Indian Journal of Public Health

LETTER TO THE EDITOR
Year
: 2020  |  Volume : 64  |  Issue : 6  |  Page : 245--246

Telepsychiatry during COVID-19: Some clinical, public health, and ethical dilemmas


Avinash De Sousa1, Sagar Karia2,  
1 Research Associate and Consultant Psychiatrist, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
2 Assistant Professor, Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Avinash De Sousa
Carmel, 18, St. Francis Road, Off SV Road, Santacruz West, Mumbai, Maharashtra
India




How to cite this article:
Sousa AD, Karia S. Telepsychiatry during COVID-19: Some clinical, public health, and ethical dilemmas.Indian J Public Health 2020;64:245-246


How to cite this URL:
Sousa AD, Karia S. Telepsychiatry during COVID-19: Some clinical, public health, and ethical dilemmas. Indian J Public Health [serial online] 2020 [cited 2021 Sep 26 ];64:245-246
Available from: https://www.ijph.in/text.asp?2020/64/6/245/285627


Full Text



Dear Editor,

The COVID-19 pandemic has resulted in a widespread lockdown, with the government and the Medical Council of India advising telephonic consultation as far as possible.[1] We highlight some key clinical, public health, and ethical dilemmas in the practice of telepsychiatry in this letter.

In India, telepsychiatry as a modality is yet to kick off in a big way although mental health telephone helplines have existed for long. Different clinicians may have different telepsychiatry approaches that may result in the nonuniformity of telepsychiatry services.[2] Many patients while wanting to be compliant after seeking a consultation online or via telephone and procuring a fresh prescription, face a shortage of medication. The short supply of medication may lead to a rise in relapses.[2]

The ethical dilemma (a personal one) is whether one must charge for a telephonic consultation or not. It is important to maintain a fine balance between the professional aspect of being a doctor and also being altruistic and maintaining the ethical standards of medicine as a noble profession.[2]

Another major concern is handling psychiatric emergencies. There is a need for developing guidelines on this aspect.[3] Cases of domestic violence and child abuse continue to emerge during the crisis, and we are required to report these to local authorities. Do we refer such patients to specific helplines or do we take it on ourselves to report such matters in the wake of the already-testing nature of an existing pandemic?

There may be a rise in fake calls with an aim to seek prescriptions for benzodiazepines. Many patients who may be abusing these drugs often phone multiple doctors on the phone with different names and may claim to have insomnia and panic attacks or may pose as old cases of anxiety to procure a prescription for the same.

Telepsychiatry has been used with adolescents, juveniles, and in school mental health, but there are no guidelines for the same in India. How does one offer intervention even if counseling without parental consent and what should be the course of action in such cases?[4]

There is a lack of a standard portal to carry out telepsychiatry during the pandemic. Telepsychiatry portals advertising the names of doctors and their personal phone numbers and using WhatsApp or Skype as a medium for communication can be dangerous.

Telepsychiatry while offering enormous potential needs to be permanently available rather than just in times of emergencies and pandemics. Indian studies on the reliability, efficacy, and cost-effectiveness of telepsychiatry also need to be for both rural and urban settings.[5]

Dedicated telepsychiatry consultation facilities need to be setup in cities to provide consultation and while doing so, many ethical and public health dilemmas need to be handled – the solutions for which are not ready to come by.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Available from: https://www.mohfw.gov.in/pdf/Te lemedicine.pdf. [Last accessed 2020 Apr 09].
2Knopf A. Telepsychiatry coming into its own with COVID-19. Brown Univ Child Adolesc Psychopharmacol Update 2020;22:1-3.
3Yellowlees P, Burke MM, Marks SL, Hilty DM, Shore JH. Emergency telepsychiatry. J Telemed Telecare 2008;14:277-81.
4Myers K, Cain S; Work Group on Quality Issues, American Academy of Child and Adolescent Psychiatry Staff. Practice parameter for telepsychiatry with children and adolescents. J Am Acad Child Adolesc Psychiatry 2008;47:1468-83.
5Sabin JE, Skimming K. A framework of ethics for telepsychiatry practice. Int Rev Psychiatry 2015;27:490-5.