Covid-19: The last call for telepsychiatry

To the Editor,

the timing of digital psychiatry implementation that the WPA-Lancet Psychiatry Commission on the Future of Psychiatry had projected for the next decade in 2017 is now accelerated by the COVID-19 health emergency (1). After two decades debating around the rationale, use and impact of telepsychiatry, COVID-19 urges us not only to ask how telepsychiatry could contribute to manage such emergency, but also to answer that question quickly and to act.

Since the World Health Organization declared the Covid-19 outbreak first a Public Health Emergency of International Concern (2) and then a pandemic (3), several countries promoted and incentivized telehealth services. In the field of mental health, we argue there is a strong rationale to push for the implementation of telepsychiatry as a tool to help reducing the current pressure on health services’ capacity and the risk of viral transmission in hospital settings, to ensure continuity of care for psychiatric patients and to support general population wellbeing during quarantine and self-isolation.

Teleconsultation can indeed compensate and help to comply with the recommendations not to access healthcare facilities for COVID-19 symptomatic suspected cases and to reduce to the minimum non urgent hospital services; recommendations that are valid for everybody and in all settings, but even more so for psychiatric patients (4). First, some mental health difficulties, and associated problems, may limit or delay perceptions of changes in the external environment and feelings of self-protection, thus negatively impacting on adherence to standard precautions for infection control when in emergency departments, hospital wards and waiting rooms. Second, psychiatric boarding in emergency departments is associated with higher risk of hospitalization and thus longer stay in psychiatric wards not always equipped with high isolation standards against infectious respiratory diseases (5).

As hospital care is restricted by COVID-19, telepsychiatry could promote continuity of care for psychiatric patients at the community-level, remotely supporting them to cope with loneliness, hopelessness, death anxiety which might be exacerbated during health emergencies and associated-social distancing imposed measures (6). In turn, ensuring continuity of care via teleconsultation might lower the risk of clinical decompensation and consequent need of hospitalization for those patients (7).

Last but not least, the new demand for mental healthcare by the general population as a consequence of prolonged social distancing in the short and long run could be effectively tackled by the offer of telepsychiatry services (8).

The protection of the mental health status of this vulnerable segment of population needs to be recognized as a real public health priority (9). Using the right recommendations and protocols, on-demand telepsychiatry has been proven to offer a closer continuity care and reduce emergency department pressure, discharge times, psychiatric hospitalization rates, and it is associated with good outcomes and high patient satisfaction.

The COVID-19 pandemic creates an opportunity to overcome normative, technological and cultural barriers to the use of telepsychiatry. We are convinced that where mental healthcare delivery takes place will be shifted for good and for the better.

Conflict of interest:

Dr. Amerio, Prof. Odone, Prof. Marzano, Dr. Costanza, Dr. Aguglia, Prof. Serafini, Prof. Signorelli and Prof. Amore report no conflicts of interest. Prof. Ghaemi is employed by Novartis Institutes for Biomedical Research, and holds equity in Novartis.

Fundings:

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author contributions:

Authors AA, AO, LM, AC, and AA wrote the first draft of the manuscript. GS, CS, SNG, and MA carefully revised the final version of the manuscript. Our manuscript has been approved by all authors.