Telepsychiatry as a public health imperative: Slowing COVID-19

To the Editor

We are currently amid the largest pandemic of the century. Exemplary hand hygiene, social distancing, isolation and contact tracing remain the best tools we have as we await novel interventions and vaccines (Wilder-Smith and Freedman, 2020). Workers globally are being encouraged to work from home while healthcare, arguably the most crucial service at present, lags woefully in the infrastructure and policy framework to enable it.

While not all specialists can work remotely, many psychiatrists are able to do so, provided the right infrastructure and workplace support. There is a rich literature demonstrating excellent acceptance and non-inferior outcomes across ages, conditions, cultures and languages (Hilty et al., 2015). In Australia, telepsychiatry Medicare item numbers have existed since 2011 and 74,878 such consults were billed in 2019 alone.

Yet, despite the overwhelming literature and extensive private practice expertise, most public hospitals have been slow to embrace telepsychiatry. We owe it to our patients and the community to do better.

The March 2020 addition of new telepsychiatry items to the Medicare Benefits Schedule is a good start but does not go far enough. The federal government should drop arbitrary limits to telepsychiatry utilisation. Current restrictions to patients who have had previous face-to-face contact with the clinician or who are actively quarantined do little to prevent unnecessary contact in waiting rooms or indeed the infection of vulnerable clinicians. Further, governments should fund clinician access to secure videoconferencing and collaboration software such as Coviu or Microsoft Teams and subsidise mobile data for vulnerable Australians to ensure access.

Further, public mental health services should (1) map out inpatient and outpatient spaces that can be appropriately modified for tele-consults; (2) leverage existing staff with an interest to provide training and local support to clinicians less familiar with technology; (3) ensure all doctors know how to use existing medical records and prescribing tools remotely via educational initiatives; (4) focus on platforms already tested at scale in other sensitive organisations and (5) encourage all staff to share successes and failures for rapid quality improvement. Telepsychiatry ethics are similar to the ethics of standard clinical practice (Cowan et al., 2019) thus existing policies can be rapidly adopted.

We should use this crisis to catalyse much overdue change that will benefit patient care now and into the future. We urge the college to continue to advocate on these issues and for all psychiatrists to consider their role in slowing the spread of COVID-19.