Question 1

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.

Question 2

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 3

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 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

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 — where you can tell us about your job interests and apply to work with us.

Question 6

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 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. 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!

Question 7

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 8

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 9

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 10

How can I combat Zoom fatigue symptoms?

Accepted Answer

Videoconferencing and remote professional services are now a regular practice in many industries. However, these remote calls can lead to feelings of fatigue.

If you find yourself exhausted by all of the video calls in your life, here are a few tips:

Schedule “no meeting” blocks of time. Make sure there are parts of your day when you are away from a screen.
Avoid multitasking. When you are on a call, focus on the business of the call. Avoid pulling up a second window to read emails or conduct other work. Multitasking during calls leads to a loss of productivity and difficulty remembering what occurred in the meeting.
Limit the number of calls. Do what you can to cut down on your overall number of calls. Group calls with separate people or teams together where feasible and appropriate. If a video call is not actually necessary, resolve the issues via phone, email, or a collaborative document. Do not default to a video call for every type of meeting. If you are meeting a stranger for the first time, such as a networking connection, for example, video calls can feel personal and invasive; start with a phone call.
Take breaks. If your call lasts more than an hour, it is important to take breaks. Get up and walk around, use the restroom, get a glass of water. Everyone will have more energy and remain more productive as a result.
Turn off your self-view. Video call programs like Zoom default to displaying your own video as well as others on the call. Staring at your own face can be distracting and increase stress and anxiety. Hide yourself from your own view so you can focus on the other people on the call.
Limit on-screen stimuli. In addition to hiding your face and keeping other windows closed, do what you can to limit what you see on-screen. Encourage people to take calls in front of plain backgrounds instead of a room full of objects. Seeing five different rooms full of furniture can cause disorientation and increase mental fatigue.

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