The Future of Mental Health Services – 12 Questions about Tele-Psychiatry with Dr. Arpan Waghray #mentalhealth #futureofhealth

This post is written in partnership with Providence St. Joseph Health

Recently, I was thinking about the natural disasters we’ve seen in 2017. Hurricane Harvey, Irma, Maria; the California wildfires; and earthquakes worldwide. All of the things we take for granted–food in the fridge, a warm bed, boxes of family photos, heirlooms, pencil marks on the doorframes–gone in an instant. How would I cope with such an unexpected and total loss? The grief would be overwhelming. But if I had to sit in a cold and clinical office filled with strangers just to get advice, I might dismiss it as more trouble than it’s worth. And in so doing, I’ve just rejected potentially life saving help. Now I’m traveling down a road without a map, and I’m bound to get lost.

 

There is still a stigma about mental health, and sometimes we perpetuate it ourselves. We are afraid we’ll have to wear a diagnoses like a scarlet letter, and we might blame ourselves for it.

This is where tele-psychiatry comes in.

Dr. Arpan Waghray

 

 

 

 

 

 

 

 

1. What is telemental health and how does it work?

Telemental health is the provision of mental health care from a distance. This is commonly delivered via live interactive videoconferencing . Telemental health (TMH) includes mental health assessment,treatment, education, monitoring, and collaboration. Patients can be located in hospitals, clinics, schools,nursing facilities, prisons and homes. TMH providers and staff include psychiatrists, nurse practitioners, physician assistants, social workers, psychologists, counselors, primary care providers and nurses.
The goal of the telehealth provider is to eliminate disparities in patient access to quality, evidence-based, and emerging health care diagnostics and treatments

2. What percentage of Americans are dealing with mental health issues?

Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.
Depression is the leading cause of disability worldwide .
Approximately 1 in 25 adults in the U.S.—9.8 million, or 4.0%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.
Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.
1.1% of adults in the U.S. live with schizophrenia.
2.6% of adults in the U.S. live with bipolar disorder.
6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year.
18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias
Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.

3. Are telepsychiatry services available for both adults and children?

Yes. Telepsychiatry is an innovative approach to extend the reach of child and adolescent psychiatrists and fill the gaps in care, particularly in rural or other underserved areas.There has been a rapid growth in the use of school-based telepsychiatry. It offers the opportunity to bring mental health treatment to a child’s natural setting and facilitates collaboration with teachers and other school staff. School-based telepsychiatry programs have reported higher follow-up rates compared to traditional community mental health settings.

4. What are the HIPPA requirements?

Use a secure, trusted platform for videoconferencing.
Make sure your audio and video transmission is encrypted. The Federal Information Processing Standard (FIPS) 140-2 is used by the United States government to accredit encryption standards. Encryption strengths and types can change.
Make sure your device uses security features such as passphrases and two-factor authentication. Your device preferably will not store any patient data locally, but if it must, it should be encrypted.
Compliance with HIPAA (Health Insurance Portability and Accountability Act of 1996) is essential. HIPAA sets a minimum federal standard for the security of health information. States may also set privacy laws that can be even more strict, so be sure to check any relevant statute for the state in which you practice.Just because software says its HIPAA-compliant isn’t enough.
Be sure your devices and software use the latest security patches and updates. Install the latest antivirus, anti-malware, and firewall software to your devices. If you’re part of an institution with IT staff, they should approve of and manage your device.

5. Is my privacy protected ?
Yes- see above note.

6. Is telepsychiatry as effective as regular visits?

Yes. Telepsychiatry’s evidence base is substantial and satisfaction is extremely high among patients, psychiatrists and other professionals.
Its effectiveness is comparable to in-person care in terms of therapeutic engagement, quality of care, validity/reliability of assessment, and clinical outcomes.

7. Is there help available at night , holidays or weekends?
Yes.

8. How long is a typical visit?

Simmilar to in person visit. Most initial psychiatric visist tend to be an hour long and follow up visits vary depending on the needs.

9. In what circumstances would Telepsychiatry not be appropriate?

If the patient prefers not to avail this technology to receive care for any reason. Obtaining the patients consent and respecting their preference is very important.
We might have some other limitations when a physical exam is needed but under most circumstances, Psychiatry being a highly cognitive discipline lends itself naturally to Telemedicine.

10. Would over the phone visits also be considered or would only video be used?

We could always use over the phone visits, secure messages via their medical record as well as videoconferencing based on the clinical needs.

11. Is telepsychiatry ever appropriate for use in a crisis situation?

Yes, however if someone is actively suicidal or very psychiatrically unstable and needs to be in a hospital, then they should recieve care in a structured supervised setting. This could be delivered via Telemedicine as well in those care settings.
More importantly, Many psychiatric crisis could be averted by providing timely access to good mental health care . If someone is unwell and unable to visit their mental health provider, the care could be brought to them in a timely manner via Telemedicine that can be tremendously helpful to prevent things from getting worse.

12. If telepsychiatry isn’t available in my area, what steps can I make to help them become available?

Telepsychiatry services should be available in every part of the Country, especially in our most underserved regions. It might help to ask your insurance provider. In 32 states Telepsychiatry is manadated to be covered in parity to in person care.It is also covered by medicaid and medicare in health care service shortage areas.

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