key: cord-1054324-9muzfnet
authors: Danilewitz, Marlon; Bahji, Anees; Gratzer, David
title: Comment on “I’m Virtually a Psychiatrist: Problems with Telepsychiatry in Training”
date: 2022-03-01
journal: Acad Psychiatry
DOI: 10.1007/s40596-022-01607-2
sha: f2a922e7e3008364ca31a445bb2c14dff5b59af5
doc_id: 1054324
cord_uid: 9muzfnet

nan

To the Editor: The recent article "I'm Virtually a Psychiatrist: Problems with Telepsychiatry in Training" raises important considerations around the challenges of telepsychiatry on the provider and, in particular, the psychiatrist in training [1] . In their response to that paper, Freedman and Zaretsky outline how telepsychiatry has widened our understanding of patients, facilitating psychiatrists access to the "milieu," which they define as "the physical and social natures of a person's observable context" [2] . The integration of the "milieu" into the mental status exam, they argue, offers psychiatrists a strong lens into the social aspect of their patient's lives. Unfortunately, while telepsychiatry, in comparison to inperson assessments, offers a balance of strengths and weaknesses as a tool for psychiatrists, it is not a tool for all patients. More than other clinical populations, there are unique aspects to patients with psychiatric disorders that limit the utility of telemedicine.

While COVID-19 has accelerated uptake of virtual mental health and helped improve access to care in the wake of social distancing, it has created profound barriers for vulnerable patient populations. Deficits underscore important patient factors that create barriers to digital care in knowledge, lack of access to technology, and disease-specific factors [3] . Patient knowledge deficits may often be overlooked or minimized but warrant attention and education. With growing consideration of hybrid models of care, effort should be made to consider all options and strategies to facilitate c a r e , i n c l u d i n g b o l s t e r i n g d i g i t a l k n o w l e d g e . Incorporating a digital health care navigator, a newly developed role on mental health teams, may be an important step in helping to address this barrier for knowledge deficits in both patients meaningfully and clinicians [4] .

Access to high-speed broadband and digital devices is another often forgotten barrier that should be of paramount concern for ensuring equitable care allocation. This reality is a factor for many patients with a psychiatric illness where socio-economic factors limit access to reliable Wi-Fi or digital devices. In addition, it should not be forgotten that access to high-speed broadband can also be a barrier for providers who may live in rural communities.

Finally, for patients with severe and persistent mental illness, disease-specific factors including cognition, motivation, psychosis, and organization may limit the ability to engage and trust digital interactions. At the same time, for individuals with severe and persistent mental illness, the impact of digital exclusion is particularly salient given the higher burden of comorbid addiction and physical health concerns, in addition to their psychiatric struggles [5] .

While virtual care has and continues to play a vital role in psychiatric care, as the pandemic continues to evolve, psychiatrists must be vigilant and nuanced in their approach to providing proper care for the particular provider-patient context. Moreover, while supplying the appropriate care, it is also incumbent upon psychiatrists to advocate at all levels to help address inequities in access. Consequently, as the delivery of psychiatric care transforms, so does the role of psychiatrists. As the public health landscape of COVID-19 evolves, psychiatry must develop a hybrid model that works for both providers and especially patients. 

I'm virtually a psychiatrist: problems with telepsychiatry in training

Comment on "I'm virtually a psychiatrist: problems with telepsychiatry in training

Digital exclusion among mental health service users: qualitative investigation

The role of digital navigators in promoting clinical care and technology integration into practice

The digital divide: amplifying health inequalities for people with severe mental illness in the time of COVID-19

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