Question 1

Why are mental health problems pervasive in correctional facilities?

Accepted Answer

There is a growing scientific consensus that proper mental health care is one of the most important parts of rehabilitation for incarcerated individuals.  Mental health treatment is one of the most effective components in reducing the likelihood of repeat offenses.  Although mental health disorders are neither a necessary nor a sufficient factor in either criminal activity or violence, mental health issues undoubtedly contribute to the likelihood of running afoul of the law.

In the United States, there are more mentally ill people in correctional facilities than there are in mental health hospitals.  Many criminal offenders struggle with mental illness and wind up in a correctional facility, and many incarcerated individuals develop psychological conditions as a result of their confinement.  The rate of mental illness in prisons may be as high as two to four times greater than in the general public.

Providing proper mental health services to people in jails, prisons, halfway houses and other facilities helps everyone.  Inmates get the psychiatric care that they need to become more productive members of society. In addition, the risk of suicide and other dangers can be mitigated, and healthy inmates are less likely to be involved in altercations with guards or other inmates while incarcerated.

By giving your correctional facility access to telepsychiatry, you can provide the mental health care that your inmates both need and deserve, without incurring the risk, inconvenience, and cost of either transporting inmates to treatment centers or transporting mental health professionals to your institution.

Question 2

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 3

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

Accepted Answer

Yes, telepsychiatry is comparable to in-person visits. In fact, studies have shown that telepsychiatry is effective for diagnosing mental disorders across ages — children, adults, and the elderly — and across ethnicities. Across studies, telepsychiatry has shown to provide clinical outcomes equivalent to face-to-face visits. Plus, across studies, diagnoses, and demographics, patients generally achieve improved symptoms and improved quality of life.

In fact, telepsychiatry has advantages over in-person care. Video visits increase access to a psychiatric practitioner, and can assist with collaborative care. Even those in rural communities and remote areas of the world — in other words, geographies with sparse populations — can access specialty care with the help of telepsychiatry.

Telepsychiatry is cost-effective. A study limited to the cost of providing clinical service has shown 10% reduction in cost per patient, when telepsychiatry was used versus in-person care. In the majority of studies, telepsychiatry is more cost-effective.

And both patients and providers are satisfied with telepsychiatry video visits. Patients feel they get along with their provider

### Sources:

* Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telemental health outcomes. World journal of psychiatry, 6(2), 269.
* Hilty DM, Ferrer DC, Parish MB, et al. The Effectiveness of telemental health: A 2013 review. Telemed J E Health 2013;(19):444-454.
* Janca, 2000. Telepsychiatry: an update on technology & implications. Curr Op Psych 13: 591-7.
* O'Reilly R, Bishop J, Maddox K, Hutchinson L, Fisman M, Takhar J. Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatr Serv. 2007;58(6):836-43.
* Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113.

Question 4

What are some of the advantages of remote group therapy?

Accepted Answer

Remote group therapy is very convenient to all who are involved.  Being able to log in for a remote group is easier than fighting traffic to and from where the onsite sessions are located.  For this reason, people may be more willing to schedule remote group sessions in their busy lives.

Also, this mode of healthcare delivery allows greater access to care to remote populations those who have been underserved by onsite care.

Question 5

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 6

How can a provider start a telepsychiatry practice?

Accepted Answer

To start a telepsychiatry practice, you must be licensed by the state to practice, and meet the requirements of your practice. Ideally, you would have board certification in psychiatry.

You'll additionally need broadband, a desktop computer such as a Mac or Windows PC, along with a webcam. Ideally, you can use a dedicated microphone and speaker headset, to maximize your audio.

You need to ensure you have the right software. You need to ensure you have an electronic health record, a prescription system, and ways to receive and send messages. Your videoconferencing setup -- whether it's Zoom, Google Meet, or Microsoft Teams -- needs to be HIPAA-compliant, and you would need a signed business associates agreement (BAA). While you could create a telemedicine service from scratch, there can be costs for telehealth implementation. Costs include human resources (HR) time, but also marketing, malpractice and legal, along with additional training time.

Finally, you can join an existing group, like Orbit Health. Orbit Health offers full-time and part-time positions in adult psychiatry (outpatient, inpatient, partial hospitalization, and more), child & adolescent psychiatry, community psychiatry, emergency & crisis psychiatry, and forensic psychiatry/health. Partnering with Orbit Health is a faster way to implement telepsychiatry services than building your own services from scratch. Orbit Health provides telepsychiatry for facilities across the United States, with board-certified physicians and nurse practitioners licensed in all 50 states.

Whether you enjoy working from home or on-site, Orbit Health has multiple positions for psychiatrists, nurse practitioners, and more! [Here’s why people like working for Orbit Health](https://www.orbithealth.com/job-opportunities/) — where you can tell us about your job interests and apply to work with us.

Question 7

How can telepsychiatry help during COVID-19?

Accepted Answer

Right now, most Americans are stuck inside their homes, while the COVID-19 coronavirus pandemic continues across the U.S. and worldwide. Normal business functions have, for the most part, shut down indefinitely. Many people, however, need services beyond food and water. Staying mentally healthy during these difficult times is one of the most challenging parts of the entire ordeal, and also one of the most important. The field of telepsychiatry allows individuals who are subject to shelter-in-place orders to get the mental health services they need without having to risk physical proximity near other individuals.

Question 8

Do I need specialized equipment for telepsychiatry?

Accepted Answer

In order to implement telepsychiatry, you need only a solid internet connection (DSL, cable, T1 or higher) and a device capable of videoconferencing.  While a laptop or PC with a good web camera and microphone are preferable, a tablet or even a smartphone can work in a pinch for teleconferencing.

No specialized media equipment is necessary, although you can certainly set up a conference room for ideal communications with a larger group of people.

Question 9

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

Question 10

Where do patients receive treatment?

Accepted Answer

Patients can visit their local clinic, medical office, or hospital.  Wherever you can set up a private space for video conferencing, patients can comfortably sit and engage with our mental health professionals.

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