Question 1

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 2

Is telepsychiatry as effective as in-person sessions?

Accepted Answer

The psychiatric professionals at Orbit Health are among the best in the industry.  They can provide clinical diagnoses, treatments, and effective outcomes, as well as increase community health in wellness, especially in underserved areas.

The lack of physical proximity does not inhibit our experts’ ability to diagnose and treat patients suffering from any number of psychiatric conditions.  The level of privacy and confidentiality is the same as in-person care.

Research shows that telepsychiatry is just as effective as in-person, face-to-face care.  Many patients, in fact, find that psychiatric treatment via videoconferencing is less intimidating or embarrassing.  Patients, psychiatrists, and other professionals have all reported high levels of satisfaction with telepsychiatry since its inception.

Question 3

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.

Question 4

How can telepsychiatry help your correctional facility?

Accepted Answer

Orbit Health brings the most qualified mental health professionals right to your facility, without the need for in-person contact.  Telepsychiatry allows your facility access to qualified, capable psychiatrists, including specialists in the field of incarceration, located anywhere around the country.  Telepsychiatry offers benefits such as:

* You are not limited to the services of the nearest mental health treatment center.
* Doctors are not put at risk by being placed in direct contact with inmates.
* Increased access, including compliance with state and federal health regulations, at a reduced cost.
* Reduced gaps in care: Get help from experts in post-traumatic stress disorder, incarceration, violence, gender transition, and any other specific issues faced by your inmates.

Question 5

What's the standard of care for telepsychiatry, compared to in-person care?

Accepted Answer

Telehealth is increasingly being adopted by providers, patients, hospitals, and clinics as a great way of providing access to much needed healthcare.  Policymakers and lawmakers have generally fallen behind the current practice and therefore there can be some uncertainty around what standard of care should apply.

Moreover, “Standard of care” can be subject to interpretation based on several factors, including, but not limited to:

Specialty or subspecialty, as it relates to the scope of practice of the provider
Circumstances of the care
Community in which care is being provided.
Notably, the applicable community is debatable in telehealth, as the doctor and patient care are in different geographic areas.

The prevailing opinion in telehealth circles is that the standard of care should be based on the location where the patient is located, however, this is not a hard and fast rule.  Each state has its own opinions about standards of care for telehealth and multiple jurisdictions can potentially apply.

As a provider, the best way to think about standard of care is to do what a reasonable and prudent provider do in similar circumstances.  Reasonable and prudent care often depends on several components, such as:

* Patient case factors- although there are no absolute contraindications for telehealth, in rare cases the patient might object to the use of the technology for reasons such as paranoia/fear about being recorded or the technology being hacked, or difficulty keeping themselves in the frame of the camera due to cognitive issues. Also, if the patient is intellectually disabled and does not understand what is going on, perhaps thinking that they are watching TV.

* Setting to which care is being delivered- the environment is noisy, distracting, or not private, this can affect the quality of care provided.

* Types of technologies being used- if the technology does not allow adequate audio or video, this brings down the quality of assessment and treatment.

* Overall framework in which care is being provided- If telepsychiatry is conducted in the absence of other potentially important support for the patient.

* Consent- consent requirements are determined by each state. Some states require specific verbal or written consent from the patient to conduct appointments via telehealth.  Others do not have this requirement or have not opined on it.

* Limitations around AIMS testing. There are ways to conduct AIMS testing remotely, although the provider should be cognizant of potential limitations and this should be factored in the standard of care.

Telepsychiatry, more so than other specialties of telehealth, offers almost the same level of services as onsite psychiatry.  Therefore, the standards of care should be considered very similar.  In fact, some state medical boards [(such as the Medical Board of California)](https://www.mbc.ca.gov/Licensees/Telehealth.aspx) make it clear that the standard of care is the same.

In reality, what a psychiatrist can do remotely may vary somewhat from what can be done in person.  For example, a psychiatrist examining a patient remotely through video cannot physically touch the patient to assess for physical conditions such as cogwheel rigidity.  In these cases, psychiatrists rely on onsite staff or other ways of obtaining a reasonable amount of information to make a diagnosis and adequate treatment plan.

Ultimately, standards of care can be interpreted in a variety of ways, and telehealth makes it even more vague and sometimes confusing.  Therefore, the provider should use their best judgment, considering clinical factors, their means to resources, and the overall nature of the care being provided.

Disclaimer- this article is our best effort to provide useful information and does not constitute legal advice.  Please make sure to consult with entities such as state medical boards, their malpractice carrier, and potentially legal counsel prior to practicing healthcare.

Question 6

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 7

How can Orbit Health serve community mental health?

Accepted Answer

Orbit Health is a beacon for underserved communities. We have extensive experience providing essential [telepsychiatry](https://www.orbithealth.com/what-is-telepsychiatry/) services to community mental health programs such as county outpatient clinics, inpatient units, and crisis stabilization centers.

Our goal is to help provide essential psychiatric treatment to those in the community at risk for severe mental illness, homelessness, poverty, addiction, and [incarceration](https://www.orbithealth.com/telepsychiatry-services/correctional-care/cycle-of-mass-incarceration-of-the-mentally-ill/). We deliver high quality and reliable patient care remotely, through state-of-the-art videoconferencing technology.

Our services help community clinics and hospital function more efficiently and effectively, reducing the burden of serious mental illness on society.

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

Question 8

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 9

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 10

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](https://telehealth.va.gov) 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](https://www.pharmacytimes.com/publications/specialty-pharmacy-times/2019/2019-Asembia-Recap/New-Frontiers-for-Pharmacists-Administration-of-Long-Acting-Injectable-Antipsychotics), 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](https://ncpa.org/administration-long-acting-anti-psychotic-injectable), 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.

Need telepsychiatry for your organization?

Job opportunities