Telepsychiatry: Promise, Potential, and Challenges

Article excerpt

Byline: Savita. Malhotra, Subho. Chakrabarti, Ruchita. Shah

Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called 'Mental Health Gap'. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store-forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.

Introduction

Information and communication technology (ICT) has percolated into various aspects of life through its varied applications; education, banking, business management, to name a few of these areas. Over the last couple of decades, advancements in ICT have been aptly utilized in the field of health care also, for example, maintenance of electronic medical records. Another and probably more promising application of ICT is its use for delivery of health care to remote and inaccessible areas - telemedicine. Telemedicine is defined as the practice of medical care using interactive audio, visual, and data communications. [sup][1] All over the globe including both developed and developing nations, various programs for health care delivery and education through telemedicine have been implemented. These programs cover various disciplines of medicine such as radiology, dermatology, pathology, systemic medicine, ophthalmology, and psychiatry. Some are focused on home-based care for specific disorders such as diabetes, cardiac conditions, etc., Of these, telepsychiatry is considered as the most active application of telemedicine in the Western world. [sup][2] However, in the developing nations, telepsychiatry is still in its infancy stage and exists more as an off-shoot of telemedicine, rather than an independent service. The field of psychiatry is unique when compared to other specialties of medicine, as human interaction and client-therapist relations are integral to its practice. Hence, whether or not psychiatry renders itself to this mode of service delivery (tele-services) has been highly debated.

Telepsychiatry, also termed as telemental health or E-mental health, is broadly defined as the use of ICT to provide or support psychiatric services across distances. The use of technology in the mental health field has been noted sporadically since the sixth decade of the last century; for example, use of closed circuit, two-way television for routine clinical and educational purposes, [sup][3],[4],[5] use of telephone to provide emergency care, etc. …