Telehealth: Clinical Guidelines and Technical Standards for Telepsychiatry

Telepsychiatry relies on videoconferencing to connect a group of mental health professionals, or a patient and his or her mental health professional, simultaneously and in real time, in order to conduct diagnostic, therapeutic, educational or other activities from separate sites. Telepsychiatry was one of the first applications of telemedicine, with the first experiments dating back to the 1950s. However, telepsychiatry truly started to develop in the 1990s.

Several clinical activities can be conducted through telepsychiatry for adult patients in order to efficiently meet the needs of patients and their families: patient assessment and diagnosis confirmation, medication review for patients who are not in an emergency situation, development of clinical care plans, treatment follow-up and review, psychological assessment and therapy, psychological and neuropsychological testing, individual, couple, family and group therapy, psychoeducation, pharmacoeducation, or case study or healthcare team supervision meetings, forensic expertise and some types of psychiatric emergencies.

The clinical conditions that lend themselves to paediatric telepsychiatry are depression, anorexia, behaviour disorders, and attention deficit disorder with hyperactivity. Telepsychiatry may also be used to conduct remote psychotherapy sessions.

However, telepsychiatry is contraindicated in certain situations, such as with violent, unstable or impulsive patients, those at immediate risk for suicide or who pose an immediate danger, or other types of patients described in the report.

Implementation guidelines and technical standards

To ensure quality healthcare services in telepsychiatry, certain organizational resources must be put into place, such as a central reservation system and a generic consultation tool, and agreements to standardize relations between the sites.

The report also describes the technical standards that seem essential to ensure quality of care. These standards apply not only to the physical characteristics of the locations where teleconsultations will be conducted, but also to the telecommunications equipment and the transmission chain. The report stresses that the entire communication chain must absolutely meet certain minimum standards. A single weak link would significantly diminish sound and image quality.