Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches

Abstract

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.

Keywords: Videoconferencing, Telepsychiatry, Tele-mental-health, Assessment, Management, Reliability, Efficacy, Effectiveness, Outcome

Core tip: Telepsychiatry refers to the use of information and communication technologies to provide psychiatric services from a distance. Evidence accumulated over six decades shows that videoconferencing-based telepsychiatry is an acceptable and feasible form of providing mental health-care. Additionally, videoconferencing-based assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations on several measures of outcome. However, problematic study-designs, uncertainty about cost-effectiveness, and poor uptake have hindered the progress of telepsychiatric services. Conducting further research to address these problems, and developing hybrid models incorporating traditional and telepsychiatric forms of care, would be the way forward.