Telepsychiatry: The Right Choice?

January 2, 2014

Opponents of telepsychiatry contest that it does not offer the same results as an in office visit but, if this were true, is no mental health treatment better than receiving treatment through telepsychiatry? Telepsychiatry is one of the more successful applications of telehealth across the spectrum of clinical services as outcomes and patient acceptance for telepsychiatry are comparable to face-to-face visits. With all the recent advancements in technology telepsychiatry has become the popular solution to the lack mental health providers across the US. We can all agree this is the best alternative for patients that need mental health care in areas affected by this shortage or don�t have the time for an office visit. In any case, here are some of the reasons opponents disagree with the use of telepsychiatry.

The 5 Senses

As humans we have 5 senses, see, touch, hear, taste and smell. The ability to see and hear a patient during an appointment with a psychiatrist, most would agree, is the most important out of the five senses. Touching and smelling would be the only senses psychiatrists� use that would be unavailable using telepsychiatry. In many cases it is unnecessary for most psychiatrists to touch their patients. If a patient needs a physical exam you can have them visit their primary care physician or, in a clinical setting, have qualified staff perform the exam. The ability to smell can be important, for example, if a patient is under the influence of alcohol you would be able to smell them in an in office visit, although you can also determine this through hearing and sight. When utilizing telepsychiatry in a clinical setting, staff can help by assisting psychiatrists with touch and smell but when seeing a patient for an in-home visit there can be some risks with regards to these two senses. Psychiatrists should be careful when providing care in an in-home setting and choose carefully which patients are right for telepsychiatry treatment.

High Risk Patients

There are specific dangers with regards to telepsychiatry and high risk patients. Psychiatrists should routinely identify patients who are and are not good fits for their telepsychiatry practice. It may be helpful to define a general patient population for whom telepsychiatry would be an appropriate (or inappropriate) method of delivering care. Suicidal patients are an example of patients that should not be treated through in-home telepsychiatry visits. They can be treated in a clinical setting with staff in the room or nearby in case of an emergency to which they can quickly respond. You should consider a plan to verify the location of the patient during each telepsychiatry encounter. When conducting in-home telespychiatry visits, patients should have a landline phone nearby where the psychiatrist can call at the beginning of the appointment. This way the psychiatrist can verify the patient�s home number is correct and if an emergency arises the psychiatrist can call 911 to direct them to the patient�s home. This is a good habit to make with all patients treated in-home through telepsychiatry. The more safeguards you have in place the better.

Telepsychiatry and HIPAA Compliance

There is some worry about utilizing telepsychiatry while remaining HIPAA compliant. The Health Insurance Portability and Accountability Act (HIPAA) does not consider an interactive video consultation to be protected health information, so it does not govern telepsychiatry encounters. However, device encryption and a private internet connection are recommended for patient security and privacy. Most telepsychiatry equipment encrypts the transmission. Other types of telehealth, such as the transmission of patient data or images, are considered protected health information and must be managed according to HIPAA requirements.

Utilizing telepsychiatry does not alter the standard of care to which psychiatrists are held; it is the same standard of care that would apply if the patient were in your office or facility. Although �the standard of care� is a vague concept, it represents the idea that psychiatrists should provide at least minimally acceptable and clinically appropriate diagnosis and treatment to all patients, regardless of circumstances. Most traditional outpatient psychiatrists do NOT get vital signs in the office and they do NOT perform anything like a physical exam. This is the standard of care for traditional outpatient psychiatry and that's part of the reason why telepsychiatry can be an effective tool for providing mental health care. To some, telepsychiatry may not be as sufficient as an in-office visit but regardless it meets the standards of care. These and many other questions haved been asked with the implementation of telepsychiatry. e-Psychiatry, a company that provides telepsychiatry services, has been able to tackle all the tough issues surrounding telepsychiatry. They have been able to help many mental health facilities and psychiatrists with successfully launching telepsychiatry programs throughout the country. If you would like to learn more about telepsychiatry you can go to or contact them by email at