Introduction: Although telehealth was a viable means of delivering psychiatric care even before the COVID-19 public health emergency, flexibilities at the federal and state levels during the pandemic prompted mass adoption in a short timeframe. Little is known about how psychiatrists plan to offer care going forward and to what degree services will be offered virtually, in-person, or in a hybrid format. Methods: We conducted a survey of American Psychiatric Association (APA) members regarding telepsychiatry practice and potential barriers. Results: The survey was completed by 1,660 APA members. Most survey respondents (94%) conduct at least some telepsychiatry. Most respondents indicate operating in a hybrid environment in which they maintain a physical practice location, while 16% indicate that they do not have a physical practice and only see patients remotely. Across all setting types, 82% of respondents deliver telehealth via all or mostly video; 11% report conducting telehealth visits via mostly audio-only modalities; and 7% report equal usage of both modalities. Barriers to telepsychiatry noted by respondents include limited reimbursement, state medical licensure, federal and state regulations regarding controlled substance prescribing via telehealth, and technical challenges. Conclusion: Results of this survey of APA members show that the majority conduct at least some telepsychiatry; operate in a hybrid environment; and deliver telehealth via all or mostly video. Reported barriers to telepsychiatry practice include legal, regulatory, reimbursement, and technical issues. The future of telepsychiatry may largely be determined by which legal, regulatory, and reimbursement flexibilities are ended, extended temporarily, or made permanent.

OBJECTIVE: The COVID-19 pandemic required mental health clinicians globally to transition to the delivery of care via telehealth. This study aimed to gain an understanding of clients\' satisfaction with and attitudes towards telehealth mental health services.
METHODS: Seventy adults who had attended a clinic for mood and anxiety disorders, and participated in at least one telehealth consultation with a psychologist or psychiatrist, completed an anonymous online survey.
RESULTS: The majority of participants (81.5%) reported satisfaction with telehealth mental health care provided during the COVID-19 pandemic. However, satisfaction overall was significantly higher amongst participants who had received both telehealth and face-to-face mental health care, compared to participants who received care via telehealth only. Advantages of telehealth care reported included convenience and increased access to mental health clinicians. However, disadvantages of telehealth care included greater difficulty developing a rapport with a clinician and expressing oneself via telehealth.
CONCLUSIONS: Whilst client satisfaction with telehealth mental health care for mood and anxiety disorders is generally high, clinicians should consider the limitations of telehealth from clients\' perspectives. In particular, strategies to enhance therapeutic connection during telehealth sessions may be needed, and client preferences for mode of delivery should be taken into consideration when possible.

OBJECTIVE: The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation.
METHODS: Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots.
RESULTS: Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services.
CONCLUSIONS: MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry.

UNASSIGNED: Providing medical care on isolated islands can be challenging in several ways. Telepsychiatry can potentially offer a solution for accessible psychiatric services on isolated islands. When video conferencing is used in telepsychiatry, the psychiatry specialist, who is remotely located, may find it difficult to establish trust. To address this, we developed a teleoperated robot system termed \"Sota 100,\" which is equipped to convey various elements of nonverbal communication, such as eye contact, in remote settings.
UNASSIGNED: In this report, we introduce the case of a patient with alcohol use disorder who lived on an isolated island and received medical care from a primary care physician at the island\'s medical clinic and from Sota 100 teleoperated by a psychiatry specialist. Using this system, the patient admitted that he had developed a physical illness and had damaged his relationships partly because of alcohol abuse. At the conclusion of the three-way conversation, the patient understood that stopping drinking alcohol was the only way to prevent worsening his physical condition and damaging his relationships further. Concurrently, the primary care physician gained a deeper understanding of the etiology of alcohol use disorder and of how to support patients with alcohol dependency.
UNASSIGNED: These case findings suggest that our system is helpful for patients with alcohol use disorder who need to receive telepsychiatry services. Future studies should include single-case experimental designs with regular measurements of key outcome variables and other relevant variables over time.

BACKGROUND: Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP\'s effectiveness in the ED setting, as well as the process of implementing TP in this setting.
OBJECTIVE: This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting.
METHODS: The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors.
RESULTS: A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting.
CONCLUSIONS: Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP\'s effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.

Aim: This project sought to ascertain views and experiences of people with intellectual disabilities, their carers\', and specialist intellectual disability psychiatrists as to use of telepsychiatry consultations. Background: During the Covid-19 pandemic specialist psychiatrists in intellectual disability services in the United Kingdom (UK) have explored and adopted use of telepsychiatry for psychiatric consultations. Method: An easy-read co-designed questionnaire was sent to potential respondents N = 590 potential respondents (N = 280 patients, N = 280 carers), and a separate questionnaire was sent electronically to N = 30 specialist intellectual disability psychiatrists. Findings: Responses were received from N = 192 respondents (N = 68 (24%) patients, N = 98 (35%) carers, and N = 26 (90%)) psychiatrists. Advantages of telepsychiatry cited were flexibility, and it being less disruptive to patients\' routines, offering convenient practice and saving travel time and cost. Disadvantages reported included loss of rapport and relationship with patients, and an inability to conduct an effective mental state examination. Conclusion: This survey has produced equivocal evidence as to acceptability of telepsychiatry for all people with intellectual disabilities, carers and psychiatrists cannot be assumed. Some patients may need significant support to enable them to engage with such an approach.

Co-occurring intellectual/developmental disability (IDD) and overweight/obesity (OW/OB) is an important consideration of IDD psychiatric care. The relationship between OW/OB and comorbid diagnoses of Autism Spectrum Disorder (ASD) and/or IDD remains inadequately described in existing literature. The purpose of this study is to explore these co-occurring diagnoses. Improved understanding of associated comorbidities can guide clinicians toward interventions to minimize complications associated with OW/OB. We conducted a retrospective review of adult patients of a telepsychiatry clinic with IDD or ASD defined by DSM-5. ICD-10 diagnosis of IDD or ASD, demographics, BMI, comorbidities, and current medications were recorded. Binary logistic regression was used to estimate associations between each predictor and the outcomes overweight (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2). Prevalence of obesity in these 412 adults was 52.4% (95% CI 47.5, 57.3). There was a significant inverse relationship between IDD severity and the odds of each outcome (p < .001). 80.3% of patients were being actively treated with an antidepressant. Patients taking an antidepressant had twice the odds of obesity (adjusted OR 2.03, 95% CI 1.23, 3.41, p = .006). These findings provide a sense of urgency for prevention of OW/OB and its associated medical sequelae. Prevalence of obesity was higher in this sample compared to the general population. The inverse relationship between IDD severity and OW/OB warrants further research examining age, caregiver involvement, and access to care as potential modifiers.

UNASSIGNED: To conduct a systematic literature review of education and training (E&T) programs for telemental health (TMH) providers in the past 10 years to qualitatively clarify field offerings and methodologies, as well as identify areas for future growth.
UNASSIGNED: We searched five major electronic databases: PubMed, PsycINFO, Scopus, CINAHL, and Web of Science for original publications on TMH E&T from January 2013 to May 2023. We extracted information from each publication and summarized key features of training programs including setting, target group, study aims, training modality, methods of assessing quality, and outcomes.
UNASSIGNED: A total of 20 articles were selected for the final review. Articles meeting inclusionary criteria were predominantly comprised of case studies and commentaries, focused on a TMH service/practice for a specific region/population, and were performed after 2020. All of the selected studies demonstrated a significant increase in the measured knowledge, skills, and abilities of the participants after TMH training. Nevertheless, there remains a lack of standardization of training methodologies, limited sample sizes and demographics, variability in study methodologies, and inconsistency of competency targets across studies.
UNASSIGNED: This systematic review highlighted the diversity of methods for TMH E&T. Future research on this topic could include more varied and larger-scale studies to further validate and extend current findings, as well as explore potential long-term effects of TMH training programs on both provider attitudes and patient outcomes.

UNASSIGNED: Although the concept of telehealth is of great interest globally, its potential has not yet been realized in Pakistan. It is therefore essential to explore the perspectives of stakeholders on the technology, particularly for mental health, to be able to increase and improve its use.
UNASSIGNED: To assess the perceptions and experiences of patients receiving tele-mental health services, including telepsychiatry and tele-psychotherapy, in Pakistan.
UNASSIGNED: For this qualitative exploratory study, we conducted in-depth interviews with 49 individuals at a tertiary care hospital in Karachi, Pakistan. Using the Cresswell framework for content analysis, we identified 3 major themes that focused on the positive and negative aspects of tele-mental health services and made suggestions for enhancing them.
UNASSIGNED: Twenty-six of the participants received telepsychiatry, while the remaining 23 received tele-psychotherapy services. Technical literacy, cost of consultation, privacy, and therapeutic alliance were the major challenges identified by the patients, while convenience and the absence of stigma were highlighted as key facilitators for tele-mental health. Tele-consultations reduced travel and waiting time, thus improving access to healthcare. Participants suggested that the processes for booking appointments and making payments should be streamlined and the cost of tele-consultation reduced.
UNASSIGNED: This study provides insightful findings on tele-mental health services from the perspectives of patients living in an Asian culture. The major benefits highlighted were destigmatization of mental health and elimination of commuting costs and travel time. There were concerns about privacy, therapeutic alliance and availability and affordability of the technology.
تجارب المرضى في باكستان في خدمات الصحة النفسية عن بُعد في أثناء جائحة كوفيد-19.
نرجس أسد، شاهينا بيراني، خان أسامة، تانيا نديم.
UNASSIGNED: على الرغم من أن مفهوم الصحة عن بُعد يحظى بأهمية كبيرة على الصعيد العالمي، فإنه لم يجرِ تقصِِّّي كامل إمكاناته في باكستان بعدُ. لذلك، من الضروري استكشاف وجهات نظر أصحاب المصلحة بشأن هذه التكنولوجيا، لا سيَّما في مجال الصحة النفسية، للتمكن من زيادة استخدام هذه التكنولوجيا وتحسينها.
UNASSIGNED: هدفت هذه الدراسة الى تقييم تصورات وتجارب المرضى الذين يتلقون خدمات الصحة النفسية عن بُعد في باكستان، ومن ذلك الطب النفسي عن بُعد والعلاج النفسي عن بُعد.
UNASSIGNED: من أجل هذه الدراسة الاستكشافية الوصفية، أجرينا مقابلات وافية مع 49 فردًا في مستشفى للرعاية التخصصية في كراتشي، في باكستان. وباستخدام إطار كريسويل لتحليل المحتوى، حددنا 3 مواضيع رئيسية ركزت على الجوانب الإيجابية والسلبية لخدمات الصحة النفسية عن بُعد، وقدَّمنا اقتراحات لتعزيزها.
UNASSIGNED: تلقَّى ستة وعشرون مشاركًا خدمات الطب النفسي عن بُعد على يد طبيب نفسي، في حين تلقَّى الثلاثة والعشرون مشاركًا الباقون خدمات العلاج النفسي عن بُعد على يد معالج نفسي. وكانت القراءة والكتابة التقنية، وتكلفة الاستشارة، والخصوصية، والتحالف العلاجي من التحديات الرئيسية التي حددها المرضى، في حين سُلط الضوء على الراحة وعدم الوصم باعتبارهما ميسرين رئيسيين للصحة النفسية عن بُعد. وخفضت الاستشارات عن بُعد إلى وقت السفر والانتظار، الأمر الذي أدى إلى تحسين فرص الحصول على الرعاية الصحية. واقترح المشاركون تبسيط عمليات حجز المواعيد وتسديد المدفوعات، وخفض تكلفة الاستشارة عن بُعد.
UNASSIGNED: تقدم هذه الدراسة نتائج متعمقة بشأن خدمات الصحة النفسية عن بُعد من وجهة نظر المرضى الذين يعيشون في ثقافة آسيوية. وإزالة الوصمة عن الصحة النفسية والتخلص من تكاليف التنقل ووقت السفر كانت من أهم الفوائد التي سُلِّط الضوء عليها. وكانت ثمة شواغل بشأن الخصوصية والتحالف العلاجي وتوفُّر التكنولوجيا والقدرة على تحمُّل تكاليفها.
Expériences des patients avec les services de télésanté mentale pendant la COVID-19 au Pakistan.
UNASSIGNED: Bien que le concept de la télésanté présente un grand intérêt à l\'échelle mondiale, son potentiel n\'a pas encore été pleinement exploré au Pakistan. Il est donc essentiel d\'explorer les perspectives des parties prenantes concernant la technologie, en particulier pour la santé mentale, afin de pouvoir augmenter et améliorer son utilisation.
UNASSIGNED: Évaluer les perceptions et les expériences des patients recevant des services de télésanté mentale, y compris la télépsychiatrie et la télépsychothérapie, au Pakistan.
UNASSIGNED: Pour cette étude qualitative exploratoire, nous avons mené des entretiens approfondis avec 49 personnes dans un hôpital de soins tertiaires à Karachi (Pakistan). En utilisant le cadre de Cresswell pour l\'analyse de contenu, nous avons identifié trois thèmes principaux qui se concentrent sur les aspects positifs et négatifs des services de télésanté mentale et nous avons proposé des suggestions pour les améliorer.
UNASSIGNED: Vingt-six des participants ont bénéficié de services de télépsychiatrie, tandis que les 23 autres ont reçu des services de télépsychothérapie. La littératie technique, le coût de la consultation, le respect de la vie privée et l\'alliance thérapeutique étaient les principaux défis identifiés par les patients, alors que la commodité et l\'absence de stigmatisation étaient soulignées comme des éléments clés qui facilitaient la pratique de télésanté mentale. Les téléconsultations ont permis de réduire les déplacements et les temps d\'attente, améliorant ainsi l\'accès aux soins de santé. Les participants ont suggéré de rationaliser les procédures de prise de rendez-vous et de paiement et de réduire le coût de la téléconsultation.
UNASSIGNED: La présente étude fournit des résultats pertinents sur les services de télésanté mentale du point de vue des patients qui vivent dans une culture asiatique. Les principaux avantages mis en évidence étaient la déstigmatisation de la santé mentale et l\'élimination des coûts et du temps de déplacement. Des inquiétudes ont été exprimées concernant le respect de la vie privée, l\'alliance thérapeutique, la disponibilité et l\'accessibilité financière de la technologie.

BACKGROUND: Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates\' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry).
METHODS: The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry.
RESULTS: Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles).
CONCLUSIONS: According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices.