JMIR Publications

ABSTRACT

As the demand for telepsychiatry increases during COVID-19, articulating strengths and challenges of telepsychiatry implementation are needed to improve clinical practices long-term. Currently, observations within United States contexts are lacking; therefore, we report on the rapid implementation and workflow experiences as a psychiatric practice based within a large healthcare system in Southeast Texas with a national catchment area. We discuss implementation logistics including modes of communication, scheduling, coordination, and capacity; psychological effects of online services, including both the loss of the physical therapeutic environment as well as unique interpersonal dynamics experienced in the virtual environment; and post-adoption patterns of engagement in our services and other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed online program (e.g., patients were receptive, well-engaged, and appreciated the continuity of accessible service) as well as the challenges (e.g., the need for backup plans and technological fallbacks, managing interruptions and telecommunications learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). Overall, we conclude from our experience that overall strengths of telepsychiatry include surprisingly receptive and well-engaged response from patients, and the expansion of boundaries allowing for a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high risk patients, maintaining professional boundaries in the newly informal virtual setting, designing the physical space both to frame the patient encounter and to maintain work-life balance for the therapist, allowing for delays and interruptions (including an initial acclimation session), and preserving interprofessional care team collaboration when the physical hallways normally facilitating such encounters are absent. We believe careful observations on strengths and challenges of telepsychiatry during this pandemic will better inform practices considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.