Question 1

Can you get reimbursements for video devices for patients who don't have a computer or smartphone?

Accepted Answer

Getting reimbursements for video devices vary depending on your work setting. Look to your workplace's patient support services, local and state government funding programs, and federally-supported services.

Federal government agencies — such as the Veterans Health Administration (Veterans Affairs, or VA) — have instituted a ["Digital Divide" consult](https://mobile.va.gov/sites/default/files/vamobile-discussion-series-202009-slides.pdf) that will contact patients, discuss their needs, and send them telehealth equipment such as Apple iPads with wireless services.

Comcast offers [Internet Essentials](https://internetessentials.com), with affordable high-speed Internet wifi, a discounted laptop or desktop computer, for those who qualify for their low-income program.

The federal government has [Lifeline](https://www.fcc.gov/lifeline-consumers), a "discount on monthly telephone service, broadband Internet service, or bundled voice-broadband packages purchased from participating wireline or wireless providers." Service providers like [SafeLink Wireless](https://www.safelinkwireless.com), [Assurance Wireless](https://www.assurancewireless.com), [TruConnect](https://www.truconnect.com) provide wireless devices, hotspots, and accounts.  States such as California implement Lifeline as [Your Call Wireless](https://yourcallwireless.com/lifeline/), providing phone services and cell phones.

Finally, large commercial organizations such as [T-mobile](https://www.t-mobile.com/offers/lifeline-program), [Verizon](https://www.verizon.com/solutions-and-services/lifeline/), and [AT&T](https://www.att.com/home-phone/lifeline/) offer Lifeline services.

Question 2

I need help.

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, [please contact us](https://www.orbithealth.com/contact-us/).

However, if you are a patient seeking services for yourself or your family/friend, Orbit Health cannot provide care directly to you.  If this is a medical or mental health emergency, please call 911 or go to an emergency room immediately.

## Immediate help
* Get immediate help through [MentalHealth.gov's Immediate Help page](https://www.mentalhealth.gov/get-help/immediate-help).
* If you or someone you know is suicidal or in emotional distress, contact the [National Suicide Prevention Lifeline](https://suicidepreventionlifeline.org). This service is available 24 hours a day, 7 days a week. Staffed by trained crisis workers.
* Are you a veteran in crisis? The [Veterans Crisis Line](https://www.veteranscrisisline.net) is available 24/7 — by phone, text message, and online chat.

## Learn more
* Find out how to get help at **[MentalHealth.gov](https://www.mentalhealth.gov)**
* Find a psychiatrist, and learn more about psychiatric topics, at [the American Psychiatric Association](https://www.psychiatry.org)
* Learn how to find mental health help at [Mental Health America](https://mhanational.org/finding-help)

Question 3

How do you optimize internet speeds, audio and video?

Accepted Answer

Internet Speed: Anyone can test the bandwidth by going to websites like speedtest.net.  Upload speeds of over 3mps are generally effective if there are not a whole lot of other programs running on the computer.  However, it’s probably best to shoot for higher speeds and your internet service provider can give you options.  If you can afford it, its best to have the highest speeds the company can offer.  Also, ask for “dedicated bandwidth” which some companies offer that prevents your neighbors internet usage to bring down your own bandwidth.  Also, keep in mind that other devices running in the same household can hog up bandwidth and reduce the quality of the telehealth connection.

Computer: Most computers these days have enough power for videoconferencing.   However, computers that have a minimum of 8 gigs of RAM and I7 processors provide a more reliable videoconferencing experience (you might be able to get away with using an I3 or I5 processor, but this sometimes results in a slow computer response).

Video: Most (but not all) computers these days have cameras that are adequate for videoconferencing.  If your computer does not have a good camera, webcams can be purchased cheaply ($50-100).  While 720p video mode (“HD ready”) may be adequate, it is helpful to have a 1080p resolution (High Definition).  
While video is important, appointments are more often impacted by poor audio.  Oftentimes, people run audio through their computers which is hit or miss.  For a better quality of audio, you can purchase a microphone/speaker combination device which can be plugged into the USB port of your computer.  This will make audio clearer and filter out background noise.

It is a good idea to do a test run with the patient, clinic, or hospital, prior to the appointment to determine what equipment is being used and to experience the quality of the videoconferencing appointment.  Look to make sure there is no pixilation, freezing, graininess, or blurry video.  Make sure the video and audio are in sync--- in other words, the audio is not lagging behind the video.  Make sure that the audio is clear and that you can easily understand what the other person is saying.  Both parties (patient and doctor) should be able to talk at the same time and still hear each other if the audio is working correctly.

Paying attention to and optimizing the quality of video and audio will improve the telehealth experience for everyone.

Question 4

Does working for the federal government allow you to see patients via telepsychiatry, wherever you are?

Accepted Answer

Working for the federal government does not necessarily allow you to see patients via telepsychiatry, wherever you are. While there are no absolute contraindications to patients being assessed or treated using telemental health, you have to check with your supervisor — and any applicable administrative rules and trainings — for these rules.

Ask your supervisor about federal telework agreements, contingency plans for persons who appear in-person or who are unable to connect by video, and whether support staff are available to guide your patient in case of an outage.

Furthermore, telemedicine requires you to know which state a patient is located. You would need to follow that state's licensing laws and regulations. Usually, this means you must have a license to practice in that patient's state, have malpractice cover your practice in that state. Some states allow for a single state license to cover multiple states — the Interstate Licensure Compact, for instance — but not all states participate in this.

Resources, such as the [American Medical Association Telehealth quick guide](https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide), can help you determine which laws apply.

Question 5

What are the benefits of telepsychiatry?

Accepted Answer

In addition to the obvious benefit of being able to see a mental health professional while under quarantine, telepsychiatry offers many additional advantages to traditional mental health care. Telepsychiatry can be much more economically feasible for many individuals who are unable to afford mental health care. Seeing a doctor from the comfort of your home eliminates the need to deal with travel, lost work hours, childcare, and other expenses that may arise from the need to travel to a specific location. It can also lead to lower co-pays by reducing overhead costs for mental healthcare providers.

Telepsychiatry also brings mental health care to regions that are currently under-served, such as rural areas. Not every locale has licensed, available mental healthcare professionals, and telepsychiatry allows qualified professionals to treat patients anywhere they can find an internet connection.

Moreover, telepsychiatry can help to escape some of the stigma associated with mental health care. Patients do not need to drive to a hospital or medical office and sit in a waiting room with strangers while at their most vulnerable. Instead, patients can simply log on and connect directly with their mental healthcare professionals.

If you are an administrator of a health system or a healthcare provider in need of a way to deliver mental health services, [reach out to Orbit Health](https://www.orbithealth.com/contact-us/) to discuss how telepsychiatry can expand your options for healthcare delivery and meet the needs of patients in today’s challenging environment.

Question 6

What is #endthecycle? Why provide mental health care throughout the legal system?

Accepted Answer

The sad reality is that jails and prisons have become the new asylums.  According to the [Treatment Advocacy Center](https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3695), 383,000 individuals with severe psychiatric disease were behind bars in the United States in 2014- roughly equivalent to the size of the city of Cleveland, Ohio.  It is tragic and unacceptable that many people who deserve mental health treatment are instead thrown behind bars where they are exposed to trauma and further deterioration.

At Orbit Health, we are determined to disrupt the cycle of mass incarceration of the mentally ill by inserting telepsychiatry at every stage of the criminal justice system.  This ensures that people who are vulnerable to incarceration have access to the right care at the right time.

Why is it important to provide mental health care throughout the legal system?  People who are in the active phase of a mental illness (psychotic, depressed, manic, etc), are not able to function appropriately within the legal system and can disrupt the courts and correctional facilities.  By contrast, when people are adequately treated for the mental illness, they are better able to navigate within the legal system, care for themselves, and stay out of trouble.

Perhaps most importantly, we have an ethical obligation to take care of our fellow man to reduce suffering and protect our communities.  Orbit Health is there to help people get the care they need, whether it is at the time of arrest, in court, behind bars, or on parole.

At Orbit Health, we believe that a healthier person means a healthier society.  Its time to #endthecycle of mass incarceration of the mentally ill.

Question 7

What conditions are treatable through telepsychiatry?

Accepted Answer

Telemedicine allows for treatment of any condition that does not require physical presence to treat.  Psychiatry is uniquely suitable for telemedicine practice.  Therapy, counseling, diagnosis, and treatment for nearly every psychological disorder — whether related to mood, anxiety, cognitive functioning, substance dependency, etc. — can be conducted via telepsychiatric sessions.

Telepsychiatry has the added benefit of allowing for specialists to conference in from anywhere in the country, or even the world, meaning that you can treat more specific, more esoteric, or more exotic conditions as needed.

Question 8

What is Forensic Psychiatry?

Accepted Answer

Forensic psychiatry is a branch of medicine at the intersection of psychiatry and the law. Forensic psychiatrists are often hired by lawyers and judges to act as expert witnesses for both criminal and civil cases. They conduct psychiatric evaluations and offer opinions about how mental health issues relate to the case. Forensic psychiatrists can also be utilized as consultants to other doctors or administrators of organizations.

Forensic psychiatrists are in short supply, and it is often difficult to find one close by. Geographical distances can cause evaluation delays and involve expensive travel costs. With Orbit Health, the most qualified and experienced forensic psychiatrists can be added to your legal team, no matter your location, and on a much more reasonable budget.

Question 9

How can I improve the telehealth experience for those with hearing difficulties or who are deaf?

Accepted Answer

You and your team may treat persons who have hearing difficulties, whether they are hard of hearing or death. Consider the following in your workflow, such as involving staff to troubleshoot audio quality, involving a sign language interpreter, and sharing your screen:

* Check to make sure if the patient is understanding you. Have them repeat back what you said from time to time.
* If you have a telepresenter (a staff member on the patient side), they can tell you if its poor audio quality or if its good quality but the patient just can’t hear you because of their impairment. You can have the telepresenter repeat your words to the patient during your appointment.
* If the patient knows American Sign Language, you can easily include an ASL interpreter into the videoconferencing session as part of a group chat.
* Type out what you want the patient to know and screen share it with them. Make sure to use a big text so they can easily see the words. You can put your words in a Word document or the like, then click screen share. Problem solved!
* If all else fails, arrange for the patient to be seen in person. Usually this is not necessary as there are so many ways to ensure good quality of audio.  These days, audio via technology should not differ much from the audio in person.

Check out our full post on ["Telepsychiatry for the Hearing Impaired – Top 10 Tips."](https://www.orbithealth.com/telepsychiatry-for-the-hearing-impaired-top-10-tips/)

Question 10

How does Orbit Health provide mobile response teams?

Accepted Answer

Orbit Health’s innovative mobile response team works with local law enforcement agencies to provide alternatives to arrest and incarceration for those suffering from mental and emotional difficulties.

We provide urgent [telepsychiatry](https://www.orbithealth.com/what-is-telepsychiatry/) evaluations to assess the safety and stability of patients in the community. Our mission is to help end the cycle of mass incarceration by providing ways to divert vulnerable people from incarceration, and toward the help that they need to be a productive member of society.

To learn more, [contact Orbit Health today](https://www.orbithealth.com/contact-us/)!

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