Mental Health and Telemedicine: Benefits, Challenges and More
Authored by Ayesha Rajan, Research Analyst at VIKRITI Management Consulting
Telemedicine is the use of telecommunication tools to provide services to patients without them coming into an office or hospital. In an age where nearly everything is digital, this is a naturally occurring idea that has many benefits – many patients with chronic conditions can struggle with a task like driving and may not be able to shoulder the burden of transportation services, many others can be immunocompromised to the degree that going to a clinic or hospital puts them at risk. As we continue to observe Mental Health Awareness Month in May, we will look at a subsect of telemedicine called telepsychiatry. Telepsychiatry is a branch of telemedicine that directly serves patients struggling with mental illness. In our last article we touched on research studies in mental health because the approach to mental health studies is so different in comparison to other medical studies. Similarly, mental health has its own set of challenges and benefits in relation to telemedicine.
Telepsychiatry provides the benefit of convenience and ease to those struggling with mental illness and for those who can barely pull themselves out of bed, this is a great way to start looking after your mental health. It can also be useful for those with busy schedules or without access to transportation as it provides them a way to protect their mental health with ease. It also helps prevent stigma and promotes privacy that can be lacking in a physical psychiatrist’s office which can encourage more people to make appointments without fear of scrutiny (Landon). Furthermore, telepsychiatry can be an important breakthrough for many people in rural areas where 65% of people cannot access mental health care even if they need it (Willingham). Another especially relevant benefit in today’s world is for immunocompromised patients who have the option to have sessions without leaving their home and putting themselves at risk. Given that mental illness is more common amongst those with chronic illnesses such as: cancer, coronary artery disease, diabetes, epilepsy, multiple sclerosis, stroke, Alzheimer’s, HIV/AIDS, Parkinson’s, lupus, and rheumatoid arthritis, this is a huge selling point. (NIMH)
One of the challenges that telepsychiatry faces is the comfort of the patient. For several reasons, a patient may feel more comfortable talking to someone about their personal lives in a setting where a private conversation can be guaranteed. A home setting means that a patient may not feel comfortable talking about the people in their home and that might be a key part of their provider’s understanding of their situation. A Zoom/Skype/FaceTime meeting can also take away a provider’s ability to interpret changes in physical demeanor and body language throughout the conversation and that can be a significant part of their analysis of a patient. These challenges are unique to telepsychiatry but telepsychiatry also struggles in the same areas as telemedicine as a whole. The University of Arizona’s Telemedicine Program has a lot experience in this area and has identified a few problems – the first issue at hand is how to bill telemedicine. Currently, Medicare only covers telemedicine for patients with conditions that have persisted for one year but may not cover a telemedicine visit for a patient hoping to be seen efficiently for a general wellness check-up. Another issue that telemedicine faces is continuity across the Electronic Health Record systems; this means that the addition of a telemedicine option may not be compatible with established workflow and can prevent physicians from keeping detailed records. Additionally it can cause problems if a patient chooses to see a different physician and their original physician does not have enough collected information for the case at hand (Varshneya). There are also issues regarding a patient’s ability to use a software they are unfamiliar with and a concern for privacy even if a network is highly secure.
Rules and Regulations
Under the Coronavirus Preparedness and Response Supplemental Act, non-HIPAA compliant videoconferencing has been allowed for telepsychiatry visits which means patient’s do not need to install new software but can proceed using FaceTime or Skype (APA). This increases ease of use, however, there are many other challenges regarding licensure and prescriptions. In terms of licensure, CMS is currently waiving the requirement that practitioners be licensed in the state they are providing services but once things begin to go back to normal, this will likely change. This is unfortunate for psychiatric patients who feel comfortable with their doctors but have to move out of state or have to give up their appointments while traveling abroad. Under the Ryan Haight Act, a provider must conduct an in-person examination to establish a doctor-patient relationship before prescribing medications – the DEA has suspended this act as long as we are under an emergency declaration (APA). This, of course, is a much more divisive issue but a conversation worth having as telepsychiatry becomes more mainstream.
Telepsychiatry is an amazing resource for those struggling with mental health issues. While there are a lot of challenges facing the field of telepsychiatry, there are also many benefits. With the rise in telemedicine appointments due to Covid-19, telepsychiatry will hopefully continue to be an option for those who feel that it is the right choice for their mental health needs.
How You Can Look After Your Mental Health During the Pandemic
The World Health Organization has listed the following items as methods and tools to cope with the stress and anxiety surrounding the COVID-19 pandemic:
- Stay informed by checking the news once or twice a day
- Keep a routine by maintaining your previous routine or creating a new routine
- Maintain a healthy lifestyle be eating healthy meals, exercising regularly, getting enough sleep, and maintaining personal hygiene
- Maintain social contact by checking in on and catching up with friends and family
- Limit screen time in terms of video games and social media
- Limit alcohol and drug use
Making sure that you are checking in with yourself and monitoring your mental health is always important, but it is even more so as we all face the struggles of a pandemic. By taking care of your body and ensuring you have enough time to rest, you can set yourself up to adapt to a trying situation. Additionally, be sure to reach out to loved ones and check in on them as well.
“Chronic Illness & Mental Health.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml.
Larson, Chase. “How Telemedicine Is Changing Mental Health.” How Telemedicine Is Changing Mental Health, blog.evisit.com/how-telemedicine-is-changing-mental-health.
“Telepsychiatry and COVID-19.” APA Resources on Telepsychiatry and COVID-19, Updated 1 May 2020, www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/apa-resources-on-telepsychiatry-and-covid-19.
Varshneya, Rahul. “7 Telemedicine Concerns and How to Overcome Them.” 7 Telemedicine Concerns and How to Overcome Them, 2018, telemedicine.arizona.edu/blog/7-telemedicine-concerns-and-how-overcome-them.
Willingham, AJ. “There’s a Severe Shortage of Mental Health Professionals in Rural Areas . Here’s Why That’s a Serious Problem.” CNN, Cable News Network, 22 June 2018, www.cnn.com/2018/06/20/health/mental-health-rural-areas-issues-trnd/index.html.