Considerations for Telepsychiatry Service Implementation in the Era of COVID-19

Telepsychiatry, or the use of technology to provide mental health services, has increasingly been studied to meet the growing demand for psychiatric care. Moreover, telepsychiatry has been implemented in various settings to address barriers to accessing psychiatric care, including shortages in mental health clinicians, remote geographic locations, social stigma related to initiating care in a mental health setting, limited mental health parity, and fragmented systems of care. The utility of telepsychiatry is relevant now more than ever, as the world endures a global pandemic and as mental health professionals seek ways to initiate and continue much-needed mental health services. For instance, where physical distancing (people keeping at least 6 feet apart) is necessary to prevent the spread of COVID-19, telepsychiatry helps meet the demand for mental health services. This benefit is of particular salience during the COVID-19 pandemic, as many clinics pare down their onsite mental health workforce to enhance safety of staff and patients.

This collection highlights the breadth of available telepsychiatry services, considerations for implementing telepsychiatry in various mental health settings, and billing implications. It also underscores the importance of helping patients use telepsychiatry services, understanding the toll this new platform can have on mental health providers, and offering ways to minimize burnout among telepsychiatry providers to improve outcomes for providers and patients alike. A host of telepsychiatry options are available, including services for patients with psychotic disorders, for veterans through the Veterans Health Administration system, and for people who live in rural areas. As we move through this crisis, we should do our best to implement needed telehealth interventions, maintain these services into the future, and expand the evidence base around telepsychiatry, including evaluating its impact on mental health services and patient outcomes.

Types of telepsychiatric services

E–Mental Health: A Rapid Review of the Literature

Lal S, Adair CE

Psychiatr Serv 2014; 65:24–32

E–Mental Health Self-Management for Psychotic Disorders: State of the Art and Future Perspectives

van der Krieke L, Wunderink L, Emerencia AC, et al.

Psychiatr Serv 2014; 65:33–49

Using Telehealth to Implement Cognitive-Behavioral Therapy

Dent L, Peters A, Kerr PL, et al.

Psychiatr Serv 2018; 69:370–373

The Use of Telepsychiatry to Provide Cost-Efficient Care During Pediatric Mental Health Emergencies

Thomas JF, Novins DK, Hosokawa PW, et al.

Psychiatr Serv 2017; 69:161–168

An Experimental Comparison of Telepsychiatry and Conventional Psychiatry for Parolees

Farabee D, Calhoun S, Veliz R

Psychiatr Serv 2016; 67:562–565

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201500025

Design and implementation of telepsychiatry

Telepsychiatry Use in U.S. Mental Health Facilities, 2010–2017

Spivak S, Spivak A, Cullen B, et al.

Psychiatr Serv 2020; 71:121–127

Evaluating the Implementation of Home-Based Videoconferencing for Providing Mental Health Services

Interian A, King AR, St. Hill LM, et al.

Psychiatr Serv 2018; 69:69–75

A Description of Telemental Health Services Provided by the Veterans Health Administration in 2006–2010

Deen TL, Ph.D., Godleski L, Fortney JC

Psychiatr Serv 2012; 63:1131–1133

Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets

Jacobs JC, Blonigen DM, Kimerling R, et al.

Psychiatr Serv 2019; 70:976–982

An Innovative Approach to Care: Integrating Mental Health Services Through Telemedicine in Rural School-Based Health Centers

Pradhan T, Six-Workman EA, Law K-B, et al.

Psychiatr Serv 2019; 70:239–242

Use of Tele–Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models

Uscher-Pines L, Raja P, Qureshi N, et al.

Psychiatr Serv 71:419–426

Using Continuous Quality Improvement to Design and Implement a Telepsychiatry Program in Rural Illinois

Mahmoud H, Vogt EL, Dahdouh R, et al.

Psychiatric Services in Advance (online April 15, 2020)

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900231

Designing an Academic-Community Telepsychiatry Partnership to Provide Inpatient and Outpatient Services in a Critical Access Hospital

Kimmel RJ, Iles-Shih MD, Ratzliff A, et al.

Psychiatr Serv 2019; 70:744–746

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800587

Rural-Nonrural Differences in Telemedicine Use for Mental and Substance Use Disorders Among Medicaid Beneficiaries

Creedon TB, Schrader KE, O'Brien PL, et al.

Psychiatric Services in Advance (online April 15, 2020)

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900444

Billing and utilization

Assessing Telemedicine Utilization by Using Medicaid Claims Data

Daugherty Douglas M, Xu J, Heggs A, et al.

Psychiatr Serv 2017; 68:173–178

Telehealth Delivery of Mental Health Services: An Analysis of Private Insurance Claims Data in the United States

Wilson FA, Ph.D., Rampa S, Trout KE, et al.

Psychiatr Serv 2017; 68:1303–1306

Special considerations for telepsychiatry

When Will Telepsychiatry Reach Its “Tipping Point”?

Flaum MA

Psychiatr Serv 2017; 68:1205–1205

Telepsychiatry: Implications for Psychiatrist Burnout and Well-Being

Vogt EL, Mahmoud H, Elhaj O

Psychiatr Serv 2019; 70:422–424

Telemedicine for Mental Health in the United States: Making Progress, Still a Long Way to Go

Barnett ML, Huskamp HA

Psychiatr Serv 2020; 71:197–198