Question 1

How can Orbit Health help your forensic evaluations?

Accepted Answer

Orbit Health brings qualified expert witnesses directly to your conference room and courthouse.

Many legal matters, both civil and criminal, turn on the opinions offered by expert witnesses. Whether a case involves the damaging effects of personal injury, the reasonableness of a medical professional’s diagnosis and treatment, or the proper operation of a piece of complicated machinery, expert opinions often form the backbone of each party’s arguments to the judge and jury. Experts in the field of forensic psychiatry, in particular, are necessary for a wide variety of legal matters.

Not every jurisdiction has access to every type of expert, however. Some parties and some matters cannot justify the expense of flying a medical professional thousands of miles to draft an opinion and testify. Moreover, with limitations imposed during the COVID-19 coronavirus pandemic and other natural disasters, it can be difficult, if not impossible, to bring an expert to the locale where a matter is taking place. Thankfully, with the use of telecommunications, you can now bring the expert to your conference meeting or courtroom immediately, efficiently, and with much less cost.

Orbit Health connects the best and brightest forensic psychiatric specialists from around the country to litigants in need of expert opinions and testimony, no matter their location, without all the extra expense and complication of travel.

If you have a pending legal matter that would benefit from advice, opinion or testimony from a qualified psychiatric expert, you do not need to rely on whoever happens to be located nearby. It does not matter if there are no such experts in your area. Orbit Health will connect you with a qualified, professional, and effective forensic psychiatric expert, transmitted to any location that has internet access. Reach out to Orbit Health to discuss your options for telepsychiatry today.

Question 2

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.

Question 3

Is telepsychiatry appropriate for inpatient settings?

Accepted Answer

Telepsychiatry has been utilized in a variety of inpatient units with success and is an acceptable mode of delivering care in these settings. Both government and corporate health care organizations have embraced telepsychiatry for this purpose. In the early days of telepsychiatry, some administrators and providers were hesitant or skeptical about using telepsychiatry for inpatient units. Reasons given were mostly a subjective and vague concern about the ability of providers to appropriately care for severely ill patients without being on site, in person.

However, in recent years, as telepsychiatry has become more widely adopted, those concerns have diminished. Those who have experience with inpatient telepsychiatry have come to understand that providing care in this way is not substantially different that how it would be provided in-person. In fact, there are several advantages of telepsychiatry over onsite psychiatry in the inpatient unit:

Telepsychiatry allows inpatient units in underserved and rural areas to be adequately staff
Telepsychiatry allows the provider to work from the comfort of his home, rather than being forced to sit for long hours under fluorescent lights within a noisy, musty and uncomfortable inpatient unit.
Telepsychiatry gives providers opportunities to create any variety of schedule that works best for their lifestyle, including working during odd hours, weekdays, nights, part time, or full time. With telepsychiatry, shifts can more easily be modified and swapped to fit the needs of the providers.
Telepsychiatry allows the inpatient unit to supplement staff easily and efficiently. This is especially useful when facilities are running short on staff due to illness, surges in patient volume, or any other factors.
Telepsychiatry allows for 24/7 coverage of inpatient units, which is often hard to do when relying solely on in-person onsite coverage.

The Importance of Effective Communication:

Reviewing the treatment plan
Reviewing progress of the patient toward discharge goals
Addressing urgent and emergent patient issues
Relaying factors on the unit which may affect patient experience. For example, excess noise from other patients, physical plant issues (like plumbing or electrical issues in the unit), overcrowding on the unit, or hostile patients that are disrupting the environment for other patients.
Oftentimes, the way a patient presents to the psychiatrist may be different than how they behave on the unit. It is helpful for the psychiatrist to know how the patient is doing both on and off camera.

Efforts should also be made to establish adequate communication between the telepsychiatrist and the patient. Although communication with a severely mentally ill person can often be challenging, the telepsychiatrist should try to involve the patient in the treatment goals and plans as well as answer any patient questions and concerns.

**What about paranoid and psychotic inpatients? Are they appropriate for telepsychiatry? **

There is no absolute contraindication for telepsychiatry and virtually any mental health condition can be treated via telepsychiatry. However, there are certain clinical situations where a patient's mental status or condition may require that arrangements are made for onsite psychiatric care. For more information, please see the article "Are psychotic patients appropriate for telepsychiatry?"

In summary, telepsychiatry is an appropriate and effective way to provide care to inpatient facilities, especially when there is good communication.

Question 4

What is telepsychiatry?

Accepted Answer

Telepsychiatry is the delivery of psychiatric care remotely using technology, usually through videoconferencing platforms. It can involve mental health evaluations, therapy, medication management, and patient education. Telepsychiatry is the fastest growing sector of the telemedicine and is the future of mental health care.

Telepsychiatry is a form of telemedicine that generally refers to the delivery of psychiatric assessment and care via telecommunication, typically using videoconferencing software. The practice of telepsychiatry has been in development since well before the pandemic quarantines, as an effort to account for the millions of Americans who suffer from mental illnesses but are unable to get proper psychiatric care.

Telepsychiatry brings mental health care to individuals who are unable to see a medical professional in person for any of a variety of reasons, including the cost and availability of travel, incarceration, or contagion. Now, with shelter orders and quarantines keeping medical offices closed and people restricted to their homes, telepsychiatry provides a promising alternative to in-person psychiatric care.

Question 5

Is special software and training needed?

Accepted Answer

When you contract with Orbit Health, we will provide your medical practice with all of the software and training necessary to implement our telepsychiatry services. The process is simple and requires very little setup.

Question 6

Is telepsychiatry subject to specific guidelines and laws?

Accepted Answer

Orbit Health psychiatric professionals strictly adhere to the federal and state guidelines that apply to their practices. Additionally, different states may implement and apply different guidelines specific to telepsychiatry.

For example, telepsychiatry practitioners must carefully follow laws that regulate prescriptions for controlled substances. This is done by a rule called the “Ryan Haight Online Pharmacy Consumer Protection Act of 2008,” enforced by the DEA (Drug Enforcement Agency).

The Ryan Haight Act requires a practitioner to conduct in-person medical evaluation before they can prescribe a controlled substance. Some exceptions apply for systems like federal healthcare providers at Indian Health System.

With the COVID-19 public health emergency, an in-person medical evaluation is not feasible. This is where telepsychiatry has a protective advantage for clinical staff and for patients. For instance, the DEA will allow prescriptions to be issued for audiovisual telemedicine communication.

Question 7

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 8

I need a psychologist

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.