COVID-19 and telepsychiatry: an evidence-based guidance for clinicians

JMIR Ment Health. 2020 Jul 10. doi: 10.2196/21108. Online ahead of print.

Abstract

Background: COVID-19 presents unique challenges in healthcare, including mental health care provision. Telepsychiatry can provide an alternative to face to face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working.

Objective: The aim was to produce an open access, easy-to-consult and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach.

Methods: We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre-COVID-19 guidelines and also other digital mental health topics where relevant. We summarised the data we extracted as answers to specific clinical questions.

Results: Findings from this study are presented as both a short practical checklist for clinicians and a detailed table with a full summary of all the guidelines. The summary tables are also available on an open access webpage (https://oxfordhealthbrc.nihr.ac.uk/our-work/oxppl/table-5-digital-technologies-and-telepsychiatry/) which is regularly updated. These findings reflect the strong evidence base for the use of telepsychiatry and include guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focussed on practical implementation, and US guidelines more expansive and detailed. Guidelines on possible combination with other digital technologies such as apps, for example from the FDA, NHS Apps Library and NICE are less detailed. Several key areas were not represented. Whilst some special populations such as child and adolescent, older adult and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines.

Conclusions: We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organisations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organisational change in the short and longer term. Providing easily accessible guidance is a first step, but will need cultural change to implement, as clinicians start to view telepsychiatry not just as a replacement, but as a parallel and complimentary form of delivering therapy, with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post-COVID-19 and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and also its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment.