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Because of the COVID-19 pandemic, mental health clinicians are being challenged by the need to provide care via telepsychiatry methods, often for the first time. But clinicians face enormous amounts of sometimes confusing or contradictory information on this topic. To provide clear guidance on how to offer good care in these conditions, U.K. investigators reviewed evidence and compared English-language guidelines and other advice on telehealth methods from several international groups.
Overall, evidence strongly supported the use of telepsychiatry methods, although little guidance specifically addressed telepsychiatric management of patients with learning disabilities, psychosis, personality disorders, or eating disorders. Clinicians must carefully attend to communication style (verbal and nonverbal), contingencies (backup plans in case of technical or clinical problems), consent, confidentiality, and confidence (in knowing how to use the systems). Clinicians should give attention to the layout and online appearance of their physical space. They also need to be fully acquainted with local regulatory issues — e.g., regarding compliance with patient privacy laws, medicolegal concerns, administering treatments (e.g., prescribing across state and other geographic boundaries), documentation requirements, and availability of additional in-person assistance during psychiatric emergencies. Written checklists at the start of treatment can be helpful; the authors noted one derived from the American Psychiatric Association's Telepsychiatry Toolkit.
Smith K et al. COVID-19 and telepsychiatry: An evidence-based guidance for clinicians. JMIR Ment Health 2020 Jul 10; [e-pub]. (https://doi.org/10.2196/21108)
Comment
Clinicians initiating telepsychiatry practices would do well to study the many readily available online presentations and guidance from their local and national professional organizations. Several difficult-to-manage patient populations might be unsuitable for exclusively telepsychiatry services, requiring either solely in-person care or hybrid approaches that combine telepsychiatry with other technologies or in-person care. While extremely helpful and likely to grow exponentially, telepsychiatry still has substantial limitations in specific patient populations (e.g., older patients).