E-psychiatry uses electronic means like the internet and mobile devices to deliver mental healthcare. It represents a cultural shift by empowering patients through increased access and choice. Online interventions can be accessed 24/7 and involve synchronous video/voice or asynchronous text communication. While psychiatry has traditionally relied on in-person consultations, technology allows for more objective assessment and remote monitoring. E-psychiatry helps address the large treatment gap and can incorporate real-time data collection. It shows potential for conditions like depression and anxiety but may not replace regular psychiatric care for more severe or complex issues. Concerns include effectiveness, guidance, and replacing conventional services, so e-mental health is best viewed as complementary.

1. E - PSYCHIATRY
Presented By
Dr Manjunath Huliyappa
MBBS DPM
Psychiatrist
Sir C V Raman General hospital Indiranagar Bengaluru

2. DEFINITION
 E-health and m-health describe the delivery
of healthcare by electronic means via the
internet using a variety of devices including
mobile phones, remote monitoring devices
and other wireless devices

3. E- PSYCHIATRY
 E-mental health is not just about technology,
but represents a cultural change in mental
healthcare by empowering patients to
exercise greater choice and control.
 The provision of online psychological
interventions
 Potentially accessible 24*7*365
 Using synchronous video/voice or
asynchronous text communication.

4. THE PAST
 Mental health professionals have historically been
reliant on face-to-face consultations in clinic settings
away from the normal lives of their patients
 In mental healthcare, assessment and diagnosis is
still largely based on subjective clinical judgements
about symptoms and behaviour.
 Technological innovations have the potential to bring
more objectivity and reliability to these processes of
assessment, diagnosis and monitoring

5. WHY TO CHANGE
 Change is good
 Psychiatry should incorporate the changing
world and be fit to it
 Push by government and private agency by
better funding for research
 Huge treatment gap
 Currently 86% penetration of mobile internet

6. EARLY YEARS
 Informal telemedicine started 100 years back
 First article on Telemedicine in 1998
 First paper on E-psychiatry presented in
2000
 Maximum literature available after 2007
 First international conference of e-mental
health held in 2009 in Amsterdam,
Netherland

7. MENTAL HEALTH TREATMENT GAP
 More than 70% of psychiatric, substance use
and neurological problem patients could not
get adequate evidence based treatment
 This is very large in developed countries also
e.g. 22% of Americans receive adequate
treatment
 Treatment gap in INDIA - published by
NIMHANS in November 2016 - about 80%
average

8. E – PSYCHIATRY TOOLS
 E-mail
 Non interactive proforma
 Computer based therapy
 Interactive programme
 Therapy assisted by qualified person
 Mobile apps monitoring the person

9. AREAS OF E-MENTAL HEALTH DELIVERY
 Screening
 Assessment
 Monitoring
 Interventions
 Social support

10. APPLICATIONS INVOVELED
 sensor technology
 online psychological therapy
 remote video consultation
 mobile applications (‘apps’)
 therapeutic gaming programs, robotic simulation and virtual
reality systems
 consumer information portals
 online support groups, forums and social networks
 online assessment or diagnostic tools
 blogs and podcasts
All present real opportunities to engage and empower patients
and create novel approaches to assessment , intervention and
treatment adherence for mental health problems

11. APPS
 Self management app
 App for improving thinking skill
 Skill training app
 Illness management and supportive care
 Passive symptom tracking
 Data collection

12. CHALLENGES IN INTRODUCING TECHNOLOGY
• Illiteracy
• Digital divide
• Old age
• Third world countries
• Cognitive decline in some disease
• Specialists need to be trained
• Not everyone has access to a computer or video
monitor
• Language barriers
• Inertia in starting the services delays the use of such
services by many professionals.

13. USES
• Pick up early signs of relapse
• Real time data
• Data for clinical, epidemiological and public health
research
• 24*7*365 service
• stand-alone systems offering prevention, self-help and
self-care approaches through websites
• Shortens wait times
• Reaches across time zones
• Improves accessibility in rural/remote areas and inner
cities
• Makes it easier to get service in your language
• Cost-effective service delivery
• Tailor services to people with specific habits/genetics

15. BENEFITS OF E-MENTAL HEALTH
• Convenient and flexible – can be accessed anytime and
anywhere, and material can be reviewed as often as required.
• Low or no service cost to patients – many interventions are
free, although related costs such as mobile data or internet
download limits should be taken into account.
• Fills service gaps – can provide an introduction to therapy, or an
alternative for people averse to face-to-face treatment.
• Saves practitioners’ time – allows mental health professionals
to focus on patients for whom e-mental health approaches are not
appropriate, thereby reducing wait lists.
• Cost-effective to the health system – inexpensive to deliver
and can be disseminated to large populations.
• Easily accessible – can provide support to patients who are
unable to attend face-to-face treatment.

16. PATIENTS WHO ARE MOST SUITABLE FOR E-
MENTAL HEALTH
 Patient who is suffering from mild to
moderate illness

17. E-MENTAL HEALTH RESOURCES
 Various website and apps of mental health
 Governments web site on mental health like
Canada ,Australia, United kingdom

18. HOW TO USE E-MENTAL HEALTH
 Self-help interventions:
are accessed through a publically-available website
are usually offered at no cost to users
offer users only automated feedback.
 Human-supported interventions:
are generally accessed through a password-protected
website
occasionally require the user to register and complete a
screening questionnaire and/or request referral from a health
practitioner
occasionally require payment from users
offer feedback or support from a health professional or
another person as part of the program.

19. MANAGEMENT OF PATIENTS USING E-
PSYCHIATRY
 Building e-mental health into the treatment
plan
 follow up
 drop outs
 keep patients engaging other times

20. TREATED BY E-PSYCHIATRY
 All literatures points towards improvement of
mild to moderate depression, anxiety disorders,
phobia ,to an extent OCD
 Severe cases of the above disease could not be
treated
 Even above disease with co morbid condition
like substance use etc could not be treated
currently
 No improvement in psychosis and personality
disorder

21. E-PSYCHIATRIC INTERVENTIONS
 Promotions
 Prevention
 Early interventions
 Active treatment
 Maintenance
 Relapse prevention

22. ADVANTAGES OF E-PSYCHIATRY
 Convenience
 Anonymity
 An introduction to care
 Lower cost
 Service to more people
 Interest
 24*7*365
 Consistency
 Support

23. DISADVANTAGES
 Effectiveness
 From whom to what
 Guidance
 Privacy
 Regulation
 Over selling

24. Web-based mental health services have the
capacity to not only overcome traditional
geographical, attitudinal and financial
barriers to access to care, but also to lower
overall delivery costs and reduce demands on
the clinical workforce.

25. CONCERNS
 Will it replace conventional service
 Divert attention & funding of conventional
service
 Costly to develop,deploy,evaluate
 Financially interest of developers
 Limited evidence
 Lack of quality control and care standards
 Technological phobia

26. CONCERNS CONT…
 Potentially to further marginalize individual
who has physical ,financial and cognitive
barrier
 Concern that availability of e-mental health
may lead to some individuals to postpone
seeking need of conventional service
 Some may receive inappropriate and harmful
care
 Ethical responsibility

27. CONCULSIONS
 It is important to consider fit to e-mental
health initiatives within the context of the
existing service system and to ensure that
they complement and not detract from needs
of direct care
 It is important to select interventions and
initiatives on the basis of available evidence
 It is important to address the ethical and
quality issues are addressed

28.  The extent to which interventions are applied
in cross culture and international context for
considerations
 Involvement of consumers and law makers
 Further research in case of other fields like
psychotic condition

29. E-psychiatry is ADD ON to regular psychiatric
service cannot replace regular psychiatric
service

30. BIBLIOGRAPHY
 TECHNOLOGICAL INNOVATIONS IN MENTAL HEALTH CARE ;HARNESS
OF DIGITAL REVOLUTION BY CHRIS HOLLIS (BJP)(2015)
 SUPPORT FROM INTERNET FOR INDIVIDUALS WITH MENTAL HEALTH
DISORDERS;ADVANTAGES AND DISADVANTAGES OF E-MENTAL HEALTH
SERVICE DELIVERY BY JORN MOOCK (FRONTEIORS IN PUBLIC
HEALTH)(2014)
 E-MENTAL HEALTH;A RAPID REVIEW OF LITREATURE BY SHALINI LAL
(PYSHIATRIC SERVICES ) (2014)
 ADVANTAGES AND LIMITATIONS OF INTERNET BASED INTERVENTIONS
FOR COMMON MENTAL HEALTH DISORDERS BY GERHARD ANDERSON
(WORLD PSYCHIATRY)(2014)
 E-MENTAL HEALTH SELF MANAGEMENT FOR PSYCHOTIC DISORDER BY
LIAN VAN DER KRIEKE (PYSHIATRIC SERVICES ) (2014)

31. THANK YOU