Patients' experiences with tele-mental health services during COVID-19 in Pakistan.

Background: Although the concept of telehealth is of great interest globally, its potential has not yet been realized in Pakistan. It is therefore essential to explore the perspectives of stakeholders on the technology, particularly for mental health, to be able to increase and improve its use. Aim: To assess the perceptions and experiences of patients receiving tele-mental health services, including telepsychiatry and tele-psychotherapy, in Pakistan. Methods: For this qualitative exploratory study, we conducted in-depth interviews with 49 individuals at a tertiary care hospital in Karachi, Pakistan. Using the Cresswell framework for content analysis, we identified 3 major themes that focused on the positive and negative aspects of tele-mental health services and made suggestions for enhancing them. Results: Twenty-six of the participants received telepsychiatry, while the remaining 23 received tele-psychotherapy services. Technical literacy, cost of consultation, privacy, and therapeutic alliance were the major challenges identified by the patients, while convenience and the absence of stigma were highlighted as key facilitators for tele-mental health. Tele-consultations reduced travel and waiting time, thus improving access to healthcare. Participants suggested that the processes for booking appointments and making payments should be streamlined and the cost of tele-consultation reduced. Conclusion: This study provides insightful findings on tele-mental health services from the perspectives of patients living in an Asian culture. The major benefits highlighted were destigmatization of mental health and elimination of commuting costs and travel time. There were concerns about privacy, therapeutic alliance and availability and affordability of the technology.

Telepsychiatry in Australia: A Scoping Review.

Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation.

Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study.

OBJECTIVE: Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. METHODS: out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. RESULTS: Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. CONCLUSIONS: Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.

Using Academic Consultation-Liaison Telepsychiatry to Meet the Mental Health Needs of Complex, Medically Ill Patients in Underserved Areas: A Case Report.

Background: The nationwide shortage of mental health resources often disproportionately affects rural areas. As innovative strategies are required to address mental health resource shortages in rural areas, telepsychiatry consultation (TPC) may represent a population health-oriented approach to bridge this gap. In this case report, we examine the use of TPC from an academic consultation-liaison psychiatry service to a rural community hospital. Case Report: We describe the case of a woman with Wernicke encephalopathy seeking to leave the hospital against medical advice and the role that the TPC service played in the patient's evaluation and management, including assessing decision-making capacity. Discussion: We then examine benefits and limitations of the service, including a narrative review of the relevant, but limited, available literature as well as suggestions for how the service may be improved and incorporated into psychiatry residency and fellowship training in the future.

Factors Associated with Reliance on Audio-Only Technology (Telephone) for Completion of Telepsychiatry Visits.

Introduction: The ability to access telepsychiatry through audio-video technology versus audio-only (telephone) technology potentially leads to inequitable outcomes. This study examines the characteristics of patients who relied on the telephone to complete outpatient telepsychiatry visits in a large health system. Methods: This is a retrospective analysis of all telepsychiatry outpatient visits conducted from May 1, 2020, to December 31, 2021. Demographic, clinical, and socioeconomic factors were extracted from the electronic health record. Two-sample t tests were used for continuous variables and χ2 tests for categorical variables for bivariate analyses. Multiple logistic regression was used to examine the association between only telephone visits and all input variables. Results: Eight hundred ninety-four (8.9%) patients completed all visits only by telephone during the study period. In bivariate analyses, factors associated with telephone-only visits included male sex, non-English primary language, Black race, unmarried status, non-Hispanic ethnicity, older age, Medicare enrollment, uninsured status, and higher social vulnerability index (SVI). Psychiatric diagnoses associated with only telephone visits included substance use disorders and psychotic disorders. In multivariate analyses, factors associated with higher odds of only telephone visits included older age, inactive patient portal, comorbid diabetes, higher SVI, and higher broadband adoption. Psychiatric diagnoses associated with higher odds of completing only telephone visits included psychotic disorders, substance use disorders, or intellectual/developmental disabilities. Conclusions: Several patient-level factors are associated with a reliance on the telephone to complete telepsychiatry appointments.

Telepsychiatry readiness assessment at the Department of Psychiatry, Dr. Soeharto Heerdjan Hospital, Indonesia.

Background: The Dr. Soeharto Heerdjan Hospital, Jakarta, Indonesia, has deployed telepsychiatry since May 2022 to ensure continuity of care for its psychiatric patients. This model of service has not functioned optimally, owing to obstacles, including the absence of a registration officer, no designated consultation room, scheduling issues and challenges for patients or their representatives in using the telepsychiatry application. OBJECTIVE: This study aimed to assess telepsychiatry readiness at Dr. Soeharto Heerdjan Hospital. METHOD: An observational survey was conducted in April-May 2022, with a sample of 40 members of the telepsychiatry workforce, using the Telehealth Readiness Assessment (TRA) tool. Five key domains of the TRA tool are associated with the successful implementation of telehealth, including core readiness, financial considerations, operations, staff engagement and patient readiness. This tool includes a questionnaire, scoring sheet, supporting guidance and additional resources. The overall readiness score is a weighted average of the concept scores included within each of the five domains. RESULTS: Of 40 respondents, 72.5% were females and 42.5% were between 31 and 40 years. From the total of five domains of telepsychiatry readiness, the level of telepsychiatry readiness at Dr. Soeharto Heerdjan Hospital was 70.05% or a moderate level. CONCLUSION: Aspects of readiness that need to be improved include providing a workforce for telepsychiatry patient registration; drug delivery; scheduling; designated consultation rooms; user-friendly telepsychiatry applications and electronic media for information on telepsychiatry services.

Development of depression assessment tools using humanoid robots -Can tele-operated robots talk with depressive persons like humans?

BACKGROUND: Depression is a common mental disorder and causes significant social loss. Early intervention for depression is important. Nonetheless, depressed patients tend to conceal their symptoms from others based on shame and stigma, thus hesitate to visit psychiatrists especially during early phase. We hypothesize that application of humanoid robots would be a novel solution. Depressed patients may feel more comfortable talking with such robots than humans. METHODS: We recruited 13 patients with major depressive disorder (MDD) and 27 healthy volunteers as controls. Participants took both tele-operated humanoid robot and human interviews to evaluate severity of depression using the Hamilton Depression Rating Scale (HDRS). In addition, participants completed a self-administered questionnaire asking about their impressions of the robot interview. RESULTS: Confidence interval and t-test analysis have revealed that the HDRS scores are equally reliable between robot and human interviews. No significant differences were observed between the two interviews regarding "nervousness about the interview" and "hesitancy to talk about depressed moods and suicidal ideation." Compared to human interviews, robot interviews yielded significantly lower scores on shame-related factors especially among patients with MDD. LIMITATION: Small sample size, and the evaluator is male only. CONCLUSIONS: This is the first report to show the reliability of tele-operated humanoid robot interviews for assessment of depression. Robot interviews are potentially equally reliable as human interviews. Robot interviews are suggested to be more appropriate in assessing shame-related suppressed emotions and hidden thoughts of depressed patients in clinical practice, which may reduce the stigma associated with depression.

Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review.

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.

Impact of COVID-19 pandemic on relapse of individuals with severe mental illness and their caregiver's burden.

Background: The implementation of quarantine and social distancing measures to control the COVID-19 pandemic led to restrictions at the community level and most of in-person psychiatric services were discontinued. This situation could affect the psychopathology of the patients and the burden of their caregivers. The aim of this study was to investigate the effects of COVID-19 pandemic on people with severe mental illnesses (SMIs) and their caregivers' burden. Method: The study sample consisted of 86 patients with severe mental illness and 86 caregivers. The mental status, relapse rate, and rehospitalization rate of the patients and the general health status and burden of caregivers were investigated in three waves, including before and 3 and 6 months after the COVID-19 pandemic. Results: The relapse rate of the patients was 14%, 33.7%, and 43% (p = 0.000) and the rehospitalization rate was 4.7%, 7%, and 10.5% in waves 0, 1, and 2, respectively (p = 0.000). Most of the psychopathological scales increased in three waves (p = 0.000). The caregivers' burden and health condition worsened during the nine months of the study as well (p = 0.000). Conclusion: The COVID-19 pandemic led to the exacerbation of symptoms and increased the relapse rate in people with SMIs. It also worsened the caregivers' condition. People with severe mental illnesses (SMIs) and their caregivers are one of the most vulnerable groups on which the COVID-19 pandemic had a marked negative effect.

The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults.

OBJECTIVE: The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN: A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS: The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS: Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS: The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS: The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.

A Telehealth and Telepsychiatry Economic Cost Analysis Framework: Scoping Review.

Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.

Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis.

BACKGROUND: Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field. OBJECTIVE: We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools. METHODS: First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions. RESULTS: Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use. CONCLUSIONS: If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non-smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential.

Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review.

Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users' socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.

Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression.

Background: Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. Methods: Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks. Results: Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. Conclusion: Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.

The Impact of COVID-19 on Pediatric Telepsychiatry Training in Child and Adolescent Psychiatry Fellowships.

OBJECTIVE: This report summarizes findings from a 2020 survey of US child and adolescent psychiatry training programs that explored the impact of the COVID-19 pandemic on pediatric telepsychiatry training. The authors hypothesized that telepsychiatry training significantly increased during the pandemic, in part due to legal and regulatory waivers during the COVID-19 public health emergency. METHODS: In August 2020, an anonymous, 28-question online survey was emailed to all (138) accredited child psychiatry fellowships on the Accreditation Council for Graduate Medical Education website. Forty-nine programs responded (36%). This analysis focuses on three of the 28 questions relevant to the hypotheses: characteristics of the program's training in telepsychiatry; perceived impediments to clinical training; and perceived impediments to didactic training pre-COVID onset vs. post-COVID onset, respectively. Total scores were created to investigate differences in training programs and impediments to including telepsychiatry pre- and post-COVID onset. Paired sample t-tests were used to compare means pre- and post-COVID onset. RESULTS: Results provided support for significant differences between training components related to telepsychiatry pre- and post-COVID onset, with participants reporting more training components post-COVID onset (M = 5.69) than pre-COVID onset (M = 1.80); t(48) = 9.33, p < .001. Participants also reported significantly fewer barriers to providing clinical experiences in pediatric telepsychiatry post-COVID onset (M = 2.65) than pre-COVID onset (M = 4.90); t(48) = - 4.20, p < .001. CONCLUSIONS: During the COVID-19 pandemic, pediatric telepsychiatry training in child psychiatry fellowships increased significantly. Perceived barriers to providing clinical, but not didactic, training decreased significantly.

Association Between Telepsychiatry Capability and Treatment of Patients With Mental Illness in the Emergency Department.

OBJECTIVE: Because of limited access to psychiatrists, patients with acute mental illness in some emergency departments (EDs) may wait days for a consultation in the ED or as a medical-surgical admission. The study assessed whether telepsychiatry improves access to care and decreases ED wait times and hospital admissions. METHODS: ED visits with a primary diagnosis of mental illness were identified from 2010-2018 Medicare claims. A total of 134 EDs across 22 states that implemented telepsychiatry between 2013 and 2016 were matched 1:1 with control EDs without telepsychiatry on several characteristics, including availability of in-person psychiatrist consultations. Outcomes included patients' likelihood of admission to a medical-surgical or psychiatric bed, mental illness spending, prolonged ED length of stay (LOS) (two or more midnights in the ED), 90-day mortality, and outpatient follow-up care. Using a difference-in-difference design, changes in outcomes between the 3 years before telepsychiatry adoption and the 2 years after were examined. RESULTS: There were 172,708 ED mental illness visits across the 134 matched ED pairs in the study period. Telepsychiatry adoption was associated with increased admissions to a psychiatric bed (differential increase, 4.3 percentage points; p<0.001), decreased admissions to a medical-surgical bed (differential decrease, 2.0 percentage points; p<0.001), increased likelihood of a prolonged ED LOS (differential increase, 3.0 percentage points; p<0.001), and increased mental illness spending (differential increase, $292; p<0.01). CONCLUSIONS: Telepsychiatry adoption was associated with a lower likelihood of admission to a medical-surgical bed but an increased likelihood of admission to a psychiatric bed and a prolonged ED LOS.

Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review.

BACKGROUND: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. OBJECTIVE: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. METHODS: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. RESULTS: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. CONCLUSIONS: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users.

The Role of Telemedicine in Rural Mental Health Care Around the Globe.

Purpose: Through a qualitative systematic literature review (n = 12), this article seeks to better understand how telemedicine is used globally to address mental health needs within rural areas. This article highlights common barriers and advantages to providing this type of care, arguing that telemedicine services may be quite impactful in addressing mental health care needs in rural areas, but barriers, risks, and other cultural considerations must be considered when designing and implementing telemental health intervention programs. Methods: A search was conducted using PubMed, Google Scholar, PsychINFO, Medline, and SocINDEX. The inclusion criteria: (1) studies published between the years 2012 and 2019; (2) studies that met rigorous methodological criteria or analyzed telemedicine programs rigorously with evidence-based approaches; and (3) studies that specifically address or discuss tested telemedicine intervention programs for mental health in rural areas. Twelve articles of the 143 reviewed met the inclusion criteria. Findings: Themes included: (1) advantages (cost-effectiveness; accessibility, feasibility, and addressing disparities; privacy/confidentiality; integrative/collaborative care with primary care providers); (2) barriers and challenges (digital divides and infrastructure; ongoing care); (3) need for evaluation, evidence-based programs, and sustainability; and (4) across-cultural considerations. Conclusions: Future research examining the use of telemedicine in mental health intervention programs for rural areas should focus on various types of rural communities across the globe, diversifying the scope of this type of research and allowing for a better understanding of how to implement programs that address specific needs and barriers unique to rural communities across the globe.

Economic evaluation and costs of telepsychiatry programmes: A systematic review.

OBJECTIVE: Telepsychiatry involves use of telecommunications technology to deliver psychiatric care and offers promise to reduce costs and increase access to mental health services. This systematic review examined cost reporting of telepsychiatry programmes for mental healthcare. METHODS: We systematically searched electronic databases for studies reporting costs, including economic evaluations such as cost-effectiveness analyses, or costs of developing telepsychiatry programmes for clinical care of mental disorders. Included studies enrolled participants with mental disorders and involved telepsychiatry for depression, anxiety disorders, serious mental illnesses including schizophrenia spectrum disorders and bipolar disorder, post-traumatic stress disorder, dementia or epilepsy. RESULTS: Twenty-six unique studies met inclusion criteria (17,967 participants), with most targeting depression (n = 7; 27%), general mental disorders and screening (n = 7; 27%), child mental health (n = 4; 15%) and geriatric mental health (n = 4; 15%). Nearly all studies (n = 25; 96%) compared telepsychiatry programme costs with either standard in-person consultation or usual care, with 15 (60%) reporting that telepsychiatry programmes were less expensive, and 8 (32%) showing telepsychiatry programmes were more expensive. Three studies reported cost-effectiveness analyses, favouring telepsychiatry programmes, but at highly elevated cost-effectiveness thresholds. Few studies reported costs of developing or delivering telepsychiatry programmes. CONCLUSION: Costs of telepsychiatry programmes varied widely, with substantial heterogeneity in how costs were defined and reported. Some programmes cost less than in-person services while others cost more. Therefore, rigorous cost-effectiveness studies following established standards in economic evaluation are needed to inform implementation and sustainability of these programmes in health systems.

The role of Colombian psychiatrists in the midst of the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. METHODS: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. RESULTS: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. CONCLUSIONS: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.