key: cord-0821570-3u2mrn5d
authors: Ramalho, Rodrigo; Adiukwu, Frances; Bytyçi, Drita Gashi; Hayek, Samer El; Gonzalez-Diaz, Jairo M.; Larnaout, Amine; Grandinetti, Paolo; Kundadak, Ganesh Kudva; Nofal, Marwa; Pereira-Sanchez, Victor; da Costa, Mariana Pinto; Ransing, Ramdas; Teixeira, Andre Luiz Schuh; Shalbafan, Mohammadreza; Soler-Vidal, Joan; Syarif, Zulvia; Orsolini, Laura
title: Telepsychiatry and healthcare access inequities during the COVID-19 pandemic
date: 2020-06-16
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102234
sha: 778890e4fcc236c98d9165a7f5d2269600967bad
doc_id: 821570
cord_uid: 3u2mrn5d

nan

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still uncertain whether the way in which various healthcare services have adapted to COVID-19, an adaptation that have often included adopting telemental health care, will be able to withstand the pandemic (Kavoor et al., 2020) .

Unfortunately, most of our countries were not entirely prepared to adopt this resource (Pereira-Sanchez et al., 2020) . Telepsychiatry had played a very marginal role before the pandemic, except in Colombia, Egypt, Kosovo, New Zealand, Singapore, and the United States of America. These countries, with the exception of Egypt, Kosovo, and Singapore, also had local guidelines for telepsychiatry. However, in most countries, it was mainly limited to private practice, and there was no adequate training for practitioners. So, while only a few countries had a somewhat well-established telepsychiatry practice, even fewer countries had sufficient training and local guidelines to support practitioners.

There are other significant challenges hindering further use of telepsychiatry. These include legal barriers, particularly in Brazil and Italy -although circumvented during the pandemic, and the population's limited digital literacy or lack of access to the necessary tools or internet connection. In Colombia, for example, service users are required to have simultaneous face-to-face support by general practitioners (GPs), hindering the use of telepsychiatry for remote regions with no access to GPs. The difficulty in most countries to provide e-prescriptions adds an extra hurdle; for instance, in Iran, service users can only access subsidized medication with a hard copy prescription.

Despite these barriers, the use of telepsychiatry has grown exponentially (De Sousa et al., 2020; Zhou et al., 2020) . Psychiatrists in all our countries are offering telecare to the general population and additional support to colleagues and non-specialists practitioners.

Particular attention has been paid to healthcare workers at the front lines, whose care needs are often driven by the additional stress associated with their circumstances. The utilization varies across different clinical and cultural contexts, but with an overall positive reception.

The population seems open to this resource, and mental health professionals are keen to use it tooalbeit somewhat unsupported in most countries. However, all the barriers mentioned above are preventing its broader use, especially to support remote or low socioeconomic populations within each country. In other words, precisely those who are likely to be in greater need of this resource are those less likely to have access to it.

Telepsychiatry is playing a crucial role during the pandemic, and it seems that it is here to stay. It is clear that telemental health care has proven a useful tool in the delivery of mental health care and it should be added to the repertoire of all mental health care services.

Moreover, telepsychiatry should be considered a valuable resource for the task of providing support and care to those coping with the aftermath of the pandemic (Das, 2020) . For most of our countries, the COVID-19 pandemic has offered a small window into the possibility of using telepsychiatry to provide this support. However, while it would be ideal for everybody

to have access to all means necessary to liaise with mental health providers online, this is not always the case, and the COVID-19 pandemic has brought this situation to the foreground. It is imperative first to address these e-mental health care access inequities. This is not a task for the future but for the present. Moreover, it is a long pending debt with the population.

None to declare.

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