Virtual Care: A case study on virtual visits from a psychiatrist perspective

Virtual care in psychiatry can help to meet patients’ needs for convenient and accessible mental health services, providing an opportunity for immediate intervention and increased access to services for vulnerable individuals, while also increasing efficiency for clinics by reducing no-shows.^1-3 However, although virtual delivery of treatment for depression and anxiety disorders has been known to achieve similar clinical outcomes to face-to-face support,⁴ systemic barriers have delayed a widespread implementation of virtual care for the delivery of mental health services.⁵ Prior to the COVID-19 pandemic, only 7% of psychiatrists delivered telepsychiatry and of the more than 48,000 Ontarians in need of psychiatric care, fewer than 1% saw a psychiatrist through virtual care.⁶

There is no doubt that the onset of COVID-19 played a role in accelerating the adoption of virtual care across the healthcare continuum. For example, the largest psychiatric hospital in Canada increased their virtual care capacity to over 850%, from 350 per month in March 2020 to almost 3,000 per month in April 2020.⁵ At Kaiser Permanente, 90% of psychiatric care is now delivered virtually.⁷ A survey of 20 American psychiatrists found that all of them changed to fully virtual practices in response to the pandemic, though most had not used telepsychiatry previously.⁸ For patients who either lack access to technology or broadband access and/or the cognitive ability to use video platforms, telephone (considered a virtual care modality) remains a necessary option when in-person restrictions are still in place.¹

Specialized mental health services are available for individuals with persistent mental health issues, patients transitioning from inpatient to gradual return to the community, seniors, and outreach consultation teams. With change management support from the eHealth Centre of Excellence, Dr. Kukreja, a psychiatrist in Kitchener, Ontario, adopted virtual care to support the delivery of specialized mental health services in response to the COVID-19 pandemic.

Video visits enabled the psychiatrist to have a virtual face-to-face visit with patients, where appropriate, offer remote check-ins with patients from any location, as well as facilitate patient engagement during psychotherapy sessions and follow-up visits.

Dr. Kukreja’s reflection on the adoption and benefits of virtual visits to support mental healthcare needs noted:

In the recovery period of the pandemic, virtual care has the potential to support timely access to coordinated and integrated mental healthcare where appropriate, enhancing the capacity to respond to demands for specialized mental health services.

Key considerations were noted in adopting virtual care in psychiatry: technology use and comfort by the patient and staff, the quality of the relationship already established with the patient may impact suitability of virtual visits, requirements for physical assessments, integration of the virtual visits solution with documentation, scheduling and billing.

1. American Psychiatric Association. (2021). Psychiatrists Use of Telepsychiatry During COVID-19 Public Health Emergency Survey Results.
2. Whaibeh, E., Mahmoud, H. & Naal, H. Telemental Health in the Context of a Pandemic: the COVID-19 Experience. Curr Treat Options Psych 7, 198–202 (2020). https://doi.org/10.1007/s40501-020-00210-2
3. Drerup, B. et al. (2021). Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic. Telemed J E Health. doi: 10.1089/tmj.2021.0002.
4. Kumar, V., et al. (2017). The Effectiveness of Internet-Based Cognitive Behavioural Therapy in Treatment of Psychiatric Disorders. Cureus 9(8):e1626. doi: 10.7759/cureus.1626
5. Cisco Canada . CAMH enhances virtual capacity to respond to demand for mental health services. Cision News. 2020 May 4 [accessed 2021 Sep 13]. https://www.newswire.ca/news-releases/camh-enhances-virtual-capacity-to-respond-to-demand-for-mental-health-services-821323149.html.
6. Serhal, E, Crawford, A, Cheng, J. Implementation and utilization of telepsychiatry in Ontario: a population-based study. Can J Psychiatry. 2017;62(10):716-725.
7. Robbins, R . Will the coronavirus be a breakout moment for virtual mental health care? STAT. 2020 Apr 13. [accessed 2021 Sep 13]. https://www.statnews.com/2020/04/13/remote-mental-health-livongo-omada/.
8. Uscher-Pines, L. et al. Use of tele-mental health in conjunction with in-person care: a qualitative exploration of implementation models. Psychiatr Serv. 2020;71(5):419-426.