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The COVID-19 pandemic has interrupted the usual mechanisms of healthcare delivery and exacerbated symptoms of mental illnesses. Telemedicine has morphed from niche service to essential platform, with newly released guidelines that cover various aspects of tele-mental health delivery. Rehabilitation services, which incorporate a range of psychosocial interventions and liaison services, have been significantly impacted too. They are currently more institute-based than community-based in India. However, recent legislation has mandated that community-based rehabilitation options be available. While a large treatment gap for mental health issues has always existed, telemedicine provides an opportunity to scale services up to minimize this gap. Community-based rehabilitation can be delivered over various platforms, from text to phone to videoconferencing, and various devices. Telemedicine is cost-effective, and enables delivery of services where existing services are inadequate. The recent guidelines allow other healthcare workers to be involved in mental health service delivery. Hence, in addition to direct delivery of services, telerehabilitation can facilitate task-shifting, with mental health professionals mentoring and supervising existing human resources, such as ASHA workers, VRWs, DMHP programme staff, and others. Tele-rehabilitation also poses challenges - not all needs can be met; access and privacy can be a problem in resource-scarce settings; liaison with existing services is required; and organisations need to plan appropriately and re-allocate resources. Digital access to welfare benefits and interventions must be expanded without disadvantaging those without internet access. Yet, many rehabilitation interventions can be adapted to telemedicine platforms smoothly, and task-shifting can broaden access to care for persons with disability.The need and the importance of telemedicine has been brought to the forefront during the ongoing pandemic of COVID-19. It has created another viable option for treatment delivery while reducing risks. However, there are major concerns regarding the delivery of services for treatment of substance use disorders using telepsychiatry. We discuss the various concerns and opportunities, the different international practices, and the Indian guidelines. We believe that there needs to be a balance between access to treatment and medication with reasonable checks and call for more patient and provider friendly practices. We also propose certain modifications in the Indian Telepsychiatry Guidelines.The exponential growth of technology in the past few decades has benefitted the healthcare sector. Telemedicine is a newer advancement which is making healthcare affordable and more accessible to the needy in recent times. This article discusses how to set up telepsychiatry services, the procedure of telepsychiatry consultation, how to record and maintain the electronic health records, the potential challenges, ethical and legal aspects concerning telepsychiatry while ensuring the good practice guidelines, medical ethics, patient rights, and the minimum requirements as established by the Information Technology Act and the telemedicine practice guidelines (TPG) 2020 issued by the Indian Medical Council.Children constitute 40% of India's population. Large number of children with psychiatric disorders and neurodevelopmental conditions are unable to access mental health services due to factors such as unavailability of these services in smaller urban and rural centres and lack of training for primary care providers. Given the relatively easy access to video conferencing technology, feasibility and acceptability of Telepsychiatry, there is an urgent need to invest resources and strengthen the use of Telepsychiatry for child and adolescent mental health training and serviced delivery . This viewpoint article discusses the need,scope,experiences and challenges related to use of Telepsychiatry in the area of child mental health.Psychiatric illnesses are an important contributor of morbidity and mortality in older adults. There is increase in older adults with psychiatric disorders paralleling their growth in absolute numbers. This leads to challenges in mental health care and service delivery. Several barriers that exists in our community hinder older adults from receiving mental health care. Additionally, lack of adequate human resources in geriatric mental health care compounds the problem. Telemedicine, though not new in other fields of medicine, is relatively new in the practice of psychiatry in India. This is probably due to lack of clear guidelines and regulations regarding the same in India. There is a recent increase in teleconsultations in India similar to other developed countries due to ongoing COVID-19 pandemic. The recent telepsychiatry operational guidelines have made telepsychiatry a legitimate and official practice in India. Challenges specific to older adults in the form of low digital literacy, sensory issues, and cognitive impairment can be overcome by adopting telepsychiatry services in coming years. Concerns related to security and safety of telepsychiatry require further evaluation.
The use of telepsychiatry (TP) for inpatient service delivery is still an emerging field and there is limited literature on its practice and evidence. selleck chemicals llc This review was conducted with the objectives of (a) exploring the models of TP for inpatient service delivery, (b) qualitative synthesis of the efficacy of TP in inpatient settings, and (c) proposing a best-fit model of TP-based inpatient care for Indian settings.
An electronic database search was conducted on July 22, 2020, in PubMed, Directory of Open Access Journals, and Google Scholar for relevant articles. Seventeen articles were included in the review.
The review revealed three models for TP-based inpatient care; direct care model, teleconsultation model, and the collaborative care model. Preliminary evidence suggests that TP is cost-effective and reliable, and that patients and service providers are highly satisfied with this approach. Evidence gaps were seen for some diagnostic categories such as psychosis and for extremes of age groups. Based on the existing models, we propose an Indian model for implementing TP in inpatient settings.
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