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Evolution of Telepsychiatry: From Alternative Back-up Modality to Mainstream Necessity

By: | Tags: , , , , | September 20th, 2023

The COVID-19 Pandemic has transformed telepsychiatry from an alternative backup model of care reserved for rural and underserved settings to a mainstream necessity utilized across the field.

What is Telepsychiatry

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. It is used to deliver psychiatric assessments and care through telecommunications technology, most often via videoconferencing. Despite its relatively newfound wide-scale exposure, forms of telepsychiatry have been used since as early as 1959, when the Nebraska Psychiatric Institute used a 2-way television circuit for group therapy, consultation-liaison psychiatry, and medical student training at the Nebraska State Hospital in Norfolk.

Over the following decades, the videoconferencing model expanded so that by the 2000s, telepsychiatry was validated as an equivalent modality to the in-person model of care in diagnostic reliability, effectiveness of treatment, and patient satisfaction. However, despite convincing data supporting its use, telepsychiatry was still viewed as an alternative option for psychiatric care delivery limited to underserved and academic grant-based settings.

So, how did a modality primarily used as an alternative option reserved for underserved, rural geographic areas become a mainstream component of psychiatric care delivery? Enter March 2020.

The Impact of COVID-19 on Mental Health

The impact that the COVID-19 pandemic had on the healthcare industry cannot be understated. Hospital waiting rooms and emergency departments were lined with people afflicted by the virus for months. The effects of the pandemic took a physical toll on millions of individuals, but mentally, there was a completely different challenge rearing its head. The stresses of physical isolation and fear led to a meteoric rise in mental health needs. Surveys collected by the CDC in 2021 showed increases in the following behavioral health symptoms that nearly doubled the rates expected before the pandemic:

  • 31% reported symptoms of anxiety and depression
  • 26% reported stress-related symptoms
  • 13% reported a start or increase in substance use
  • 11% reported serious thoughts of suicide within the past 30 days

Children and adolescents appeared to have been impacted the most. In fact, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association have declared a national emergency in children’s mental health.

The Pandemic Fueled the Expansion of Telepsychiatry

A sharp increase in mental health needs coupled with attempts at minimizing in-person care pushed through previous barriers and propelled telepsychiatry to the forefront of psychiatric care delivery. Due to social distancing and attempts at minimizing in-person contacts, the virtual care model became a reliable method for psychiatric care delivery across the field. Additionally, reimbursement barriers and state and federal regulations related to remote prescribing have been lifted, which historically have been major roadblocks to the expansion of virtual care.

Paradigm Shift

The impact of telepsychiatry post-coronavirus is undeniable. An American Psychiatric Association (APA) survey showed that 64% of psychiatrists reported seeing zero percent of their patient caseload via telehealth before the pandemic. As of January 2021, 81% reported seeing 75 – 100% of their patients via telehealth.

Telepsychiatry is also beneficial in several settings, including outpatient, emergency departments, corrections facilities, consultative inpatient, and inpatient psychiatric units. It is also important to highlight the advantages of telepsychiatry compared to a traditional in-person model, which includes:

  • Faster and improved care delivery
  • A reduction in the need for trips to the emergency room
  • Improved continuity of care and follow-up
  • Improved throughput in emergency departments, and
  • Cost savings of up to $2,300 for inpatient costs

The Future of Telepsychiatry

Long gone are the days when telepsychiatry was relegated to rural and underserved geographic areas – it is here to stay as a mainstream model of care. As we face the many facets of post-COVID recovery, it is unlikely that we will see a decline in demand for psychiatric care. To meet the vast demands, psychiatrists will continue to utilize telepsychiatry, especially in convenience, good clinical reliability, and patient-provider satisfaction. Patients, in many cases, will prefer the convenience, privacy, efficiency, and reduced stigma associated with virtual visits. Considering favorable clinical evidence supporting use and increased demand for access to psychiatric care, it is likely that telehealth visits will remain reimbursable. Furthermore, with advances in technology and integration, telepsychiatry will continue to expand its reach in providing access to psychiatric care, only with fewer barriers and even greater impacts.

To learn more about TeleSpecialists TelePsychiatry program, contact us.

Nattasha Acevedo, MD

Dr. Acevedo received her medical degree from the Ponce School of Medicine in Puerto Rico and did her neurology residency at Montefiore Medical Center in New York. She went on to do a clinical neurophysiology fellowship at Emory School of Medicine in Atla nta, Georgia and then joined private practice in Fort Myers, Florida. She currently resides in San Juan, Puerto Rico. She likes running, paddle boarding and spending time with family.

Bernadette Borte, MD

Dr. Borte received her medical degree from St. Matthew’s University School of Medicine in Grand Cayman. She completed her neurology residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Her areas of interest include inpatient neurology and acute stroke. When not working, she enjoys spending time outdoors with her family. Dr. Borte joined the TeleSpecialist family in March of 2019.

Mazen Almidani, MD

Dr. Almidani is board certified in pediatrics by the American Board of Pediatrics and board certified in epilepsy, as well as neurology with special  qualification in child neurology by the American Board of Psychiatry and Neurology.  Dr. Almidani is happily married with 4 children. His oldest son has autism and his daughter has complicated seizures; both were a drive for him to become a neurologist. Dr. Almidani enjoys soccer, running and spending time with his family. He is very involved with his sons’ therapy and helping with daily challenges. He is double board certified in Pediatric and Adult Neurology and Epilepsy. He sees children and adults. He also participates in charities for children in Syria who may be underprivileged and/or affected by the war. Dr. Almidani joined TeleSpecialists in August 2020.

Amanda Cheshire, MD

Dr. Cheshire received her medical degree from the University of Louisville School of Medicine in Louisville, Kentucky. She completed her neurology residency at the University of Cincinnati Medical Center in Cincinnati, Ohio. She did a fellowship in neurophysiology at the University of Michigan Medical School in Ann Arbor, Michigan. Dr. Cheshire is double board certified in neurology and clinical neurophysiology. She enjoys traveling, reading and music. She currently resides in Viera, Florida.  Dr. Cheshire joined TeleSpecialists in June 2019.

Jessica Floyd, MD

Dr. Floyd completed her neurology residency at Mayo Clinic in Jacksonville, Florida followed by fellowship training in clinical neurophysiology with focus in EEG and epilepsy at the Medical University of South Carolina in Charleston, South Carolina. She has particular interest in hospital neurology and patient education as well as the blossoming specialty of lifestyle medicine. She strives to take advantage of every encounter with patients and medical staff to empower them to do their own research into how daily thoughts, choices, and habits can add up to create greater and longer-lasting brain and neurologic health for ourselves and our loved ones. She lives in Florence, South Carolina with her awesome husband of 13 plus years and three beautiful children. She is an avid yogi, astrologer, and lover of food and all things neurology! Dr. Floyd joined the TeleSpecialist family in July 2017.

Nancy Futrell, MD

Dr. Futrell received her medical degree from the University of Utah in Salt Lake City, Utah. She also did her neurology residency at the University of Utah as well as a research fellowship in cerebral vascular disease at Jackson Memorial Hospital in Miami, Florida. She currently resides in Salt Lake City, Utah. She has authored 2 books and 50 peer reviewed papers. 

Rebecca Jimenez-Sanders, MD

Dr. Jimenez Sanders received her undergraduate degree from Emory University, and her medical degree from the San Juan Bautista School of Medicine in Puerto Rico. She completed her neurology residency at the University of South Florida in Tampa, Florida, where she also did a specialized headache medicine and facial pain fellowship. She currently resides in Tampa, Florida with her husband and her two daughters. She is also fluent in Spanish and Italian languages, and enjoys photography, baking, boating, and biking.

Cory Lamar, MD

Dr. Lamar received his medical degree from Meharry Medical College in Nashville, Tennessee. He completed his internship and residency at Wake Forest Baptist Health in Winston Salem, North Carolina. Following residency, he completed a clinical fellowship in neurophysiology, with a concentration in epilepsy. He currently resides in Florida and enjoys outdoor activities.

Clifford Meyers, MD

Dr. Meyers received his medical degree from Brown University in Providence, Rhode Island and his MBA from the Simon School of Business at the University of Rochester in Rochester, New York. He completed his neurology residency at the University of Rochester, where he also did a neurophysiology fellowship. Dr. Meyers resides in Webster, New York with his wife and daughter. When not doing teleneurology, he enjoys playing sports with his wife and daughter.

Tao Tong, MD

Dr. Tong received her medical degree from the University of Miami School of Medicine in Miami, Florida. She completed her neurology residency at Jackson Memorial Hospital in Miami, Florida, where she also did a neuromuscular/EMG fellowship.  She currently resides in College Station, Texas. Dr. Tong is married with two boys. She enjoys spending time with her family, traveling and reading.

Shubhangi Chumble, MD

Dr. Chumble attended BJ Medical School. She is a board certified neurologist with a subspeciality interest in sleep medicine. Dr. Chumble did her residency at Howard University in Washington DC and has practiced neurology since 2001 in private and corporate settings. She lives in Melbourne, Florida and loves the sunshine state. Her hobbies include yoga, meditation, cooking , traveling and meeting new people. She also loves to do stained glass, pottery and painting. She joined TeleSpecialists in June 2019.