COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians

Abstract

Background The coronavirus disease (COVID-19) presents unique challenges in health care, including mental health care provision. Telepsychiatry can provide an alternative to face-to-face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. Objective The aim of this paper is to produce an open-access, easy-to-consult, and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach. Methods We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre–COVID-19 guidelines and other digital mental health topics where relevant. We summarized the data we extracted as answers to specific clinical questions. Results Findings from this study are presented as both a short practical checklist for clinicians and detailed textboxes with a full summary of all the guidelines. The summary textboxes are also available on an open-access webpage, which is regularly updated. These findings reflected the strong evidence base for the use of telepsychiatry and included guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance, and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focused on practical implementation and US guidelines more expansive and detailed. Guidelines on possible combinations with other digital technologies such as apps (eg, from the US Food and Drug Administration, the National Health Service Apps Library, and the National Institute for Health and Care Excellence) are less detailed. Several key areas were not represented. Although some special populations such as child and adolescent, and older adult, and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder, and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, the initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines. Conclusions We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organizations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organizational change in the short- and long-term. Providing easily accessible guidance is a first step but will need cultural change to implement as clinicians start to view telepsychiatry not just as a replacement but as a parallel and complementary form of delivering therapy with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post–COVID-19, and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment.

An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19

“…An added value of digital mental health is that it may be designed for automated thematic and metadata review, traceability for quality assurance, and assignment of responsibility for identified cases of mental ill health. Existing telepsychiatry guidelines (including other relevant digital technologies) should be considered [ 23 ] for a consistent and consolidated knowledge management strategy for integrated services. Consensus, expert, and position statements are required from psychiatrists, psychologists, and academic researchers on the individual, cultural, and environmental factors that affect the well-being of the patient with suggestions for brief, valid and reliable screening and tracking surveys for the prevention and treatment of mental health symptoms and disorders.…”

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

“…The COVID-19 illness and governments’ attempts to manage its spread bring a range of new social, physical and psychological risks for clinicians to consider (see https://oxfordhealthbrc.nihr.ac.uk/our-work/oxppl/covid-19-and-mental-health-guidance). Acceptance and uptake of telepsychiatry has accelerated during the pandemic, with consequences for all aspects of professional practice (Smith et al, 2020). As we note below, a key challenge for clinicians is keeping abreast of technological developments, which emerge not through traditional scientific processes (across time frames of years), but through the marketplace (across time frames of months).…”

Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective

“…However, the forced adoption of and mass transition to telehealth during the COVID-19 pandemic has resulted in significant challenges for the implementation of telehealth for psychiatric services [ 9 , 10 ]. While guidelines exist for postpandemic telepsychiatry [ 11 , 12 ], given the unique characteristics of this COVID-19 pandemic, lessons learned from these transitions as well as implementation-specific guidelines would be highly applicable to other practices. To date, clinical implementations and lessons learned (and with largely positive results) have been reported largely from settings outside the United States, such as China [ 13 , 14 ], Europe [ 15 - 23 ], Turkey [ 24 ], and Australia [ 10 , 25 - 28 ], with only some US coverage (notably [ 9 ], [ 29 ], and [ 30 ]).…”