With the onset of COVID-19, mental health services around the globe are experiencing their own vulnerability and limitations. Patients with mental illnesses are being triggered by social distancing, isolation, and the loss or fear of losing jobs. They may become more anxious, angry, stressed, agitated, and withdrawn during the pandemic outbreak or whilst in quarantine. Due to the pandemic, only the most affected patients (i.e. suicidal, psychotic or delirious) can access public health facilities through emergency wards. Here, COVID-19 protection measures reduce service efficiency. Many patients currently avoid hospitalisations due to fear of corona contamination; nevertheless, they still need professional help. In such situations a “Home-Telepsychiatry” model may offer continuous psychological support and necessary medical treatment despite isolation and quarantine.
Telepsychiatry is the oldest of all e-mental health applications, with its first appearance in 1959. Unfortunately, its adoption in daily practice has not yet resonated with mental health professionals worldwide. Potential reasons might have been the lack of expertise, as well as difficulties in changing well-established daily routines. Furthermore, regulatory issues (i.e. data safety concerns, reimbursement, quality of practice, etc.) have undoubtedly kept Telepsychiatry from being widely adopted. Although such advances have been slow, patients have repeatedly expressed high levels of satisfaction and comfort using remote consultations.
The current Coronavirus pandemic could prove to be a turning point for Telepsychiatry. Its development is partially dependent on policymakers’ insight and willingness to act promptly. Further obstacles are overall lack of expertise and/or clinical experience. To our knowledge, colleagues all over the world are currently striving to work within protocols to establish telepsychiatry; guidelines and protocols have been developed already for decades in various parts of the world and are frequently updated. Precious time right now could instead be spent collaborating globally to share much needed competence and experience.
WPA is perfectly positioned to be the frontrunner in establishing an international group of acknowledged experts who may advise public mental health institutions worldwide on this issues. In particular, an expert panel could advise on how to quickly set up secure “Home-Telepsychiatry” services that are capable of serving patients in need without compromising the quality of care. Necessary training and theoretical education could be done online, parallel with the setting-up of the remote services. Without training, overall user-satisfaction as well as efficacy in care provision will not be optimal, and such services may not have the bright long-term perspective that would otherwise possible.
Innovation comes from limitation. Nevertheless, recognising the problem is the first step towards a solution. It is not too late to make a difference and improve access to qualified care for those who are most vulnerable in these very challenging times. We have never before been presented with a tool that requires so little while in return it gives us as much as is the case with telepsychiatry.
Author: Davor Mucic, M.D. Launcher of Telemental Health Section (European Psychiatric Association); re-launcher and board member of Section on Informatic (World Psychiatric Association); Editor in chief on Edorium Journal of Psychiatry
Acknowledgement: Thanks to Andrea Belancic, MD, for valuable input.