. 2020 Jul 9;66:89–95. doi: 10.1016/j.genhosppsych.2020.07.002

Table 3.

Advantages and limitations of telepsychiatry as reported by Massachusetts General Hospital Department of Psychiatry clinicians.

Advantages	Limitations
• Limits viral transmission • Protects patients and providers with underlying health conditions or who are immunocompromised • Minimizes productivity loss due to commuting • Enhances ease of scheduling • Increases privacy by eliminating the need to physically travel to a mental health clinic, thereby reducing exposure to stigmatizing attitudes and beliefs from others • Increases understanding of family and home dynamic • Decreases rate of no-shows • Increases access to care for patients suffering from conditions that interfere with their ability to leave home • Increases sense of personal safety for patients at risk for violence and behavioral dysregulation	• Can increase disruptions during sessions due to home-life issues and technological glitches—freezing, delays, needing to reconnect • Can increase difficulty reading nonverbal communications (e.g., subtle changes in tone of voice, inflection, affect, and gaze) • Can increase effort required to establish rapport • Presents greater challenges for patients with auditory and visual impairments and migraines • Prevents physical examination for certain conditions (i.e., movement disorders, medication-induced extrapyramidal symptoms or tremors, neurocognitive disorders) and mental status examination markers • Prevents cardiac and metabolic monitoring for patients on certain antipsychotic medications, and autonomic monitoring for patients at risk for withdrawal or on stimulant medications. • Loss of sense of intimacy provided by closed-door office space • Difficulty using silence as an intervention • Loss of privacy and risk of self-disclosure by provider due to visibility of home environment • Exacerbates already present disparities and structural inequities for those unable to utilize technology

Advantages

Limitations

•
Limits viral transmission
•
Protects patients and providers with underlying health conditions or who are immunocompromised
•
Minimizes productivity loss due to commuting
•
Enhances ease of scheduling
•
Increases privacy by eliminating the need to physically travel to a mental health clinic, thereby reducing exposure to stigmatizing attitudes and beliefs from others
•
Increases understanding of family and home dynamic
•
Decreases rate of no-shows
•
Increases access to care for patients suffering from conditions that interfere with their ability to leave home
•
Increases sense of personal safety for patients at risk for violence and behavioral dysregulation

•
Can increase disruptions during sessions due to home-life issues and technological glitches—freezing, delays, needing to reconnect
•
Can increase difficulty reading nonverbal communications (e.g., subtle changes in tone of voice, inflection, affect, and gaze)
•
Can increase effort required to establish rapport
•
Presents greater challenges for patients with auditory and visual impairments and migraines
•
Prevents physical examination for certain conditions (i.e., movement disorders, medication-induced extrapyramidal symptoms or tremors, neurocognitive disorders) and mental status examination markers
•
Prevents cardiac and metabolic monitoring for patients on certain antipsychotic medications, and autonomic monitoring for patients at risk for withdrawal or on stimulant medications.
•
Loss of sense of intimacy provided by closed-door office space
•
Difficulty using silence as an intervention
•
Loss of privacy and risk of self-disclosure by provider due to visibility of home environment
•
Exacerbates already present disparities and structural inequities for those unable to utilize technology