The benefits of Telepsychiatry

[Rafterman]

Hey all,
 

Has anyone here availed themselves of the services of telepsychiatry? It's really exploding, prompted by a turnaround by the American Psychiatric Association ( who now fully support it). Insurance companies have been slow to come around, but that is beginning to change. The APA reversal triggered most states (38, and counting)  to allow insurance reimbursement for telemedicine/telepsychiatry . My wife has been using a telepsychologist for about 3 years now and greatly prefers it to having to take a ride into the office. I believe that my wife is similar to others in that she is more likely to keep her appointments, given that she doesn't have to dress up and take a car trip order to attend them. And the service is INVALUABLE for those who are severely depressed or agoraphobic and find it very difficult to appear anywhere in person.

Are all telephychiatry programs created equal? Not in my experience. If you are considering it, try ascertaining a few things in advance. (For obvious reasons, it would be better to find the answers to these questions anonymously, if possible). What level of education will your counselor have? (In some states, it can be as little as a bachelors degree). What session frequency would the counselors schedule usually allow for? Do they accept any medical insurance on assignment? What is their fee for those without insurance? (The going rate is about $50 per appointment). Do they script for medication without a client coming in for a visit in person? Do they script for controlled meds, if they find them to be necessary, in the same manner? Then check with your own insurance company to see if you are covered.

(This is a booming field and the competition is fierce, as different practices compete for new business. This just might lead some of them to be a little more likely to go to the prescription pad. I think that is what happened in the case of my wife. They want to keep her as a client. They are an up and coming practice and need teleclients badly).

Let me tell you about my wife's experience. Her counselor is a psychiatric nurse-practitioner. She has never seen her in person. She talks to my wife using "Facetime" through her phone. She wrote for an AD on the first "visit". Wrote for ALP on the second visit. (.50 x45 w. 3 refills without ever having seen her). Wrote for a different AD on the third visit. She eventually found the right AD for her and her counselor has been providing scripts for that straight through. Same thing with the ALP! She constantly asks my wife if she needs more. My wife leads a charmed life. Where do you ever find a medical person who tries to push a benzo on you? Anyhow, all that to say that it has been a great experience. An important thing to note is that she never had to appear at the office, pick up a script for the ALP and bring it to the pharmacy. It was sent electronically to the pharmacy by a practitioner whom he has never met in person. Can't beat it.

Would love to hear from anyone who used telepsychiatry, is thinking of using it, or anyone else who feels like commenting. Thanks

[Rafterman]

Thank you so much, Fire. You raise an excellent point when you ask if it was possible that the counselor more easily scripted for the benzo, given that she had already written for the AD. I was thinking the same thing and probed my wife about it when she came home with the ALP's the first time. I asked her if she thought that she would have been given the ALP if she had turned down the benzo. She thought that she would have, in her particular case, for a few reasons. The first was that she had a long history of successfully using ALP on a short term basis. Never a problem with habituation. The second was that the counselor knew my wife had been an RN for 30 years and was probably a more responsible and knowledgeable person than the average Jane or Joe off the street. As you know, all nurses have a kind of sorority/fraternity thing going on, kind of like the police do. They tend to stick together. It could be that helped her get the ALP, but maybe not because she said that that she didn't even ask for it. She said that the woman treating her was kind of pushing it and definitely pushed the refills prematurely. I was delighted by the whole thing because, although my wife appears cool as an iceberg, she is actually a nervous wreck. To find a practicioner who appeared to be benzo-happy was a welcomed change. I am going to pose your question to her and will post back. I am so glad that people are beginning to use these services, especially those shut in by panic disorder. I have been in their position for a good portion of my life. I could not bear the idea of sitting still, for a set amount of time, and being scrutinized. Alas, such is the nature of PD. I would so love for others who experience that to be able to be helped. I thing all the "tele" forms of medical treatment that are out there are a huge change for the better. Thanks again, Fire.  RF

[coffeedude22]

This is really interesting in that I took quite a few classes leading towards an RNP degree a few years ago. One google search and you can see that telepsychiatry is a huge field for employment. Kind of amazing how you can work from home as well. I used to go to a RNP back in the day whose main complaint about the job was the long commute and the money it cost to have an office. This completely takes that out of the equation, making life easier for both parties. Very interesting Rafterman, thanks for posting!

[Rafterman]

Not quite sure I follow My Friend, are you saying it is just Psychiatry over the phone? When I heard the term I thought of Bio-Feedback, that a counselor used on me in the late seventies when I was a troubled youth,and it was amazing,kind of a form of meditation. If it is just visiting over the phone couldn't anyone with a brain describe the symptoms needed too get a script? I would think the medical community would frown on such a thing, but maybe I  mis-understood? Your Wife being a Nurse certainly helped I would. I have found that RNP's are generally much more Benzo friendly than Doc's and that is why I chose a RNP when I moved. Not a psych nurse but just in Place of a general Doc.- FF

Howdy FF,
Sometimes its face to face via a smartphone or computer, sometimes just by telephone. To someone suffering with panic disorder (or high anxiety, social phobia, claustrophobia, or even a physical ailment), the difference  between having to go into an office setting, versus being in the comfort of their home for the appointment, is everything. Its the difference between them seeking, or not seeking, treatment. People with PD can particularly benefit. They often feel trapped by having to commit to sitting still and committing to a set amount of time. With telemedicine, they can move around their house while having the appointment, or even be driving around. That extra freedom means everything. I know it from first hand experience. I put off going for cognitive therapy for a decade, fearing the idea of feeling trapped and precipitating a panic attack. If telemedicine was available back then, I would not have put off treatment. I should also mention that smartphones are beginning to feature attachments that will take your ekg, blood pressure, heart rate and, by next year they say, do an EEG. If telemedicine continues to take off, the demand for these attachments will grow greater and doctors will start providing stand alone (no smart phone) devices to their patients, so that they can send their vitals from home. Does this replace a conventional doctors appointment? Not really. But for many shut-in's and people who are apt to shy away from going into an office to see a doctor, the availability of telemedicine can mean everything. An in-office visit is often best but, for the people who wouldn't have gone for any visit at all, telemedicine is a close second. Have a good night, my friend.  RM

[Rafterman]

Thanks for adding your story, my Brother. I am glad that you mentioned how one can sidestep the stigma of going for mental health care. That is huge. So many benefits to telepsychiatry that I almost forgot that one. Oh, Clowns was also the breakout med for me. Calms your brain, calms your muscles, puts things back in prospective. I often think of it as a long acting version of ALP. They are each wonder drugs, if you ask me. Thanks again, FF.

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This is really interesting in that I took quite a few classes leading towards an RNP degree a few years ago.  One google search and you can see that telepsychiatry is a huge field for employment.  Kind of amazing how you can work from home as well.  I used to go to a RNP back in the day whose main complaint about the job was the long commute and the money it cost to have an office.  This completely takes that out of the equation, making life easier for both parties.  Very interesting Rafterman, thanks for posting!

My pleasure, 'dude. Thank YOU for your comments. IMO, the medical world is heading toward RNP domination. MD's will be more and more scarce, just as in Europe. As they leave the field, or fail to come into the field, PA-C's and RNP's move up a notch in responsibility. To that end, my wife (and RN of 30 years) went back to school to get her masters and has entered into a RNP program. They told her it will take about 6 months to complete, due to her previous education and job experience. She had to do something to make herself more indispensable. You say that you took classes toward that degree. Are you thinking or returning? That has always been a great position but, as you say, with the advent of telepsychiatry, it may add the perk of work-at-home and will be more booming than ever. Have a fine day.  RM

[Rafterman]

I was just thinking the other day how I would love to be able to Skype with my doctor. I think this would be especially great if you live far from where your doctor is located, if you have social anxiety, if the weather conditions are bad, etc.  I think what has kept me from looking into this more is that I just assume it is going to be more expensive or my health insurance won't cover it.

Hey Naomi,
I really think that its the wave of the future and insurance companies will be scrambling to cover it. It saves them money in the long run because people will tend to underreport health problems if it takes a trip to the doctor to do so. Some of those unreported and underreported problems may turn into huge issues, eventually costing ones insurance company big time. The whole focus these days is on preventative care and early reporting of symptoms is part of that. What better way then to just Skype with a doc? The fact that Medicare covers it is a very good sign. They are usually the difficult ones. If they approve of it, which they do, the harder insurers are sure to follow.  I also think that the standard $50 per visit will be coming down and competition increases.  RM

[Naomi]

I was just thinking the other day how I would love to be able to Skype with my doctor. I think this would be especially great if you live far from where your doctor is located, if you have social anxiety, if the weather conditions are bad, etc.  I think what has kept me from looking into this more is that I just assume it is going to be more expensive or my health insurance won't cover it.

Hey Naomi,
I really think that its the wave of the future and insurance companies will be scrambling to cover it. It saves them money in the long run because people will tend to underreport health problems if it takes a trip to the doctor to do so. Some of those unreported and underreported problems may turn into huge issues, eventually costing ones insurance company big time. The whole focus these days is on preventative care and early reporting of symptoms is part of that. What better way then to just Skype with a doc? The fact that Medicare covers it is a very good sign. They are usually the difficult ones. If they approve of it, which they do, the harder insurers are sure to follow.  I also think that the standard $50 per visit will be coming down and competition increases.  RM


The facility I go to charges $20 if you see an attending doctor and then it's free if you see a resident. (This is how it works with my insurance at least). If I could pay that same co-pay online, I would switch to that in an instant. Especially for the appointments that aren't for treatment, but rather a check in to see how your meds are working. "Everything good with your meds?" "Yep." "Ok" *sends in rx refills*

[yellowdog]

I think it is great option but only for SOME people. ( never tried it myself) HOWEVER if people are forced to use this service as opposed to seeing someone face to face then that is concerning.

[Rafterman]

I think it is great option  but only for SOME people. ( never tried it myself)  HOWEVER  if people are forced to use this service as opposed to seeing someone face to face then that is concerning.

Howdy Yellowdog,
Agreed. That is what I was saying in my post to FishFarmer on this thread. An in-person visit is preferable for many reasons, but for those who have special needs, the tele version can be invaluable. I know that you see it the same way. Sometimes people just won't attend an in-office visit because of this aversion or that aversion. Its doesn't appear as a statistic because it falls between the cracks. This particularly applies to those who may benefit by using telepsychiatry because so many suffer from social anxiety, panic disorder, GAD, and mood regulation disorders that makes something that is easy for a typical person, an in-office visit, nearly impossible. I know because I suffered with that aversion for years. I hate being anywhere where I just can't pick up and leave when I want to. It makes me feel trapped. An office visit brings on that feeling. I like knowing that there is another option for me. On some days, it may be the only option because I just become paralyzed (if you know what I mean) at the thought of going in person. During an in-office counseling session, there is rarely any kind of physical examination, so the tele visit is basically identical in content to the office visit.  Regards,  RM

[Naomi]

I think it is great option  but only for SOME people. ( never tried it myself)  HOWEVER  if people are forced to use this service as opposed to seeing someone face to face then that is concerning.

I agree, I think it would be great if people had the option for whichever works best for them and that it was standard practice when you start seeing a doctor that you choose how you'd like your visits.