Paul E. Ruskin, M.D., Michele Silver-Aylaian, Ph.D., Mitchel A. Kling, M.D., Susan A. Reed, C.R.N.P., C.N.S., Douglas D. Bradham, Dr.P.H., J. Richard Hebel, Ph.D., David Barrett, M.D., Frederick Knowles, III, M.D., and Peter Hauser, M.D.
Published online: August 01, 2004
American Journal of Psychiatry

OBJECTIVE: Telepsychiatry is an increasingly common method of providing psychiatric care, but randomized trials of telepsychiatric treatment compared to in-person treatment have not been done. The primary objective of this study was to compare treatment outcomes of patients with depressive disorders treated remotely by means of telepsychiatry to outcomes of depressed patients treated in person. Secondary objectives were to determine if patients’ rates of adherence to and satisfaction with treatment were as high with telepsychiatric as with in-person treatment and to compare costs of telepsychiatric treatment to costs of in-person treatment.

METHOD: In this randomized, controlled trial, 119 depressed veterans referred for outpatient treatment were randomly assigned to either remote treatment by means of telepsychiatry or in-person treatment. Psychiatric treatment lasted 6 months and consisted of psychotropic medication, psychoeducation, and brief supportive counseling. Patients’ treatment outcomes, satisfaction, and adherence and the costs of treatment were compared between the two conditions.

RESULTS: Hamilton Depression Rating Scale and Beck Depression Inventory scores improved over the treatment period and did not differ between treatment groups. The two groups were equally adherent to appointments and medication treatment. No between-group differences in dropout rates or patients’ ratings of satisfaction with treatment were found. Telepsychiatry was more expensive per treatment session, but this difference disappeared if the costs of psychiatrists’ travel to remote clinics more than 22 miles away from the medical center were considered. Telepsychiatry did not increase the overall health care resource consumption of the patients during the study period.

CONCLUSIONS: Remote treatment of depression by means of telepsychiatry and in-person treatment of depression have comparable outcomes and equivalent levels of patient adherence, patient satisfaction, and health care cost.

Jay H. Shore, M.D., M.P.H.
View Author and Article Information
Received: August 13, 2012
Accepted: November 30, 2012
Published online: March 01, 2013
American Journal of Psychiatry

The provision of psychiatric treatment via live interactive videoconferencing, frequently termed telepsychiatry, is a viable option for psychiatrists to provide care to individual patients, populations, and communities faced with limited access and to move the point of care delivery into patients’ living environments. Psychiatric providers new to videoconferencing should not be intimidated by the technology or its encompassing logistics, but they do need to develop an awareness of the salient regulatory, administrative, and clinical issues that arise in the practice of videoconferencing-based telepsychiatry. This article provides an overview of the current evidence base in telepsychiatry and reviews administrative and clinical issues in videoconferencing-based treatment. These points are then highlighted in a case example.

Steven Chan M.D., M.B.A. Arshya Vahabzadeh M.D.
Published online: March 17, 2015
American Journal of Psychiatry

Could the era of Internet technologies and consumer electronics boost access to mental health care? Dr. Phil McGraw and numerous other exhibitors at the 2015 Consumer Electronics Show (CES) believe so.
At the CES Digital Health Summit, television talk-show host and Doctor on Demand cofounder McGraw presented his vision of how wireless and communications technology will boost wellness and mental health. McGraw highlighted how telemedicine must play a greater role in providing mental health care, or “tele-mental” health.

World J Psychiatry.
2015 September 22; 5(3): 286–304.
Published online: 2015 September 22
doi:  10.5498/wjp.v5.i3.286
PMCID: PMC4582305

Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.

CONCLUSION

Is telepsychiatry an idea whose time has come? There is no doubt videoconferencing-based telepsychiatry facilitates effective service-provision in a large number of areas, where access to high-quality services is difficult. Consequently, it promotes an equality of access, a sense of empowerment among patients, and high levels of satisfaction among them. The evidence to date is highly suggestive that it is comparable to face-to-face care on several aspects of what is traditionally considered effectiveness. However, by the present stringent standards, the quality of the evidence is, perhaps, not adequate. Additionally, there are several barriers to telepsychiatry’s wider implementation such as cost-effectiveness, uncertain ethical and legal implications, and concerns about sustainability of programmes. These continue to thwart its integration into the routine network of mental health services. Accordingly, at present telepsychiatric services can only serve as an adjunct to the more traditional modes of service-delivery, but can never replace them. Therefore, the way forward would be to develop hybrid models, which incorporate both forms of service-delivery[84,172]. If telepsychiatry settles into this niche, it has the potential to enhance the overall efficiency of mental health services by removing the many obstacles, which afflict conventional systems of service-delivery. This model may also work for low- and middle-income countries, provided that effective, needs-based forms of telepsychiatric services are developed in these countries as well.