Psychiatrists have been using videoconferencing for psychiatric consultations for almost sixty years. Now with the advent of web and cloud based systems, mobile computing, the impact of commercial telemedicine service companies, and a growing body of evidence and research, more and more patients are being treated online. This occurs in primary care clinics, at work and at home – and by an increasingly large number of mental health therapists from all disciplines. Patients can be treated securely and in high definition on a laptop or tablet at minimal cost using video systems that are increasingly ubiquitous and easily accessible. The opportunity for mental health professionals to engage in brief psychotherapy with their patients is here, and in 2015 alone the American Telemedicine Association estimated that over 1 million patients in the USA were treated using video. Technologies are gradually changing the doctor-patient relationship, softening its boundaries, and making it more of an “anytime, anywhere” collaborative partnership, something that will be especially helpful when practicing the range of psychotherapies that are known to be effective, and evidence based, for the treatment of anxiety and depression.
From a large body of research we know that telemental health leads to high patient and provider satisfaction ratings and achieves health outcomes equivalent to in-person care across all diagnostic groups. The only absolute contraindications are patient refusal, or extreme suicidal or homicidal danger. Trials of multiple types of brief therapy, particularly cognitive behavioral approaches, have demonstrated equivalent outcomes to in person care, while some studies in veterans of therapy for PTSD, and with children who have ADHD, have led to better outcomes than in person therapy. Not surprisingly younger patients who use video for social interactions routinely often prefer online over in-person encounters and there is increasing evidence that being online encourages intimate conversations and for many patients is better than seeing a therapist in-person.
As someone who has treated thousands of patients online for more than 20 years I regularly get asked a core group of questions:
- How do you pick an online provider? In the same way as you would in-person. Ideally they will be recommended by someone you trust. You need to make sure that they are well qualified, have expertise and training in your disorder, and are experienced seeing patients online. A large number of providers are now advertising telemental health as an area of interest, and insurance companies are increasingly including them in their networks.
- What are the licensing and legal issues? The provider must generally be licensed and have malpractice insurance that covers them in the state that the patient is in.
- Can MD’s prescribe online? Yes for almost all psychiatric drugs except for controlled substances like stimulants and narcotics.
- Where can I get more information? The website of the American Telemedicine Association is the best place – www.americantelemed.org - Providers who wish to become more involved and increase their professional knowledge and skills should consider joining the ATA and going to the annual conference which attracts over 6000 professionals each year. I have also published a book for consumers and providers which is commonly used as a teaching resource and is available on Amazon – “Your Health in the Information Age: how you and your doctor can use the Internet to work together”.
Peter Yellowlees, MD is an experienced speaker and media commentator who written and produced over 150 video editorials on Psychiatry for Medscape. He has a number of research interests and is presently working on the development and validation of asynchronous telepsychiatry, automated translation and clinical interpreting systems, internet e-mail and video consultation services and assessment and treatment protocols to improve physician health and wellness.