Teaching Telepsychiatry in the Age of Health Care Reform

Telepsychiatry or telemedicine is a specifically defined form of videoconferencing that can be utilized to deliver or facilitate healthcare. In the diagnosis and treatment of mental illness, telepsychiatry is playing an increasingly important role.

There are several reasons for this. First, telepsychiatry allows more people to benefit from psychiatric treatment, especially those in rural areas. There are many individuals who do have ready access to mental health services, particularly specialized services such as child and adolescent psychiatry, or to specialists who are trained in a particular modality (e.g. cognitive-behavioral therapy for psychotic disorders). Telemedicine can bring patients together with appropriate specialists, or achieve a link between a specialist and a primary-care practitioner who can evaluate the patient together or collaborate in providing needed consultation and treatment.

Even in urban areas, providing 24-7 coverage to emergency rooms or crisis centers can be challenging and having specialists available via telemedicine who serve as consultants to physicians in emergency centers can provide a very cost-efficient solution.

In situations where psychiatric services are available, travel to and from a clinic or practitioner’s office can be time consuming and can serve as an impediment to treatment. In some cases, the illness itself can make it difficult to visit a clinician’s office (e.g. panic and phobic disorders, obsessive-compulsive disorder, and post-partum depression) and the availability of in-home treatment via telemedicine can make a substantial difference.

The number of individuals receiving evaluation and treatment via telemedicine has been increasing at a very rapid rate. There are some hurdles, however, such as licensing across state borders and variations in reimbursement, but these obstacles are being reduced and telemedicine will play an increasingly large and important role in health care. A critical issue now is providing the necessary training to psychiatric residents and other mental health trainees in order to have sufficient numbers of professionals to ensure high-quality treatment using this technology.

I recently helped conduct a survey of residency training programs in the U.S.¹  The objective of this study was to determine the extent of telepsychiatry training in U.S. residency programs. Surveys were distributed to 183 residency programs and 46 (25%) responded. Almost one half of responders reported direct connections with telepsychiatry.