Abstract
Post covid-19 pandemic, tele-consultations have been an important medium to connect with patients in times of stringent lockdown and quarantine restrictions. Tele mental health has provided an opportunity for people to discuss and take help from trained professionals to manage their stress and other mental health concerns. Recently the Union government had announced the start of tele mental health program across the country to coordinate and improve the network of mental health services. It is a welcome move but yet challenged with roadblocks at the ground level. Various hurdles such as network connectivity, gadgets, infrastructure and technical support have to be sorted out to utilize the potential benefits of tele mental health. Privacy, safety concerns and confidentiality issues need to be taken into consideration with the help of regular updates and policy guidelines. Although tele mental health cannot replace the traditional hospital visits entirely, it can still be a bridge between doctor and the patient in times of health crises like the ongoing pandemic. Awareness about tele mental health will help to reinforce the trust among the patients and transform the same into a viable alternative in the coming future.
Telemedicine consultations for health concerns have seen an exponential rise in the last two years after the onset of covid 19 outbreak.[1] The ongoing pandemic has tested the potential of our basic health care system in an unprecedented way. Access to a doctor in this crisis has become an arduous task in recent times due to various restrictions at the hospital and as well as in the community. When people’s physical and mental health was at stake in these difficult times, teleconsultation had been the savior in many cases where personal visits to the treating consultant was not possible or feasible. Thanks to the advancement in technology, patients were able to be in touch with their physicians and seek advice on their ailments just with help of a simple smartphone. This platform has helped to alleviate the sense of apprehension in people regarding their medical advice in the easiest way possible and hence has become a vital source of psychological support to patients and their families.[2]
It has been observed that, mental health problems such as anxiety, depression, sleep disturbances and addiction disorders have significantly increased in the general population now compared to pre-pandemic levels due to various psychosocial stress and life events.[3] People already suffering with mental illness are at more risk in case if their regular consultations are hampered. Tele mental health can be considered as one of the options to address this rapidly growing concern amidst lack of widespread psychiatric services in the country. It provides an easy access to mental health professionals in times of need even from remote areas. In psychiatric emergencies such as suicidal ideations, immediate contact and guidance from a trained person can turn to be life saving for many. Moreover, with help of simple text messages or mobile app-based communications, people can discuss their mental health issues at the convenience of staying at home. People also feel consulting a psychiatrist over teleconsultation is less stigmatizing rather than visiting in a hospital. Logistic and financial difficulties involved in visiting the hospital can be minimized effectively which can improve the adherence and compliance to the treatment in a significant way. Other interventions such as counselling, cognitive therapy, behaviour therapy, family therapy and motivational enhancement is also possible where video call function is available.[4] All these advantages put forward tele mental health as a promising and viable option in the coming future in the management of psychiatric disorders.
It is welcoming to note that in the recent budget session, the union government has announced the start of 23 tele mental health centers with an aim to improve the network of mental health services. But the real challenge is, our preparedness and willingness to implement it successfully at all possible levels. Currently the number of trained professionals available in the country is still less compared to the larger population who need mental health services. Tele mental health requires adequate infrastructure in terms of a proper setup with appropriate telecommunication devices and network facilities for seamless interaction with the patients. Round the clock technical support and manpower is essential for uninterrupted services. Dedicated tele mental health units need to be established in all centers where psychiatric services are available. Robust network connectivity in rural and remote areas is still a long way forward which remains the biggest hurdle for an effective outcome. Moreover, elderly people and individuals who don’t use modern communication devices often may find uncomfortable in adopting the services of tele mental health. With use of internet and software applications, cases of online crimes and abuse have become rampant in recent days. Hence measures to maintain people’s privacy, confidentiality and safety has to be properly ensured for a trusted and hassle-free use of tele mental health services.[5]
Although tele mental health cannot entirely replace the traditional doctor patient consultation in person, it appears to be a good option especially in times of health crisis like the ongoing pandemic. Simple and routine consultations can be dealt online thus minimizing the burden of hospital visits. Available resources can be used effectively in place of overwhelmed health care system. But any new initiative requires a dedicated and persistent effort for a productive outcome. People may find the online consultations as not very convincing or assuring. Gaining the confidence of patients and family members through awareness programs can be helpful. Educational sessions on the technical aspects of telemedicine can improve the acceptance among the general public. Funding and support from the government agencies, NGO, software and IT industry is required for regular updates, improvement and modifications in the existing services. Uniform guidelines and policy regarding use of teleconsultations with ethical considerations has to be formulated for successful establishment of tele mental health system in India.[6]
References
1. Koonin LM, Hoots B, Tsang CA, Leroy Z, Farris K, Jolly B, Antall P, McCabe B, Zelis CB, Tong I, Harris AM. Trends in the use of telehealth during the emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:1595–1599. doi: http://dx.doi.org/10.15585/mmwr.mm6943a3
2. Agarwal N, Jain P, Pathak R, Gupta R. Telemedicine in India: A tool for transforming health care in the era of COVID-19 pandemic. J Educ Health Promot. 2020 Jul 28;9:190. doi: 10.4103/jehp.jehp_472_20.
3. Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, Pattojoshi A, Rao GP, Saha G, Mishra KK, Chakraborty K, Rao NP, Vaishnav M, Singh OP, Dalal PK, Chadda RK, Gupta R, Gautam S, Sarkar S, Sathyanarayana Rao TS, Kumar V, Janardran Reddy YC. Psychological impact of COVID-19 lockdown: An online survey from India. Indian J Psychiatry. 2020 Jul-Aug;62(4):354-362. doi: 10.4103/psychiatry.IndianJPsychiatry_427_20. Epub 2020 Jul 27.
4. Sharma P, Parmar A. Telemental health: Need and application in Indian setting. Asian J Psychiatr. 2016 Feb;19:26-7. doi: 10.1016/j.ajp.2015.12.003.
5. Langarizadeh M, Tabatabaei MS, Tavakol K, Naghipour M, Rostami A, Moghbeli F. Telemental health care, an effective alternative to conventional mental care: a systematic review. Acta Inform Med. 2017 Dec;25(4):240-246. doi: 10.5455/aim.2017.25.240-246.
6. Dash S, Aarthy R, Mohan V. Telemedicine during COVID-19 in India-a new policy and its challenges. J Public Health Policy. 2021 Sep;42(3):501-509. doi: 10.1057/s41271-021-00287-w.
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