Telepsychiatey , telemedicine , appears to be a big part of the solution in psychiatry services in the future.

1. Dr. Ahmed Albehairy, M.D
Psychiatry Consultant

2.  Telemedicine :
has been defined as the intervention of
a telecommunication device in the diagnosis and the
overall care of patients that are separated from
providers by a distance.

3.  The use of videoconferencing in psychiatry began
during the 1950s.
 In 1959, Norfolk, the Nebraska Psychiatric Institute
was using early videoconferencing to provide group
therapy, long-term therapy, consultation-liasion
psychiatry, and medical student training.
 By the 2000s, outcome studies provided a platform for
practice guidelines ( e.g. the American Telemedicine
Association). APA and ATA have helped to
disseminate information of guidelines in USA
organization.

5.  United Kingdom have on average14.6 psychiatrists per
100,000 people. In contrast, 17 Commonwealth
countries in Africa have fewer than 0.5 psychiatrists
per 100,000 people. India have 0.2 psychiatrists per
100,000 people. USA have 12.4 psychiatrists per
100,000 people.
 In Egypt , 0.68 psychiatrists per 100,000 people.
 The lifetime prevalence of psychiatric morbidity in
Egypt , USA, UK and India are 168 ,214, 332 ,and 370
per 1000 population, respectively.

6.  Internet penetration in Egypt increased from 0.8% to
49.6% through last 15 years.
 Comparing to other countries internet penetration
are in India 15.1% , UK 89.8% , and USA 84.2%.

7.  In Egypt ,
Such a gross mental health gap appears too great
to be overcome in the near future with measures through
modest expansion of existing resources.
 With the multiple problems of unmet needs, scarce
resources, especially in urban–rural areas, and no easy and
tangible solutions, the ongoing technological
advancements in are a blessing.
 Telepsychiatey , telemedicine , appears to be a
big part of the solution in psychiatry services
in the future.

8. Modes, Scope,
and
Applications
of Telepsychiatry

10.  Synchronous ( mimic face to face ), or asynchronous
(non real time, store and forward).
 Through , telephone, cell phone messages, two way
closed circuit television, E-mail, online chat , website
& blogs, and virtual chat rooms.
 Sets of communications :********
- Patient at home ± family with Physician at office
±team work.
- Physician with Physician.
- Patient in remote office ± family with Physician at
office ±team work.

11.  Studies showed significant results as regard
telepsychiatry validity and reliability of clinical
assessments, clinical outcomes, outcomes in terms of
acceptability and satisfaction of patients and
clinicians, quality of life, and cost-effectiveness.
 Direct clinical case management, education, and
consultation–supervision.
 Adults, children, adolescents, elderly, and in special
populations such as in prison inmates and veterans.

12.  Quality of care (83% of patients were correctly diagnosed
by DSM-IV through telepsychiatry ).
 Access ( increased to the patients with locked apply care,
rural areas, collage student, prisoners).
 Cost ( reducing cost by more than 70% , but may cost more
than face to face / hour ).
 Technology ( standards, covered by insurance , problem in
transmission speed sp. In rural areas as there s no fiber
optics)
 Licensure ( may appear if cover inter-counrties services).
 Legal and ethical issues: Safety, security, and
confidentiality ( compromised with self harm and suicide,
filing , recordings, documentations).
 Constraints ( billing and reimbursement, covering
medical insurance ).

13.  Depression disorders.
 Panic disorder, agoraphobia, social phobia, and generalised
anxiety disorders.
 PTSD.
 A.N & B.N.
 Schizophrenia.
 Emergency department.
 Liasion consultation.
 Consultation care model in 1ry care services.
 Neurological assessment, movement disorders.
 CBT, Crisis intervention, and counseling.
 Geriatric population, and Video link consultation and
psychotherapeutic management of children and adolescents,
(ADHD).
 Forensic clinic

14.  Include:
 General clinic procedures (schedule, documentation, records
keeping, and rule of support staff ).
 Physical environment.
 Site and check in procedures.
 Emergency procedures.
 Patient enrollment and informed consent .
 Role of interdisciplinary team.
 Care between telepsychiatry sessions.
 Doctor orders, lab and treatment.
 Confidentiality, and privacy of information, approval for seesion.
 Quality review.
 Training review.
 Billing guidelines.
 Technology standards.

15.  Administrative Issues : Perform a remote site
assessment . Obtain information of local regulations
and resources. Identify local collaborators, Create
emergency protocols with clear delineations of roles
and responsibilities, Decide the “tipping point” for
psychiatric emergencies when other staff and
resources are brought to bare, and Determine after
hours emergency coverage procedures.
 Legal/Ethical Issues: Know local civil commitment
and duty to warn regulations, and Arrange with local
staff to initiate/assist with civil commitments.
 General Clinical Issues.
 Rural Issues.

16.  Hardware : camera/webcam, speakers, headphones,
monitor, and microphone.
 Software: videoconferencing, encryption, and
codec.
 Network : ISDN, T1, Satellite, microwave , and IP ,
internet protocol network.
 Others, speed , quality, encryption algorithm, and
bandwidth.

17. Advantages :
 Sense of freedom and avoid
confrontation in shy
patients.
 Better follow up and case
managements.
 Less costs.
 Special population , rural
areas services and,
Community care services .
 Reliable and valid in most
of mental services.
Disadvantages:
 Increased cost/hr.
 Reimbursements and
billing.
 Interoperability problems.
 Suicide and self harm lacks
care.

18.  Telepsychiatry could help in covering the current and
future demands of mental health services in Egypt .
 Legal and ethical issues needs special care with activating
the clinical guidelines for telepsychiatry services.
 To activate the services in Egypt, we need to include the
telepsychiatry services mainly in governmental mental
hospitals and primary care services in rural areas or prisons
or remote areas.
 Also it must provide advanced fiber optic technology in
order to facilitate online services.
 Non- governmental and private sections need a special
guidelines for legal and ethical issues and for collaborating
teams specially in emergency .

20.  WHO, mental health psychiatrists and nurses working in mental health
services, 2014.
 American Telemedicine Association., Practice Guidelines for Video-Based
Online Mental Health Services, MAY 2013.
 Telepsychiatry: Promise, potential, and challenges, Savita Malhotra, Subho
Chakrabarti, and Ruchita Shah, Indian J Psychiatry. 2013 Jan-Mar; 55(1): 3–11.
 Telepsychiatry in the 21st Century: Transforming Healthcare with Technology,
Stacie Deslich, , Bruce Stec, , Shane Tomblin, , and Alberto Coustasse, Perspect
Health Inf Manag. 2013 Summer; 10(Summer): 1f.
 Telepsychiatry in Commonwealth Africa a first step, Commonwealth Health
Partnerships 2013.
 National Survey of Prevalence of Mental Disorders in Egypt: preliminary
survey M. Ghanem, M. Gadallah, F.A. Meky,S. Mourad and G. El-Kholy:
Eastern Mediterranean Health Journal, Vol. 15, No. 1, 2009 65.
 Emergency Management Guidelines for Telepsychiatry, Jay H. Shore,
MPH,corresponding author Donald M. Hilty, and Peter Yellowlees, MBBS : Gen
Hosp Psychiatry. Author manuscript; available in PMC 2008 May 1.
 American psychiatric association guidelines,: psychiatryonline.org/guidlines