Patient’s Perspectives of Telepsychiatry: The Past, Present and Future

Abstract

Access to mental health care has significant disparities due to treatment gap, more so particularly for the remotely residing, physically vulnerable, aging populations. Adoption of technology will enable more people to receive specialty care addressing distance, transportation and cost-related barriers to treatment engagement from the comfort of home. Telemedicine has been regarded as “electronic personal protective equipment” by reducing the number of physical contacts and risk contamination for patients during COVID-19 crisis. This review aimed to give a broad view of patients’ perception of the use of telepsychiatry in terms of clinical outcome, cost-effectiveness, and solutions to address patients’ challenges with the adoption of technology. Over the years, telepsychiatry, both in synchronous and asynchronous modalities, had shown to improve patients’ adherence to treatment, follow-up rates, and clinical symptoms, overcome stigma and discrimination, and save cost expenses accessing health care with better satisfaction and usability outcomes. Its utility is widespread such as in delivering care emergency evaluation, crisis intervention, conducting neuropsychological assessments, psychotherapy, promoting lifestyle modification, enhancing self-efficacy, and overcoming patients’ linguistic and cultural barriers to care. However, patients’ privacy and confidentiality and psychiatrists’ legal liability remain as matter of major concern in digital platform. To keep up with the pace of technology and patients’ expectations, a more agile approach is essential to develop, improve, and evaluate telepsychiatric interventions.

A promising future for tele-mental health in Oman: A qualitative exploration of clients and therapists’ experiences

“…The literature supports the tele-mental health service and it has been proved to be effective in overcoming the stigma related to mental health and a significant contributor toward expanding mental health care to clients who fear the stigma. 24 In addition, receiving care in the patient’s own supportive and familiar environment made clients feel more comfortable during virtual clinics compared to office visits, and this finding is in line with previous research as well. 25 , 26 Another previous study supports these findings, indicating that patients’ anxiety during their meetings with the mental health specialist was alleviated during video-based consultations compared to their meetings with the therapists in person.…”

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis

“…Larger clinics providing substantial services to the community reported the need to transition rapidly to ensure continuity of care, whereas smaller clinics were able to temporarily pause services or refer their clients elsewhere [ 70 ]. Articles also pointed to mental health professionals identifying concerns around the impact on the treatment relationship itself, noting the potential for inferior patient-clinician interactions [ 71 , 72 ] and therapeutic alliance [ 64 , 73 , 74 ]. They highlighted particular issues around the identification of nonverbal cues [ 59 , 66 ], transference processes [ 73 , 74 ], disturbances or interruptions to the session [ 27 ], and difficulties in assessing and responding appropriately to high-risk situations [ 59 ], particularly for children [ 75 , 76 ].…”

“…Concerns were also raised in some publications of patients with certain conditions not being suitable for e-mental health solutions, such as patients with psychosis, in acute crisis, or at risk of self-harm [ 63 , 64 ]. As identified by Naik et al, a “‘one-size-fits-all’ approach will not suit the needs of all patients,” with the need to refine e-mental health services to meet patient-specific needs (page 6) [ 74 ].…”

“…Included articles suggested that the experience has been largely valuable for patients and health care professionals alike; however, a number of concerns remain, with complexities identified at the levels of the patient, clinician, technology, treatment, ethics, organization or service, and broader system. A “one-size-fits-all” approach will not suit the needs of all patients, clinicians, or services [ 74 ]. Future research and interventions in e-mental health should investigate how to overcome or improve upon these barriers.…”

Feasibility and Effectiveness of Telecounseling on the Psychological Problems of Frontline Healthcare Workers Amidst COVID-19: A Randomized Controlled Trial from Central India

“… 1 , 14 These findings highlight the potential logistic problems MHP may face while delivering telecounseling services in a country like India where the stigma with mental illnesses is still higher. 36 Furthermore, it underscores the need to increase awareness among the fHCW about work-related mental health problems and the need to avail mental health services, thereby reducing stigma.…”