Talking Telepsychiatry

By Kanishka Mehra

Telepsychiatry, a subset of telemedicine, has been around in the psychiatry practice for over sixty years. At Integrated Psychiatric Consultants, telepsychiatry has been practiced for over a decade. 

But until the onset of the COVID-19 pandemic, telepsychiatry was largely overlooked by many providers.

Even though the COVID-19 pandemic recently made telemedicine commonplace, the providers at Hopewell Center began telepsychiatry nearly fifteen years ago – tailoring psychiatric evaluations, patient education, and medication management to the virtual realm.

As we have seen over the last two years, telepsychiatry is crucial for increasing access to mental and behavioral healthcare and improving patient outcomes across the board.

With virtual platforms, patients in rural and remote areas can schedule regular behavioral health appointments without having to take time off from work for the commute and spend time waiting in the reception room. 

Additionally, those who might not be able to readily leave their residence can still seek trusted mental health recommendations from qualified telepsychiatry providers. This means fewer missed appointments need to be rescheduled, saving everyone time and money. 

For providers, telepsychiatry allows for more flexibility in scheduling, even if the practice comes with a learning curve. 

Some telepsychiatrists allow patients who don’t have a device or prefer clinical settings to attend their appointment on a large screen at the facility itself – a practice that was in place at IPC before the pandemic. 

Dr. Steven Kisker, a psychiatrist at Hopewell who’s been in the field since the late 1980s, started doing telepsychiatry over four years ago. He said he’s finally come to appreciate the practice and recognizes the need for more telepsychiatry providers everywhere, as they offer invaluable services to underserved communities.

“There’s no doubt that it’s a touch harder by telepsychiatry than in-person. But at this stage, I’ve been doing it for so long that I’m fairly confident in diagnosing and treating.”

Steven Kisker, M.D.

Marsha Kempf, APRN, works as a psychiatric nurse practitioner at Hopewell, alongside Dr. Kisker. Kempf has been an advanced practice nurse for over twenty years, merging paths with IPC in 2018 to conduct telepsychiatry because she was ready to try a different approach to behavioral health. 

“Virtual appointments are an opportunity for providers to get a little glimpse of what’s going on in their patient’s life – distractions and all,” Kempf said. She added that the reality check is beneficial because providers can meet their patients where they are – mentally and physically – allowing both parties to set more reasonable expectations.

Patients have reported feeling more comfortable in their home environment than in clinical settings, which can help augment the patient-provider relationship in the absence of in-person behavioral health checkups. 

“I’m old-school so growing up, there were doctors who did those medical home visits,” said Kempf. “[Telepsychiatry] allows you to do that in the current world that we live in without the safety concerns.”

Telehealth technology has been around since the 1960s, but there’s no doubt that efforts to reduce viral transmission of COVID-19 have accelerated the development of reliable telepsychiatry platforms. 

Dr. Kisker emphasized the importance of explaining the telepsychiatry process to new patients and reinforcing that the virtual platforms in use are as confidential as in-person meetings. Overall, he said his patients have expressed positivity towards virtual appointments. 

“Very few of [the patients] try it a time or two then drop out, most of them have been a-okay with it,” said Dr. Kisker. “Some just have a slight fascination that we’re able to see each other on the TV screen and actually be able to interact that way.”

The American Psychiatric Association’s January 2021 survey on psychiatrists’ use of telepsychiatry during COVID-19 indicated that over 80% of providers were still seeing a majority of their patients virtually following the public health emergency. 

Even as some psychiatry practices return to traditional appointments, virtual behavioral health could be the future of mental healthcare in remote areas throughout the country, improving healthcare equity for vulnerable populations and underserved areas.

There has also been a recent push to address critics’ concerns like internet connectivity issues, environmental distractions, and missing out on important body language cues. Telepsychiatry will continue to benefit the mental healthcare field in unprecedented ways as more investments are made to improve telemedicine technology and optimize provider management.

“If they’re patient with me, I’m patient with them because I know the internet is tricky,” said Kempf. “It would be great if we could have really fast-speed internet across all of the places. You could see people from different locations and different states.”