Question 1

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 2

Should groups be based on demographics, location, culture, or perhaps topic-focused?

Accepted Answer

The more group members have in common, the easier it is for them to develop bonds.

However, in today's world, there are so many ways you can categorize people. People of the same race may have vastly different attitudes and values, for instance.

But more than anything else, people bond over shared experiences. Also, people with different mental conditions may have great difficulty relating to each other, even if they share the same culture or race. Thus, it is important that a group be focused on a specific mental health condition.

Question 3

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 4

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 5

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 6

I need a psychiatrist

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 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

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 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!

Question 9

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 10

Are psychotic patients appropriate for telepsychiatry?

Accepted Answer

There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry. Generally, the concerns about psychotic patients becoming more paranoid or distrustful with telepsychiatry are overblown.

However, in rare cases, a patient may not be appropriate for telepsychiatry if they are truly fearful about a delusion that involves the camera or videoconferencing equipment. Does this mean that telepsychiatry is inappropriate or impossible to effectively treat such as patient? Not necessarily...

It is important to remember that psychotic patients can incorporate anything from their environment into their delusional beliefs. For example, a patient may be delusional that they are being held captive in a secret Nazi prison camp. This does not mean that they should be discharged from the unit out to the street. Likewise, a patient who has delusions about telepsychiatry does not necessarily fail to benefit from telepsychiatry.

Nevertheless, it is theoretically possible for a patient to be so paranoid about telepsychiatry that they become mute or refuse to participate in the telepsychiatry session. If that same patient is willing to converse with a psychiatrist in the facility, then perhaps onsite psychiatry may be a more effective option. This would be a clinical decision based on the case factors. Ultimately, if the treatment team feels that the patient fundamentally cannot benefit from telepsychiatry due to their delusional beliefs about that modality of care, then other arrangements should be made to provide care onsite.

In summary, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care. However, this happens very rarely. Overall, telepsychiatry is an effective option in the vast majority of mental health cases.