key: cord-0871989-8qrkghit authors: Greenhalgh, Trisha; Wherton, Joseph title: Telepsychiatry: learning from the pandemic date: 2022-02-18 journal: Br J Psychiatry DOI: 10.1192/bjp.2021.224 sha: 0dde7cf22f1527779acb2d45b2fc9f2e274e825a doc_id: 871989 cord_uid: 8qrkghit This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient’s clinical needs and social context as well as by service-level socio-technical and logistical factors. pandemic was comparable to that in in-person encounters (video can be seen as a vehicle for 227 building rapport and trust rather than an obstacle to achieving it) [37] . For instance, video may allow 228 the clinician to witness some of the living circumstances the patient describes in their sessions, 229 provide a comfortable space to engage in relaxation exercises, and facilitate engagement and playful find close contact overwhelming [37] . But this is contingent on the capabilities of the clinician to 233 account for the physical and symbolic differences in the technology-supported environment, and to 234 make adjustments to convey empathy and warmth. Our previous research highlighted the 'opening' to be an important part of the consultation because 236 this is when both patient and clinician establish whether the video and/or audio connection is 237 adequate before proceeding with the consultation proper. Greetings and rapport-building should be 238 used to help put patients at ease, given that more conventional forms of prosocial interaction and 239 contact during face-to-face medical encounters (eg, shaking hands and inviting into the consultation 240 room) are absent. contacted the GP saying she had become agitated over the past week. The GP had tried to speak to 285 her on the phone but she was unable to continue a conversation. Her husband noted that she was 286 pacing constantly and sleeping only 2-3 hours per night, and had on one occasion left the house in 287 her underwear and had to be brought back by a neighbour. He had returned form work yesterday to 288 find her smelling of alcohol and the children unfed. The family live in rented council accommodation 289 and whilst they have a broadband connection, the husband says their data package is somewhat 290 restrictive so he hopes that the video consultation won't last more than a few minutes. Reena has 291 never used the family computer, which was bought 10 years ago and has a habit of crashing. Case 3: A psychogeriatric patient 294 Daniel is a 76-year-old retired engineer who has been living in a residential home for two years. He 295 has diabetes, heart failure, depression, a leg ulcer and gout, as well as progressively worsening 296 cognitive function (perhaps early Alzheimer's disease). He has recently become incontinent of urine 297 (though a specimen showed no growth), and seems to be becoming slower and more withdrawn. His 298 medication includes sertraline, insulin injections, allopurinol, enalapril, and omeprazole. He has 299 begun to decline all his tablets (though he will take them with coaxing) and this morning refused to 300 have his insulin injection. The care home staff have asked for an urgent assessment. 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