Last updated June 25, 2024

History

The COVID-19 pandemic significantly impacted the practices of mental health professionals, particularly in the United States, pushing the use of health technologies past the “tipping point” and changing the practice of psychiatry. During the pandemic, inhibitory regulations related to telepsychiatry were eased. These regulatory relaxations likely led the rapid expansion of the use of telepsychiatry and its extended use. The Public Health Emergency (PHE) relaxation of regulations had the greatest effect on the number of patients seen via telepsychiatry. It is estimated that about 3% of all outpatient appointments in the U.S. during 2020 were telepsychiatry visits, totaling approximately 26 million visits nationally. A survey by the American Psychiatric Association (APA) found that by June 2020, 85% of 500 surveyed American psychiatrists were using telepsychiatry with more than 75% of their patients, compared to about 3% before the pandemic. In the updated 2023 survey, about 60% of office-based respondents conduct most of their visits via telehealth.

Apps and other forms of online care also saw a surge in popularity during the pandemic, offering text messages and therapy sessions, reporting a 65% increase in clients. The pandemic also led to the introduction of novel clinical workflows, such as hybrid rounding, which became popular with inpatient medical and psychiatric teams. This practice expanded across many inpatient services, including psychiatric hospitals, and enabled services to be conferenced to and from community sites. The many novel approaches to hybrid work, more time and geographically flexible working arrangements, led to long-term workplace solutions that offer psychiatrists increased flexibility and further support the well-being of clinicians and their families, allowing them to offer online mental health services literally anytime and anywhere.

Inpatient Telepsychiatry During COVID-19

• Hospitals have rapidly adapted to telepsychiatry during COVID in order to follow state and federal emergency guidance.
• As inpatient units try to ensure the safety of patients and staff during the public health emergency, telepsychiatry is being used to complete patient rounds, facilitate team discussions, engage patients in group therapy sessions, and even allow for family visitation.
• Telepsychiatry can offer the same level of inpatient psychiatric care for patients who have been exposed to COVID-19, with a few adaptations.

College Telepsychiatry during COVID-19

• Continuity of care remains a challenge for college students who may travel between home and school. Telepsychiatry provides an opportunity to ensure the continuity of care for students who go away to school.
• Psychiatrists treating college students via telepsychiatry should be sure to practice within their scope of practice and using the same standard of care as they would in-person; if the patient requires treatment beyond their scope of practice, the psychiatrist should refer them to another provider.
• The practice of medicine occurs where the patient is located, and so appropriate state licensure laws must be followed; during COVID-19, however, many states have temporarily waived this requirement, so psychiatrists should be sure to check with the respective state's department of health or board of medicine.
• If the patient is located in another state, psychiatrists should check with their malpractice carrier to be sure that they're covered.
• Be sure to read the APA's College Mental Health, Telepsychiatry: Best Practices, Policy Considerations & COVID-19 (.pdf) for guidance on practicing telepsychiatry with college students.

References

• Saeed SA, Shore JH, Yellowlees P. Using Technology for Providing Care. (2023). Lauriello J, and Roberts LW (Editors). Section "COVID-19 Pandemic, Telepsychiatry, and the Transformation of Psychiatric Practice.” Textbook of Psychiatric Administration and Leadership, Third Edition. American Psychiatric Association Publishing, Washington, DC. ISBN 978-1-61537-337-6