Question 1

How do you prescribe long-acting injectables via telepsychiatry?

Accepted Answer

Prescribing long-acting injectables (LAI) is similar to that of prescribing any medication — determine the dose, frequency, and applicable dispensing location.

Many clinics and work settings allow you to arrange for the long-acting injectable to be provided at another clinic site or nursing site. For instance, the Veterans Affairs' telehealth system allows a prescriber to order the medication, and request nursing support at a specific clinic, through their electronic health record.

According to the Pharmacy Times, as of 2019, pharmacists can provide vaccinations in all 50 U.S. states and the District of Columbia. Only 44 states allow pharmacists to give long-acting injectable medications. Calling your pharmacy for options can help clarify what services are available.

And, according to the National Community Pharmacists Association, industry programs from pharmaceutical manufacturers of long-acting injectable atypical antipsychotic medications — such as Invega Sustenna — can help determine which locations can administer such medications. Recognized "Injection Centers" are networks of pharmacies and healthcare facilities that help provide these injections.

Question 2

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 that will contact patients, discuss their needs, and send them telehealth equipment such as Apple iPads with wireless services.

Comcast offers Internet Essentials, 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, 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, Assurance Wireless, TruConnect provide wireless devices, hotspots, and accounts. States such as California implement Lifeline as Your Call Wireless, providing phone services and cell phones.

Finally, large commercial organizations such as T-mobile, Verizon, and AT&T offer Lifeline services.

Question 3

I need help.

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please 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.
If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Lifeline. 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 is available 24/7 — by phone, text message, and online chat.

Learn more

Find out how to get help at MentalHealth.gov
Find a psychiatrist, and learn more about psychiatric topics, at the American Psychiatric Association
Learn how to find mental health help at Mental Health America

Question 4

What is Zoom Fatigue, and why does it occur?

Accepted Answer

As the COVID-19 coronavirus pandemic continues into its second year, people have become accustomed to handling most or all of their personal and professional interactions remotely. Videoconferencing has become a normal part of daily life. Videoconferencing fatigue, now commonly called “Zoom fatigue” in reference to one of the most popular videoconferencing platforms, refers to the exhaustion caused by constant video calls.

While Zoom fatigue is not yet an official diagnosis, many psychologists state that the condition is both real and prevalent in the new pandemic era.

Constant video calls on any platform, including Google, Skype, Microsoft Teams, FaceTime, and other professional platforms can lead to fatigue. People can start to feel extra irritable, less energized, constantly “on the clock” for work, confused or awkward during meetings, and isolated even while communicating with others.

There are scientific reasons for these feelings. Video calls can make people feel like they are always “on.” People are hyper-aware of their appearance, their mannerisms, the sound of their voice, and they can begin to feel like they are “performing” in a way that is not true of in-person interactions. The silence on the other end of the line when people mute their microphones, delays in response time, as well as the added effort necessary to identify nonverbal cues via video chat, contribute to stress and fatigue as well.

Video calls from home also allow us to become easily distracted. When technology fails us--the WiFi goes out, someone’s camera or microphone fails to work, etc.--we can feel even more overwhelmed.

Learn more in our complete article, "Videoconferencing Fatigue and What to Do About It."

Question 5

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 6

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).

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 7

What hardware and apps should I use for telehealth visits for those with hearing impairments?

Accepted Answer

If you see enough patients, you are bound to run into patients who may be hard of hearing or deaf. Persons with disabilities deserve great care. Effective communication is essential to ensure a high quality of care.

Consider using the following computer equipment, hardware setup, and apps, for your telehealth and telepsychiatry visits:

Make sure that there is as little background noise as possible on both sides of the camera. This can be challenging in certain facilities that are inherently noisy, such as jails or inpatient units. Its helpful to have a dedicated office for telepsychiatry that can be insulated against background noise.
Use a high-quality microphone speaker on both sides of the telehealth session. These are easy to use and inexpensive devices. You just plug and play, with a USB port.
If the quality is still not good, you can connect the audio through the telephone while keeping video with the telemedicine platform.
Provide the patient with headphones (noise cancelling preferred). This allows the patient to increase the volume and minimize the diffraction of noise.
There are several closed-captioning apps on the market. Also, some videoconferencing platforms include closed captioning as an option. Just be sure that these technologies are all HIPAA compliant.

Check out our full post on "Telepsychiatry for the Hearing Impaired – Top 10 Tips."

Question 8

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 9

Are there certain conditions that benefit more from remote care for group therapy?

Accepted Answer

There is insufficient research to determine if group therapy done remotely is more suited for a specific type of patient.

However, remote care is often less intimidating than being in person. For example, a patient with an anxiety disorder such as social phobia or agoraphobia may be reluctant to put themselves in front of a group of strangers for the first time. They may be more likely to participate in remote groups instead.

Question 10

Does remote group therapy allow the participants to develop a bond?  How important is that?

Accepted Answer

One of the main purposes of group therapy is to allow patients to learn from, and be supported by, other members of the group. This happens more easily if there is a sense of solidarity or connection amongst the group members.

Can you achieve that same level of connection with remote groups? Yes: Ensure that all members of the group can see and hear each other clearly at all times. Also, encourage and give space for all members to actively participate in the discussion so that no one is left behind.