Telepsychiatry uses telecommunication technologies to provide psychiatric services remotely. It allows patients in underserved areas to access mental healthcare. A successful telepsychiatry program requires verifying patient identity and location, obtaining informed consent, ensuring private physical environments, coordinating with treatment teams, managing emergencies, using technical guidelines, and addressing challenges like remote locations and patient disabilities. Overall, telepsychiatry increases access to services for patients who otherwise may go without care.

1. Best Practices in
Psychiatry
and
Long Term Care:
TELEPSYCHIATRY
Erin Morrison, MD

2. What is Telepsychiatry?
Telepsychiatry, also known as e-psychiatry, is the
application of telemedicine to the specialty field
of psychiatry.
Telemedicine is the use
of telecommunication and information technologies in
order to provide clinical health care at a distance.
Tele mental health care is the use of tele-
communications technology to provide mental
health services to individuals in communities or locations
that are underserviced, typically as a result of geographic
isolation.
• Examples: providing health workers in remote areas with continuing education on mental health topics,
videoconferenced consultations on routine and urgent mental health cases using a "virtual" case
management team, and providing direct mental health care services through two-way interactive
systems. One of the most controversial telemental health care applications is providing treatment
services over the Internet directly.
Wikipedia, The Free Encyclopedia

3. Provider and
patient identity
and location
Challenges and Patient
Benefits appropriateness
Elements of
Technical
guidelines
Video-Based Informed
consent
Mental Health
Services1
Emergency Physical
management environment
Collaboration
Medical issues with treatment
team
1American Telemedicine Association

4. Provider + Patient Identity and Location
Verify patient identity and
location
(must verify patient location
for provider state licensure
rules)
Contact information for
Expectations regarding
provider and patient should
contact between sessions
be exchange in case of
should be addressed prior
dropped sessions or for
to the first session
routine questions
1American Telemedicine Association

5. Patient Appropriateness
Situation dependent, but possible in both:
• Home care setting-must consider degree of patient independence
and have more comprehensive emergency plan in place
• Supervised setting- more issues with privacy
Diagnostic considerations-telepsychiatry has been
successfully employed in patients with:
• Psychosis
• Panic disorder
• Cognitive impairment (though may not be appropriate for
unsupervised settings)
“To date, no studies have identified any patient subgroup that does
not benefit from, or is harmed by, mental healthcare provided
through remote videoconferencing.”1

6. Informed Consent
 Are there any differences?
 Informed consent process is the same as for face to face
care, but must ALSO include (if applicable):
An agreed upon Conditions under which
Process by which
Confidentiality limits in emergency plan telepsychiatry services
patient information will
electronic (patients in settings may be terminated and
be documented and
communication without clinical staff a referral made to face-
stored;
immediately available) to-face care
It is very important to use language the patient can understand when discussing
technical issues (such as data encryption or technical failure of equipment)

7. Physical Environment
Rooms/environments should be comparable to a
standard services room
Ensure privacy so clinical discussion cannot be
overheard
Presence of attendants or family members is situation
dependent and subject to patient consent:
For cognitively impaired patients it is often necessary
for an attendant to be present in the room:
• to assist with orientation
• to tend to audio or visual sensory deficits
• for patient comfort (a familiar caretaker often eases patient anxiety)

8. Communication and Collaboration with
the Patient’s Treatment Team
 Essential in the geriatric population
 The geriatric patient often has multiple medical problems needing a full
workup (appropriate laboratories, radiologic, and other diagnostic
procedures). This communication can require more effort when one or
more members of the treatment team is located at a remote site, but
can still be accomplished.
Some solutions:
• schedule monthly phone/video treatment team meetings
• ensure all available records for other providers are
available during session
• ensure that the facility (or other providers) have contact
information for the telepsychiatry provider

9. Coordinating Medical Issues-
Who Does What?
Medical
work up
Referrals Ordering or
available for prescription
face to face s/ laboratory
care studies
Follow up of
Management
laboratory or
of medication
radiological
side effects
studies

10. Emergency Management
 Based on the facility’s emergency procedures

11. Technical Guidelines
1American Telemedicine Association

12. Technical Contingencies
 Technology “breakdown”
• Poor/no audio
• Poor/no video
• Dropped sessions
 Backup plans
• Discussed with patient before session
• Alternate contact information
Backup plans include calling the patient or facility via telephone and
attempting to troubleshoot the issue. Sessions may be continued by
telephone (situation dependent).

13. Privacy
 Recognized encryption standards for
transmission of video & audio
• Federal Information Processing Standard
• Advanced Encryption Standard (AES)
 Physical environment (facility limitations)
 Appropriate security of medical records
1American Telemedicine Association

14. Challenges
 Remote facilities and available internet speed
 Patients with sensory impairments - The patient
end would ideally have large monitors, good audio
capabilities, and high bandwidth and video
resolution to make sure there is a large and clear
picture for the elderly
 Increased reliance on facility staff, e.g.:
 to assist with patients with disabilities,
 to give limited physical exams (AIMS test), and
 occasionally track down or confirm medication/lab values

15. Overall Benefits - Options!
 Choice of providers
 Transportation
 Scheduling
Bottom Line:
Delivering services to patients who would otherwise go without

16. References
1. Coleman, M., Dennison, O., Drude, K., Goldenson, M., Hirsch, P.,
Kramer, G., … Zucker, M. (2013). Practice Guidelines for Video-
Based Online Mental Health Services-DRAFT. American
Telemedicine Association. Retrieved from
http://www.americantelemed.org/practice/standards/ata-standards-
guidelines