Question 1

I need a psychologist

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please contact us through our website,https://www.orbithealth.com/contact-us/  However, if you are a patient seeking services for yourself or your family/friend, we 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.

Question 2

How does telepsychiatry work for forensic evaluations?

Accepted Answer

Identify a small, confidential area in your forensic setting that has internet access, a desk, and a chair. We will place a video screen there and provide psychiatrists via high quality videoconferencing technology. We can use the facility’s existing computers or devices to stream a connection over a web-based telepsychiatry platform.

Alternatively, we can provide a portable device that is dedicated to telepsychiatry and is always on. The technologies we use are specifically designed for telehealth encounters and are HIPAA-compliant.

When the subject of the forensic evaluation is ready to be seen, our telepsychiatrist will appear on the screen to conduct an expert evaluation. Forensic evaluations can be recorded if given permission from the subject’s attorney or by direction of the judge presiding over the case. Otherwise, the session will not be recorded. After the session(s), the telepsychiatrist will prepare his/her forensic report.

**Contact Orbit Health to Get Connected to a Qualified Expert Witness Today:** If you have a pending legal matter that would benefit from advice, opinion or testimony from a qualified psychiatric expert, you do not need to rely on whoever happens to be located nearby.  It does not matter if there are no such experts in your area.  Orbit Health will connect you with a qualified, professional, and effective forensic psychiatric expert, transmitted to any location that has internet access.  [Reach out to Orbit Health](https://www.orbithealth.com/contact-us/) to discuss your options for telepsychiatry today.

Question 3

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 4

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 5

Can medication be prescribed via telepsychiatry?

Accepted Answer

Yes.  Our licensed psychiatrists are able to prescribe medications for patients they diagnose and treat remotely.  Our providers will write and sign the prescriptions, which can then be transmitted to the clinic for local fulfilment.

Question 6

Has research been done to prove forensic telepsychiatry works? What’s the evidence base?

Accepted Answer

Yes, telepsychiatry has been comparable to in-person care among inmates in jail, prison, and correctional facilities. Video visits with telepsychiatric evaluations are used used to treat inmates with a variety of psychiatric illness in a range of severity, including severe mental illness. Decades of studies demonstrates telepsychiatry’s usefulness.

Vacancies and staffing issues in correctional facilities can impact access to care. Physical space requirements, security requirements, and correctional work culture pressures discourage healthcare providers from working in the correctional facility environment.

Telepsychiatry fills these vacancies, can ease burden on clinicians and providers, and takes less physical space than having more personnel on-site.

With the adoption of telepsychiatry, inmates can be seen early in their incarceration. Patient satisfaction has been shown to be high in forensic psychiatric patients with remote video visits. Acceptability has additionally shown to be high amongst jail personnel.

A meta-analysis — a study of multiple studies — looked at telepsychiatry used in acute settings, including inpatient units. They showed that the quality of clinical interaction is similar to in-person face-to-face encounters, and that telepsychiatry has been cost-effective.

Sources:

* Kaftarian, Edward. "Lessons Learned in Prison and Jail-Based Telepsychiatry." Current psychiatry reports 21.3 (2019): 15.
* Salmoiraghi A, Hussain S: "A Systematic Review of the Use of Telepsychiatry in Acute Settings" Journal of Psychiatric Practice. 2015; 21 (5):389-93
* Brodey et al, 2000. Satisfaction of forensic psychiatry patients with remote telepsychiatric evaluation. Psych Services: Oct 51(10): 1305-7.
* Leonard S: "The Successes and Challenges of Developing a Prison Telepsychiatry Service" Journal of Telemedicine and Telecare. 2004; 10 (S1): 69-71
* Zaylor C, Whitten P, Kingsley C: "Telemedicine Services to a County Jail" Journal of Telemedicine and Telecare. 2000; 6 (S1): 93-95

Question 7

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 8

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/)!

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 can forensic telepsychiatry help your case? Which forensic issues?

Accepted Answer

In many cases, forensic evaluations and testimony can be accomplished remotely via videoconferencing. Forensic telepsychiatry makes sense, and it saves time and money. Attorneys and judges are increasingly accepting of the concept of forensic telepsychiatry as a convenient and effective way to utilize expert testimony.

Orbit Health can provide teleforensic experts to help sort through the following forensic issues:

* **Competency to Stand Trial.** In matters involving criminal defendants or other parties who lack mental capacity, a forensic psychiatrist can evaluate whether the party possesses the mental faculties necessary to stand trial on their own behalf.
* **Insanity Defense/ Criminal responsibility.** Crimes of passion often turn on the mental state of the defendant.  A forensic psychiatrist can evaluate whether a defendant possessed the mental capacity to understand the consequences and morality of their actions, or whether they should be subject to a lesser penalty or alternative treatments instead.
* **Civil Commitment/ Involuntary treatment.** Forensic psychiatrists evaluate whether individuals could pose a danger to themselves or others in order to inform a court’s decision as to the wisdom and morality of involuntary commitment to a psychiatric institution. A remote telepsychiatrist can perform an evaluation of an elderly or disabled individual and offer an opinion as to their mental capacity.  Such opinions form the basis of whether an adult or elderly person should be placed under the legal care of another.
* **Competency to Make Treatment Decisions.** End of life care is complicated at the best of times.  When an injured or ill person appears to lack the ability to make competent decisions about their own health, it is important to have a psychiatrist evaluate their mental faculties and their emotional state.  This can be accomplished remotely via telepsychiatry, wherever the patient is located.
* **Worker’s Compensation and Torts.** Injured parties, whether they suffer a physical injury, a psychological injury, or both, require expert evaluation and testimony to prove or disprove their case.  A forensic telepsychiatrist can evaluate the extent of their injuries and the emotional trauma connected thereto. Forensic psychiatrists can provide vital insight and opinion as to whether an injured worker possesses the capacity to return to work or should instead qualify for disability benefits.
* **Violence Risk Assessment.** Judges often rely on forensic psychiatrists to evaluate the propensity of a defendant for violent action when deciding upon bail.  With telepsychiatry, your defendant will have access to the most qualified and most neutral evaluation in order to ensure that the principles of justice are not violated.
* **Child custody and visitation.** Child psychiatrists can play a vital role in determining the healthiest placement for children of divorce.  With Orbit Health, the best child psychiatrists can be brought in remotely for an unobtrusive evaluation and opinion.
* **Psychic injury.** A forensic psychiatrist can remotely evaluate a plaintiff following a traumatic event to establish the extent of their emotional trauma and provide an expert, reasoned opinion as to the severity of their psychic injury, all without the expense of flying a medical professional to your location.
* **Mental disability.** Disability is available for mental and emotional disorders as well as physical ailments.  Telepsychiatrists can remotely evaluate applicants regarding whether they are capable of working or should instead receive disability benefits.
* **Malpractice cases often turn on the credibility of each side’s expert:**  Was the medical professional’s conduct appropriate, or did they violate standards and norms?  With telepsychiatry, the strength of your expert opinion will not depend solely on which licensed psychiatrists simply happen to be in your region.
* **Juvenile justice.** Experts are often employed in cases involving juveniles to establish the mindset and maturity of juvenile defendants and opine on whether they should be tried as adults
* **Other issues:** Probate/ Testamentary Capacity/ Undue Influence; Defense Base Act (workman’s comp for military contractors); Sentence Mitigation;  Personal Injury;  PTSD;  TBI (traumatic brain injury); IME (Independent Medical Examinations);  Fitness for Duty;  Sexual Assault; Sexual Harassment; Immigration (Asylum, Trafficking T-Visa, VAWA);  Intoxication/ DUI/ DFSA (Date Rape); Suicide

Need telepsychiatry for your organization?

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