% reported a start or increase in substance use
- 11% reported serious thoughts of suicide within the past 30 days
Children and adolescents appeared to have been impacted the most. In fact, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association have declared a national emergency in children’s mental health.
The Pandemic Fueled the Expansion of Telepsychiatry
A sharp increase in mental health needs coupled with attempts at minimizing in-person care pushed through previous barriers and propelled telepsychiatry to the forefront of psychiatric care delivery. Due to social distancing and attempts at minimizing in-person contacts, the virtual care model became a reliable method for psychiatric care delivery across the field. Additionally, reimbursement barriers as well as state and federal regulations related to remote prescribing have been lifted, which historically have been major roadblocks to expansion of virtual care.
Paradigm Shift
The impact of telepsychiatry post-coronavirus is undeniable. A survey conducted by the America Psychiatric Association (APA) showed that prior to pandemic, 64% of psychiatrists reported seeing zero percent of their patient caseload via telehealth. As of January 2021, 81% reported that they see between 75 – 100% of their patients via telehealth.
The use of telepsychiatry is also seen as beneficial in several settings including outpatient, emergency departments, corrections facilities, consultative inpatient, and inpatient psychiatric units. It is also important to highlight the advantages of telepsychiatry compared to a traditional in-person model, which include:
- Faster and improved care delivery
- A reduction in the need for trips to the emergency room
- Improved continuity of care and follow-up
- Improved throughput in emergency departments, and
- Cost savings of up to $2,300 for inpatient costs
The Future of Telepsychiatry
Long gone are the days when telepsychiatry was relegated to rural and underserved geographic areas – it is here to stay as a mainstream model of care. As we face the many facets of post COVID recovery, it is unlikely that we will see a decline in demand for psychiatric care. To meet the vast demands, psychiatrists will continue to utilize telepsychiatry especially in the setting of convenience, good clinical reliability, and patient-provider satisfaction. Patients in many cases are going to prefer the convenience, privacy, efficiency, and reduced stigma associated with virtual visits. Considering favorable clinical evidence supporting use and increased demand for access to psychiatric care, it is likely that telehealth visits will remain reimbursable. Furthermore, with advances in technology and integration, telepsychiatry will continue to expand its reach in providing access to psychiatric care, only with fewer barriers and even greater impacts!
About TeleSpecialists
TeleSpecialists is a physician-owned management service organization committed to providing exceptional and comprehensive patient care via telemedicine. Founded in 2013, TeleSpecialists has rapidly expanded to over 100 board-certified physicians serving over 250 hospital locations across the US. TeleSpecialists is accredited by The Joint Commission and is an ISO 9001:2015 certified organization.
About the Author
Dr. Kristina Bedynerman is board-certified in psychiatry by the American Board of Psychiatry and Neurology and is a Fellow of the American Psychiatric Association. She obtained her medical degree from the American University of the Caribbean School of Medicine and completed her residency in psychiatry at SUNY Upstate Medical University. She joined TeleSpecialists in 2021.
