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Use of Telepsychiatry in Emergency and Crisis Intervention: Current Evidence

  • Psychiatry in the Digital Age (J Shore, Section Editor)
  • Published:
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Abstract

Purpose of Review

The aim of this review is to evaluate recent literature on the use of telepsychiatry in mental crises or emergency situations.

Recent Findings

Results from recent studies which evaluated the implementation of a telepsychiatric consultation model in emergency departments point at a reduction of length of stay and a drop in admissions, increased cost-effectiveness, and improved satisfaction of patients and staff. There was almost no empirical evidence on videoconferencing in crisis intervention within the context of crisis resolution teams or online therapies. No study reporting on telepsychiatry videoconferencing in the context of disasters was found.

Summary

There is still very little but increasing empirical evidence supporting the implementation of telepsychiatry in emergencies. Other mental crisis–related implementation settings remain to be researched. The implications and future research potential are discussed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM. The empirical evidence for telemedicine interventions in mental disorders. Telemed J E Health. 2016;22(2):87–113.

    Article  Google Scholar 

  2. Shore JH. Telepsychiatry: videoconferencing in the delivery of psychiatric care. Am J Psychiatry. 2013;170(3):256–62. https://doi.org/10.1176/appi.ajp.2012.12081064.

    Article  PubMed  Google Scholar 

  3. Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry. 2016;6(2):269–82.

    Article  Google Scholar 

  4. Fletcher TL, Hogan JB, Keegan F, Davis ML, Wassef M, Day S, et al. Recent advances in delivering mental health treatment via video to home. Curr Psychiatry Rep. 2018;20(8):56.

    Article  Google Scholar 

  5. Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health. 2013;19(6):444–54.

    Article  Google Scholar 

  6. Chakrabarti S. Usefulness of telepsychiatry: a critical evaluation of videoconferencing-based approaches. World J Psychiatry. 2015;5(3):286–304.

    Article  Google Scholar 

  7. What is a crisis? Joint Commissioning Panel for Mental Health. https://www.jcpmh.info/commissioning-tools/cases-for-change/crisis/what-is-a-crisis/. Accessed 5 Apr 2019.

  8. Trondsen MV, Bolle SR, Stensland GO, Tjora A. Video-confidence: a qualitative exploration of videoconferencing for psychiatric emergencies. BMC Health Serv Res. 2014;14:544.

    Article  Google Scholar 

  9. Shore JH, Hilty DM, Yellowlees P. Emergency management guidelines for telepsychiatry. Gen Hosp Psychiatry. 2007;29:199–206.

    Article  Google Scholar 

  10. •• Yellowlees P, Burke MM, Marks SL, Hilty DM, Shore JH. Emergency telepsychiatry. J Telemed Telecare. 2008;14:277–81. This overview article describes the possible applications of telepsychiatry in psychiatric emergencies. In addition to case studies, the potential and limits of telepsychiatry in acute situations are also examined.

    Article  Google Scholar 

  11. • Meyer JD, McKean A, Blegen RN, Demaerschalk BM. Emergency department telepsychiatry service model for a rural regional health system: the first steps. Telemed E-health. 2017. https://doi.org/10.1089/tmj.2017.0293. This paper describes a model for a stepwise implementation of a comprehensive regional telepsychiatry service.

    Article  Google Scholar 

  12. Letvak S, Rhew D. Assuring quality health care in the emergency departments. Healthcare. 2015;3:726–32.

    Article  Google Scholar 

  13. Zachrison KS, Hayden EM, Schwamm LH, Espinola JA, Sullivan AF, Boggs KM, et al. Characterizing New England emergency departments by telemedicine use. West J Emerg Med. 2017;18(6):1055–60. https://doi.org/10.5811/westjem.2017.8.34880.

    Article  PubMed  PubMed Central  Google Scholar 

  14. •• Seidel R, Kilgus M. Agreement between telepsychiatry assessment and face-to-face assessment for emergency department psychiatry patients. J Telemed Telecare. 2014;20:59–62. https://doi.org/10.1177/1357633X13519902. This much cited study showed the equivalence of face-to-face and telepsychiatric assessments in emergency situations.

    Article  PubMed  Google Scholar 

  15. •• Roberts N, Hu T, Axas N, Repetti L. Child and adolescent emergency and urgent mental health delivery through telepsychiatry: 12-month prospective study. Telemed J E Health. 2017;23:842–6. This prospective study showed the equivalence of face-to-face and telepsychiatric treatment of pediatric patients in emergency situations.

    Article  Google Scholar 

  16. •• Narasimhan M, Druss BG, Hockenberry JM, Royer J, Weiss P, Glick G, et al. Impact of a telepsychiatry program at emergency departments statewide on the quality, utilization, and costs of mental health services. Psychiatr Serv. 2015;66(11):1167–72. https://doi.org/10.1176/appi.ps.201400122. This study evaluated the implementation of a statewide telepsychiatry program in a control group design.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Southard E, Neufeld J, Laws S. Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department. Telemed J E Health. 2014;20:664–8.

    Article  Google Scholar 

  18. Reliford A, Adebanjo B. Use of telepsychiatry in pediatric emergency room to decrease length of stay for psychiatric patients, improve resident on-call burden, and reduce factors related to physician burnout. Telemed E Health. 2018. https://doi.org/10.1089/tmj.2018.0124.

  19. Thomas JF, Novins DK, Hosokawa PW, Olson CA, Hunter D, Brent AS, et al. The use of telepsychiatry to provide cost-efficient care during pediatric mental health emergencies. Psychiatr Serv. 2018;69:161–8.

    Article  Google Scholar 

  20. • Saurman E, Lyle D, Perkins D, Roberts R. Successful provision of emergency mental health care to rural and remote New South Wales: an evaluation of the Mental Health Emergency Care-Rural Access Program. Aust Health Rev. 2014;38(1):58–64. https://doi.org/10.1071/AH13050. The paper describes the Australian Mental Health Emergency Care-Rural Access Program which helped to decrease the admission rates of ED patients to local hospitals.

    Article  PubMed  Google Scholar 

  21. Donley E, McClaren A, Jones R, Katz P, Goh J. Evaluation and implementation of a telepsychiatry trial in the emergency department of a metropolitan public hospital. J Technol Hum Sci. 2017;35:4,292–313.

    Google Scholar 

  22. Saurman E, Kirby SE, Lyle D. No longer ‘flying blind’: how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study. BMC Health Serv Res. 2015;15:156. https://doi.org/10.1186/s12913-015-0839-7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Trondsen MV, Bolle SR, Stensland GØ, Tjora A. VIDEOCARE: decentralised psychiatric emergency care through videoconferencing. BMC Health Serv Res. 2012;20(12):470. https://doi.org/10.1186/1472-6963-12-470.

    Article  Google Scholar 

  24. • Trondsen MV, Tjora A, Broom A, Scambler G. The symbolic affordances of a video-mediated gaze in emergency psychiatry. Soc Sci Med. 2018;197:87–94. https://doi.org/10.1016/j.socscimed.2017.11.056. This qualitative study evaluated a Norwegian telepsychiatry program by conducting semi-structured interviews with patients, psychiatrists, and nurses and identified four beneficial aspects of telepsychiatry in emergency settings.

    Article  PubMed  Google Scholar 

  25. • Bolle SR, Trondsen MV, Stensland GØ, Tjora A. Usefulness of videoconferencing in psychiatric emergencies - a qualitative study. Health Technol. 2018:111–7. This qualitative study defines four situations in which videoconferencing consultations were useful.

    Article  Google Scholar 

  26. Pangka KR, Chandrasena R, Wijeratne N, Mann M. Exploring the views of emergency department staff on the use of videoconferencing for mental health emergencies in southwestern Ontario. Stud Health Technol Inform. 2015;209:114–20. https://doi.org/10.1037/e514532013-001.

    Article  PubMed  Google Scholar 

  27. Lange K. Innovating for improvement. Introducing telepsychiatry into routine practice in an emergency department psychiatric service. Oxford Health NHS Foundation Trust (final report 2017). https://www.health.org.uk/sites/default/files/5.%20Oxford%20Health_Telepsychiatry.pdf. Accessed 9 Apr 2019.

  28. Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L, et al. Implementation of the crisis resolution team model in adult mental health settings: a systematic review. BMC Psychiatry. 2015;8(15):74. https://doi.org/10.1186/s12888-015-0441-x.

    Article  Google Scholar 

  29. Predmore Z, Ramchand R, Ayer L, Kotzias V, Engel C, Ebener P, et al. Expanding suicide crisis services to text and chat. Crisis. 2017;38(4):255–60. https://doi.org/10.1027/0227-5910/a000460.

    Article  PubMed  Google Scholar 

  30. Mokkenstorm JK, Eikelenboom M, Huisman A, Wiebenga J, Gilissen R, Kerkhof AJFM, et al. Evaluation of the 113Online suicide prevention crisis chat service: outcomes, helper behaviors and comparison to telephone hotlines. Suicide Life Threat Behav. 2017;47(3):282–96. https://doi.org/10.1111/sltb.12286.

    Article  PubMed  Google Scholar 

  31. Burke Center Mental Health Emergency Center, Lufkin, Texas. A telepsychiatry solution for rural Eastern Texas. Psychiatr Serv. 2011;62:1384–6.

    Article  Google Scholar 

  32. Lee A, Sikka N, O’Connell F, Dyer A, Boniface K, Betz J. Telepsychiatric assessment of a mariner expressing suicidal ideation. Int Marit Health. 2015;66(1):49–51. https://doi.org/10.5603/IMH.2015.0012.

    Article  PubMed  Google Scholar 

  33. Turgoose D, Ashwick R, Murphy D. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. J Telemed Telecare. 2018;24(9):575–85. https://doi.org/10.1177/1357633X17730443.

    Article  PubMed  Google Scholar 

  34. • Lawes-Wickwar S, McBain H, Mulligan K. Application and effectiveness of telehealth to support severe mental illness management: systematic review. JMIR Ment Health. 2018;5(4):e62. https://doi.org/10.2196/mental.8816. This review gives a good overview about the use of telehealth technologies for people with severe mental illness.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Berry N, Lobban F, Emsley R, Bucci S. Acceptability of interventions delivered online and through mobile phones for people who experience severe mental health problems: a systematic review. J Med Internet Res. 2016;18(5):e121. https://doi.org/10.2196/jmir.5250.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Acierno R, Knapp R, Tuerk P, Gilmore AK, Lejuez C, Ruggiero K, et al. A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: in person versus home-based telehealth. Behav Res Ther. 2017;89:57–65. https://doi.org/10.1016/j.brat.2016.11.009.

    Article  PubMed  Google Scholar 

  37. Nielssen O, Dear BF, Staples LG, Dear R, Ryan K, Purtell C, et al. Procedures for risk management and a review of crisis referrals from the MindSpot Clinic, a national service for the remote assessment and treatment of anxiety and depression. BMC Psychiatry. 2015;15:304. https://doi.org/10.1186/s12888-015-0676-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Hulsbosch AM, Nugter MA, Tamis P, Kroon H. Videoconferencing in a mental health service in The Netherlands: a randomized controlled trial on patient satisfaction and clinical outcomes for outpatients with severe mental illness. J Telemed Telecare. 2017;23(5):513–20. https://doi.org/10.1177/1357633X16650096.

    Article  PubMed  Google Scholar 

  39. •• Gilmore AK, Ward-Ciesielski EF. Perceived risks and use of psychotherapy via telemedicine for patients at risk for suicide. J Telemed Telecare. 2019;25(1):59–63. https://doi.org/10.1177/1357633X17735559. This article examines the risks perceived by mental health providers for patients using telepsychiatry in situations of high risk of suicidality.

    Article  PubMed  Google Scholar 

  40. Doarn CR, Merrell RC. Telemedicine and e-health in disaster response. Telemed J E Health. 2014;20(7):605–6. https://doi.org/10.1089/tmj.2014.9983.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Balch D. Developing a national inventory of telehealth resources for rapid and effective emergency medical care: a white paper developed by the American Telemedicine Association Emergency Preparedness and Response Special Interest Group. Telemed J E Health. 2008;14(6):606–10. https://doi.org/10.1089/tmj.2007.0127.

    Article  PubMed  Google Scholar 

  42. Lafity R, Tilley EH. Telemedicine for disaster management: can it transform chaos into an organized, structured care from the distance? Am J Disaster Med. 2014;9:25–37.

    Article  Google Scholar 

  43. Delaigue S, Bonnardot L, Steichen O, Garcia DM, Venugopal R, Saint-Sauveur JF, et al. Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value. J Glob Health. 2018;8(2):020414. https://doi.org/10.7189/jogh.08.020414.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Augusterfer EF, Mollica RF, Lavelle J. A review of telemental health in international and post-disaster settings. Int Rev Psychiatry. 2015;27(6):540–6. https://doi.org/10.3109/09540261.2015.1082985.

    Article  PubMed  Google Scholar 

  45. Jefee-Bahloul H, Bajbouj M, Alabdullah J, Hassan G, Barkil-Oteo A. Mental health in Europe’s Syrian refugee crisis. Lancet Psychiatry. 2016;3(4):315–7. https://doi.org/10.1016/S2215-0366(16)00014-6.

    Article  PubMed  Google Scholar 

  46. Kazour F, Zahreddine NR, Maragel MG, Almustafa MA, Soufia M, Haddad R, et al. Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Compr Psychiatry. 2017;72:41–7. https://doi.org/10.1016/j.comppsych.2016.09.007.

    Article  PubMed  Google Scholar 

  47. Aadil M, Cosme RM, Forcen FE, Khan AR. A call for emergency action: telepsychiatry for trauma treatment among Syrian refugees. Cureus. 2017;9(8):e1578. https://doi.org/10.7759/cureus.1578.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Jefee-Bahloul H. Telemental health in the middle East: overcoming the barriers. Front Public Health. 2014;2:86. https://doi.org/10.3389/fpubh.2014.00086.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Qadir TF, Fatima H, Usmani MH, Hussain SA. Telepsychiatry in Pakistan after natural disasters. Lancet Psychiatry. 2016;3(11):1016. https://doi.org/10.1016/S2215-0366(16)30323-6.

    Article  PubMed  Google Scholar 

  50. Burchert S, Alkneme MS, Bird M, Carswell K, Cuijpers P, Hansen P, et al. User-centered app adaptation of a low-intensity E-mental health intervention for Syrian refugees. Front Psychiatry. 2019;9:663. https://doi.org/10.3389/fpsyt.2018.00663.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ruzek JI, Kuhn E, Jaworski BK, Owen JE, Ramsey KM. Mobile mental health interventions following war and disaster. Mhealth. 2016;2:–37. https://doi.org/10.21037/mhealth.2016.08.06.

  52. Kuhn E, van der Meer C, Owen JE, Hoffman JE, Cash R, Carrese P, et al. PTSD coach around the world. Mhealth. 2018;4:15. https://doi.org/10.21037/mhealth.2018.05.01.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Sijbrandij M, Acarturk C, Bird M, Bryant RA, Burchert S, et al. Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries. Eur J Psychotraumatol. 2017;8:1388102. https://doi.org/10.1080/20008198.2017.1388102.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Knaevelsrud C, Brand J, Lange A, Ruwaard J, Wagner B. Web-based psychotherapy for posttraumatic stress disorder in war-traumatized Arab patients: randomized controlled trial. J Med Internet Res. 2015;17(3):e71. https://doi.org/10.2196/jmir.3582.

    Article  PubMed  PubMed Central  Google Scholar 

  55. • Salmoiraghi A, Hussain S. A systematic review of the use of telepsychiatry in acute settings. J Psychiatr Pract. 2015;21(5):389–93. https://doi.org/10.1097/PRA.0000000000000103. This systematic review included 23 papers on the use of telepsychiatry in acute treatment settings until June 2013.

    Article  PubMed  Google Scholar 

  56. •• Fortney JC, Pyne JM, Turner EE, Farris KM, Normoyle TM, Avery MD, et al. Telepsychiatry integration of mental health services into rural primary care settings. Int Rev Psychiatry. 2015;27(6):525–39. https://doi.org/10.3109/09540261.2015.1085838. The authors describe five models on how telepsychiatry can be used to address capacity and equity challenges in rural areas.

    Article  PubMed  Google Scholar 

  57. Draper J, Murphy G, Vega E, Covington DW, McKeon R. Helping callers to the National Suicide Prevention Lifeline who are at imminent risk of suicide: the importance of active engagement, active rescue, and collaboration between crisis and emergency services. Suicide Life Threat Behav. 2015;45(3):261–70. https://doi.org/10.1111/sltb.12128.

    Article  PubMed  Google Scholar 

  58. Shore J. The technological transformation of psychiatric care - telepsychiatry comes of age. Int Rev Psychiatry. 2015;27(6):467–8. https://doi.org/10.3109/09540261.2015.1120008.

    Article  PubMed  Google Scholar 

  59. Hoffman P, Kane J. Telepsychiatry education and curriculum development in resident training. Acad Psychiatry. 2015;39:108–9.

    Article  Google Scholar 

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Correspondence to Isabelle Reinhardt.

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Isabelle Reinhardt and Euphrosyne Gouzoulis-Mayfrank each declare no potential conflicts of interest.

Jürgen Zielasek has received travel support and attendance fee waiver for attending the annual conference as a member of the scientific board of the annual congress from the German Association for Psychiatry, Psychotherapy and Psychosomatics.

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Reinhardt, I., Gouzoulis-Mayfrank, E. & Zielasek, J. Use of Telepsychiatry in Emergency and Crisis Intervention: Current Evidence. Curr Psychiatry Rep 21, 63 (2019). https://doi.org/10.1007/s11920-019-1054-8

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