Telepsychiatry, future implications in mental health services ethics guidelines of services parameters

1. Telepsychiatry, future
implications in mental
health services
Dr. Ahmed Albehairy, M.D
Psychiatry Consultant

2. History and Background :
• Telemedicine :
has been defined as the intervention of
a telecommunication device in the diagnosis
and the overall care of patients that are
separated from providers by a distance.

3. History and Background :
• The use of videoconferencing in psychiatry began
during the 1950s.
• In 1959, Norfolk, the Nebraska Psychiatric
Institute was using early videoconferencing to
provide group therapy, long-term therapy,
consultation-liasion psychiatry, and medical
student training.
• By the 2000s, outcome studies provided a
platform for practice guidelines ( e.g. the
American Telemedicine Association). APA and ATA
have helped to disseminate information of
guidelines in USA organization.

4. TELEMEDICINE

9. Modes, Scope,
and
Applications
of Telepsychiatry

11. Modes of Communications
• Synchronous ( mimic face to face ), or
asynchronous(non real time, store and forward).
• Through , telephone, cell phone messages, two
way closed circuit television, E-mail, online chat ,
website & blogs, and virtual chat rooms.
• Sets of communications :********
- Patient at home ± family with Physician at office ±team work.
- Physician with Physician.
- Patient in remote office ± family with Physician at office
±team work.

12. Scope of Telepsychiatry
• Studies showed significant results as regard
telepsychiatry validity and reliability of clinical
assessments, clinical outcomes, outcomes in terms of
acceptability and satisfaction of patients and
clinicians, quality of life, and cost-effectiveness.
• Direct clinical case management, education, and
consultation–supervision.
• Adults, children, adolescents, elderly, and in special
populations such as in prison inmates and veterans.

14. Applications of Telepsychiatry
• Depression disorders.
• Panic disorder, agoraphobia, social phobia, and
generalised anxiety disorders.
• PTSD.
• A.N & B.N.
• Schizophrenia.
• Emergency department.
• Liasion consultation.
• Consultation care model in 1ry care services.
• CBT, Crisis intervention, and counseling.
• Geriatric population, and Video link consultation and
psychotherapeutic management of children and
adolescents, (ADHD).
• Forensic clinic .

15. Paramaters in Assessing Telepsychiatry
Services Outcome
• Quality of care (83% of patients were correctly diagnosed by
DSM-IV through telepsychiatry ).
• Access ( increased to the patients with locked apply care,
rural areas, collage student, prisoners).
• Cost ( reducing cost by more than 70% , but may cost more
than face to face / hour ).
• Technology ( standards, covered by insurance , problem in
transmission speed sp. In rural areas as there s no fiber
optics)
• Licensure ( may appear if cover inter-counrties services).
• Legal and ethical issues: Safety, security, and confidentiality (
compromised with self harm and suicide, filing , recordings,
documentations).
• Constraints ( billing and reimbursement, covering medical
insurance ).

16. GUIDELINES OF TELEPSYCHIATRY
. Clinical Guidelines of Telepsychiatry, APA .
• . Guidelines for Telepsychiatry , Emergency
Management.
• Guidelines of Telepsychiatry Technology
Standards.

17. Clinical Guidelines of
Telepsychiatry,
APA

18. Include:
• General clinic procedures (schedule, documentation, records keeping,
and rule of support staff ).
• Physical environment.
• Site and check in procedures.
• Emergency procedures.
• Patient enrollment and informed consent .
• Role of interdisciplinary team.
• Care between telepsychiatry sessions.
• Doctor orders, lab and treatment.
• Confidentiality, and privacy of information, approval for session.
• Quality review.
• Training review.
• Billing guidelines.
• Technology standards.

19. Guidelines for
Telepsychiatry
Emergency Management

20. • Administrative Issues : Perform a remote site
assessment . Obtain information of local regulations
and resources. Identify local collaborators, Create
emergency protocols with clear delineations of roles
and responsibilities, Decide the “tipping point” for
psychiatric emergencies when other staff and
resources are brought to bare, and Determine after
hours emergency coverage procedures.
• Legal/Ethical Issues: Know local civil commitment and
duty to warn regulations, and Arrange with local staff
to initiate/assist with civil commitments.
• General Clinical Issues.
• Rural Issues.

21. Guidelines of
Telepsychiatry
Technology Standards

22. • Hardware : camera/webcam, speakers,
headphones, monitor, and microphone.
• Software: videoconferencing, encryption, and
codec.
• Network : ISDN, T1, Satellite, microwave , and IP ,
internet protocol network.
• Others, speed , quality, encryption algorithm, and
bandwidth.

23. Pros and Cons of Telepsychiatry
Advantages :
• Sense of freedom and
avoid confrontation in shy
patients.
• Better follow up and case
managements.
• Less costs.
• Special population , rural
areas services and,
Community care services .
• Reliable and valid in most
of mental services.
Disadvantages:
• Increased cost/hr.
• Reimbursements and
billing.
• Interoperability problems.
• Suicide and self harm lacks
care.

24. Conclusion :
• Telepsychiatry could help in covering the current and
future demands of mental health services in KSA .
• Legal and ethical issues needs special care with
activating the clinical guidelines for telepsychiatry
services.
• To activate the services in KSA, we need to include the
telepsychiatry services mainly in governmental mental
hospitals and primary care services in rural areas ,
prisons , military or remote areas.
• Non- governmental and private sections need a
special guidelines for legal and ethical issues and for
collaborating teams specially in emergency .

26. REFERENCES:
• WHO, mental health psychiatrists and nurses working in mental health services,
2014.
• American Telemedicine Association., Practice Guidelines for Video-Based Online
Mental Health Services, MAY 2013.
• Telepsychiatry: Promise, potential, and challenges, Savita Malhotra, Subho
Chakrabarti, and Ruchita Shah, Indian J Psychiatry. 2013 Jan-Mar; 55(1): 3–11.
• Telepsychiatry in the 21st Century: Transforming Healthcare with Technology,
Stacie Deslich, , Bruce Stec, , Shane Tomblin, , and Alberto Coustasse, Perspect
Health Inf Manag. 2013 Summer; 10(Summer): 1f.
• Telepsychiatry in Commonwealth Africa a first step, Commonwealth Health
Partnerships 2013.
• National Survey of Prevalence of Mental Disorders in Egypt: preliminary survey M.
Ghanem, M. Gadallah, F.A. Meky,S. Mourad and G. El-Kholy: Eastern
Mediterranean Health Journal, Vol. 15, No. 1, 2009 65.
• Emergency Management Guidelines for Telepsychiatry, Jay H. Shore,
MPH,corresponding author Donald M. Hilty, and Peter Yellowlees, MBBS : Gen
Hosp Psychiatry. Author manuscript; available in PMC 2008 May 1.
• American psychiatric association guidelines,: psychiatryonline.org/guidlines