Over half of all U.S. hospitals use telemedicine, and this trend is fast becoming adopted across different states. Depression affects about one in 10 Americans at any moment in time, and 40 percent of Americans are thought to have had at least one major depressive episode throughout their lifetime. The consequence of not getting psychiatric treatment can include suffering, irritability, anger, irrational guilt, self-devaluation, occupational difficulty, marital discord, and other interpersonal difficulties.
What is Telemedicine ?
Telemedicine, or telepsychiatry which is the practice of seeing patients over a HIPAA compliant video platform rather than in the office, has the potential to connect more patients to providers.
Patients generally report the following difficulties accessing a psychiatrist, including; distance from home, the psychiatrist not practicing the required therapy modality, time off work, finding babysitters, and transportation.
Telepsychiatry is used for supportive psychotherapy, cognitive behavioral therapy, relationship counseling, medication management, and after hospital care although more providers are providing psychodynamic psychotherapy services over a telemedicine platform.
Is Telepsychiatry effective for treating depression ?
One study by researchers at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center in Charleston suggests that telemedicine can be equally effective as a modality for treating depression as office visits :
Two hundred forty one (241) depressed elderly veterans were followed, some of whom received psychiatric treatment via telemedicine, while others received in-person care. At the end of one year, no meaningful difference was found in symptom relief or satisfaction between the two groups.
“Based on results of this study and prior research, telemedicine is a highly relevant option to address the needs of rural patients or those living in remote locations, while providing patient satisfaction and quality of life similar to that provided by in-person treatment delivered at clinics,” lead study author, Dr. Leonard Egede told Reuters.
“In addition, this study was focused specifically on the elderly population, who have limitations in terms of mobility and transportation options that make them good candidates for depression therapy using telemedicine. Based on our analyses, there are no subpopulations based on age, race, or gender that showed worse outcomes and therefore would require in-person treatment.”
Barriers to Mental Health Care
Carolyn Turvey, PhD, a professor of psychiatry at the University of Iowa and vice chair of the American Telemedicine Association’s Telemental Health special interest group made the following statement:
“By insisting that patients come to our offices, we’re excluding potentially millions of patients who need care,”
Despite being an advocate of telepsychiatry, I still prefer seeing people in the office. The reason is not scientific, I personally just like it better. If that is my experience, that is also the experience of many patients. Part of training as a doctor is understanding that not everyone gets ideal care. No matter how idealistic you were in medical school, and how good your intentions, there is a necessity to adapt to current circumstances and provide the best possible care with the resources available.
I can recall an experience at Project Renewal, a safe haven for homeless men, (Depression being a common cause of homelessness) seeing patients on my laptop in a broom cupboard like office. Patients were often too depressed to get out of bed, even for breakfast in the winter months . One patient said to me ‘I know I am depressed when I can’t get out of bed to buy a packet of cigarettes on check day.’
I took to calling patients in their rooms when they missed appointments and if they didn’t pick up the phone sending security to knock on their door and ask them to come to their appointment. Sometimes they came, and sometimes they would ask to be left alone. But generally I didn’t detect any bad will, and the safe haven security guards assured me that I was doing the right thing. This wasn’t exactly what I have been taught in my psychodynamic training. Possibly disrespectful, definitely a boundary crossing under normal circumstances.
A psychodynamic psychotherapy model was not possible in a shelter setting , and if I had insisted on adhering to what I had been taught during my residency and psychodynamic training, at least half of my patients would not have been treated. Some needed the knock on the door, and the gentle escort in their current regressed state.
There were a few success stories. I bumped into one patient two blocks from my home in midtown. He was on his way to work and told me not to be alarmed but he had looked me up and was now my neighbor. He said, “You were right, there is nothing wrong with my intelligence. It is my mood that was holding me back, the Paxil really helps”. He said he was doing well and had looked me up to say thank you, but had never contacted me in the end.
I am not advocating for psychiatrists should make their own rules, but adaptations to ensure an increase in reach, and an understanding that some care, and even a sub-optimal modality of care is better than no care. A prescription for Paxil and a monthly visit, although not as ideal as biweekly titration and weekly psychotherapy can still be effective.
Likewise, although I prefer seeing patients in the office, I still believe telepsychiatry should be utilized, as it increases patient reach and is also highly effective.