Telepsychiatry

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing. Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. Most commonly, telepsychiatry encounters take place at medical facilities under the supervision of onsite staff, though at-home models are becoming accepted as long as they are in compliance with HIPAA standards.

One of the drivers behind telepsychiatry's growth in the United States has been a national shortage of psychiatrists, particularly in specialty areas such as child and adolescent psychiatry; telepsychiatry can allow fewer doctors to serve more patients by improving utilization of the psychiatrist's time. Telepsychiatry can also make it easier for psychiatrists to treat patients in rural or under-served areas by eliminating the need for either party to travel. The most common means of insurance coverage for telehealth services among the United States is to incorporate coverage into the Medicare program. Reimbursement for Medicare-covered services must satisfy federal requirements of efficiency, economy and quality of care. Since 1999, Medicare and Medicaid reimbursement for all kinds of telehealth services have expanded, requirements of providers have been reduced, and grants have been given to support telehealth program adoption. For 2014, the Center for Medicare (CMS) services does cover telemedicine services, including telepsychiatry in many areas.

Sub-specialties
Telepsychiatry includes a variety of sub-specialties based on different contexts of service delivery.

Home-based telepsychiatry
Psychiatric treatment of patients who are at home or in another private setting is called home-based telepsychiatry, and it can require only a webcam and high-speed internet service. This practice raises issues of security and possible HIPAA violations, so while an increased number of individual psychiatrists are adopting this method with willing, interested patients, larger telepsychiatry providers generally focus on delivering services to formal facilities where secure video links can be established.

Forensic telepsychiatry
Forensic telepsychiatry is the use of a remote psychiatrist or nurse practitioner for psychiatry in a prison or correctional facility, including psychiatric assessment, medication consultation, suicide watch, pre-parole evaluations and more. Telepsychiatry can deliver significant cost savings to correctional facilities by eliminating the need for prisoners to be escorted to off-site appointments and psychiatric interventions.

Emergency telepsychiatry
As of 2008, guidelines are being developed for the provision of telepsychiatric consultation for emergency psychiatric patients, such as the evaluation of suicidal, homicidal, violent, psychotic, depressed, manic, and acutely anxious patients. However, emergency telepsychiatry services are already being provided to hospital emergency departments, jails, community mental health centers, substance abuse treatment facilities, and schools. Emergency telepsychiatry can ease staff shortages in overworked hospital emergency departments and increase patient throughput and emergency room disposition. Rather than employ expensive, short-term locum tenens doctors or have emergency room physicians evaluate the psychiatric stability of their patients, hospitals can use telepsychiatry to decrease costs and increase patient access to behavioral health evaluations by psychiatric specialists.

Other settings
Telepsychiatry services are also expanding into other settings, such as military bases, cruise ships, nursing homes, medical/surgical floors, crisis centers and disaster sites.

HIPAA compliance in the United States
HIPAA (the Health Insurance Portability and Accountability Act) is a United States federal law that establishes security and privacy standards for electronic medical information exchange, including telemental health services. In order to comply with HIPAA guidelines, many providers develop their own specialized videoconferencing services, since common third-party consumer solutions do not include sufficient security and privacy safeguards. There are also a growing number of HIPAA-compliant technologies available for telepsychiatry.

Telepsychiatry in India
India's large population and relatively small number of psychiatrists makes telepsychiatric service a good option for expanding access to mental health care. Telepsychiatry in India is still a young industry, but it is gradually growing, led by institutes such as the Post Graduate Institute of Medical Education and Research in Chandigarh and the Schizophrenia Research Foundation in Chennai. Private players like Mindcares and Online Psychiatrist are also increasing telepsychiatry's availability.