In 2020, an unprecedented roadblock struck humanity hard, shook their hearts and disrupted all forms of human life. The Covid-19 pandemic has affected all physical forms of communication, brought healthcare to its knees and left the global economy in relentless free fall. The epidemic has also cast its shadow on the psychological front. Society was in a constant state of panic and fear, unsure of where and when Covid will strike next. His reign of terror was more evident.
in countries like India that have struggled to cope with the massive workload due to a severe shortage of manpower and infrastructure. Our country, already shaken by the insufficient number of mental health professionals for its gigantic population, has been hit hard by this pandemic. This is where telepsychiatry or e-mental health has a role to play, with its enormous potential and obvious promises.
Like most spheres of human life, information and communication technologies, due to their rapid progress over the past two decades, have also violated the health system. The use of internet, television, social media, etc., has started to play an important role in everyday medicine and surgery in developed countries, while telepsychiatry is also taking center stage. In India, although still in its infancy, telepsychiatry is the “new normal” and promises to bridge the huge mental health divide. Mental health workers can now seemingly go out of their way and reach the far corners of the country to educate, treat and give psychotherapy and counseling to any population in desperate need of it, which was not possible before. At the time of this pandemic and afterwards, it has a definite role to play.
In India, although still in its infancy, telepsychiatry is the new normal and promises to bridge the huge gap. Mental health workers can now reach the farthest corners of the country to raise awareness and treat any population that desperately needs it
According to India’s National Mental Health Survey 2015-16, one in six Indians suffers from some kind of mental disorder. The actual number could be even higher. This, coupled with an acute shortage of qualified professionals, paints a poor picture of mental health in the country. It is estimated that only about 29% of mental health needs are met by the available workforce. This number could see a serious drop, given the pandemic and its consequences. In addition, there is a huge difference between the supply and use of mental health services between rural and urban areas, which further compounds the problem. Telepsychiatry may well be the much needed shot in the arm of burdensome mental health services.
There are various methods of providing telepsychiatry to the masses. The most used consultations were phone calls, emails, text messages, social media forums such as special newsgroups, websites, blogs, vlogs and video conferencing. Of these, videoconferencing comes closest to a true doctor-patient interaction because of its live, two-way and audiovisual interaction. This can almost eliminate the need for a nearby mental health expert. Overall, there are two main types of e-mental health technologies: synchronous or interactive, and asynchronous or store and transfer. Synchronous technologies offer real-time interaction, whether audio or visual, and have the advantage of immediate response. The quality, however, is limited by the nature of the technology provided. The asynchronous or store-and-forward technique involves transfer and interaction of data in non-real time, mainly via emails and web applications for later reading by the expert and does not require the presence of both parties in same time. But its force majeure is also its main drawback because urgent resolutions in real time are not possible.
Telepsychiatry can be used to conduct various types of real-time and emergency case management as well as planned consultations for education, outreach, training, and educational and counseling liaison services. Various internet-based psychotherapies and neuropsychological assessments that would otherwise suffer from lack of adequate manpower and infrastructure can also be provided.
The biggest challenges of this mental health reform proposal come in the form of a lack of proper logistics and technology, delivery methods, cost effectiveness, and trained personnel. While such online mental health services would reduce expenses incurred for things like travel, the cost of the best available technology and skilled staff would take a heavy toll, calling into question its promise to be profitable.
Apart from the above functional challenges, various ethical and legal questions remain unanswered. The role and responsibility of a telepsychiatrist in an emergency situation such as a suicidal or severely agitated patient may be questioned, but may be mitigated to some extent in the presence of the primary care physician or other professional. mental health. Another legal challenge is the confidentiality and confidentiality of patient data and the unwanted disclosure of clinical notes or mental health status to a foreign source. This can be overcome by the promise of encrypted software that does not allow data sharing with third parties. However, these threats cannot be taken lightly and cybersecurity needs to be stepped up.
In a historic move, the Indian government’s Department of Health and Family Welfare last year released guidelines on telepsychiatry in association with the Indian Psychiatric Society (IPS) and NIMHANS, Bengaluru. In addition, very recently the IPS launched its very first suicide prevention helpline (1800-532-0807) for the public. These are welcome steps to digitize mental health for service delivery and training in our country. Even with its challenges, the transition from psychological health to a virtual platform received a positive boost during Covid. It remains to be seen how it will stand the test of time.
Dr Mayank Rai
Psychiatrist, AIIMS Rishikesh
Dr Debanjan Banerjee
Gerontopsychiatrist consultant, Calcutta