Two years ago, I began to take more of an interest in the field of telehealth. Like many of my colleagues, I had been reading about telehealth for several years and began to see more and more job postings related to my training as a clinical psychologist and a psychiatric nurse practitioner. Eighteen months ago, I finally decided to leave the traditional brick and mortar workplace for the new frontier known as telepsychiatry. However, it was not without much anxiety and trepidation. Those anxious feelings quickly subsided once I began.
Apprehensions Met with Solutions
As I approached the field of telepsychiatry, several concerns came to mind. My first concern as a trained psychologist was whether I could establish a therapeutic relationship with a patient through the lens of a camera. I soon came to realize the answer is simple, yes you can. Not only have I been able to establish strong therapeutic alliances with my patients, but these alliances are strong and effective.
The second area of concern was the technology. I found that the key to successful telehealth is to have strong internet service and the right equipment. Efficiency is key to convey a sense of professionalism, confidence, and trust with your patients. I use three monitors that allow me to perform my duties with minimal to little distraction or disruption. I have a laptop that I use to email the staff at the facility and access references, websites, and resources. I use one monitor to view and use the electronic health record, and finally, one of the monitors is exclusively devoted to the video platform. I also use an external camera for better clarity of the picture and a headset for better clarity of sound. Finally, I like to show the patient how the setup works by using the external camera to pan the room to give the patient a better understanding of the process. An additional feature that can be used with patients is sharing your screen with them. I often share my screen to review information with the patient, such as medications, lab reports, psychological testing results, and any other documentation that is pertinent to their care.
A third concern and the most important is how to manage patients who might present a danger to themselves or others. I find having their address, cell phone number, and a release with contact information for a family member or friend in place prior to the session will provide a safeguard for those patients who may need immediate attention.
There are many benefits to telepsychiatry compared with other disciplines. First, it is important to point out that in psychiatry practitioners do not need to conduct a physical exam or hands-on assessment which makes telehealth an ideal platform for those working in this area. The most important benefit to telepsychiatry is the ability to provide psychiatric care and services to those who live in rural areas and who might not otherwise be able to access care.
The safety aspect of providing telepsychiatry is one benefit that cannot be understated. It is not uncommon for those of us who work in mental health to see patients who might become violent or aggressive. In addition to telepsychiatry providing safety by creating a physical barrier, telehealth can also provide safety by eliminating the risk of contracting infectious diseases, such as the Coronavirus.
I found it very encouraging when I first started doing telehealth at how receptive the patients were to this new format. While there were a few who preferred in-person sessions, the majority seemed to be comfortable engaging in sessions using video technology. This helps to ensure the safety of both the patient and staff at our facility. Like myself, several patients experienced a learning curve, but over time their skill at connecting and their comfort levels improved.
My takeaway from the use of telepsychiatry is that more and more people are going to experience telehealth and much like myself, begin to appreciate the benefits of telehealth, few will want to return to the old ways of in-person sessions. Some of the benefits of telehealth, including not having to venture out in bad weather, not having to fight traffic, not having to find childcare, and not having to wait in a waiting room.
Telehealth is like flying first class, once you fly first class you can never go back to coach. As I said, telehealth is here to stay.
Marc J. Romano is a Licensed Psychologist, Advanced Registered Nurse Practitioner, Board Certified in Primary Mental Health, and a Certified Addiction Professional. Dr. Romano provides telehealth services for Integrated Telehealth Partners, Des Moines, IA. He specializes in the treatment of mental illness, chemical dependency, and co-occurring disorders in adolescents and adults.