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Havard M, Ndebele NF, Dhakras S, Johns G, McCafferty I, Ahuja A. A step-by-step guide for remote working in the NHS: evaluation of a virtual consultant psychiatrist hiring scheme. BJPsych Bull 2024:1-7. [PMID: 39188226 DOI: 10.1192/bjb.2024.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024] Open
Abstract
AIMS AND METHOD In 2021, Solent NHS Trust advertised for a fully remote consultant psychiatrist to meet increasing clinical demand. This pilot scheme was evaluated to determine its success. The job applications underwent content analysis, recruitment and support staff were interviewed, and in-depth rolling interviews were conducted with the three now-employed virtual psychiatrists. RESULTS We have gained an objective understanding of this new and innovative way of working and, overall, shown that fully remote working in the National Health Service (NHS) is feasible. IMPLICATIONS The findings were used to create a step-by-step guide for the remote hiring process, which outlines the necessary steps for conducting it in a safe, swift and successful way. This guide could help other NHS organisations to advertise, recruit and manage fully remote employees.
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Affiliation(s)
- Megan Havard
- TEC Cymru, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Gemma Johns
- TEC Cymru, Aneurin Bevan University Health Board, Newport, UK
| | | | - Alka Ahuja
- TEC Cymru, Aneurin Bevan University Health Board, Newport, UK
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Shalev L, Eitan R, Rose AJ. The Use of Telepsychiatry Services in Emergency Settings: Scoping Review. J Med Internet Res 2024; 26:e51814. [PMID: 39008831 PMCID: PMC11287096 DOI: 10.2196/51814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/25/2024] [Accepted: 04/29/2024] [Indexed: 07/17/2024] Open
Abstract
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.
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Affiliation(s)
- Ligat Shalev
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Renana Eitan
- Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Adam J Rose
- School of Public Health, Hebrew University, Jerusalem, Israel
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de Beurs E, Rademacher C, Blankers M, Peen J, Dekker J, Goudriaan A. Alcohol use disorder treatment via video conferencing compared with in-person therapy during COVID-19 social distancing : A non-inferiority comparison of three cohorts. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2208-2217. [PMID: 38226749 DOI: 10.1111/acer.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid-March 2020, nearly all in-person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non-inferior to in-person treatment. METHODS In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre-test and post-test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID-19 lockdown. RESULTS Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in-person, but were continued through video conferencing, compared to in-person treatments that were conducted prior to COVID-19. The number of drop-outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID-19 pandemic lasting longer. CONCLUSIONS Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID-19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in-person care, in spite of the potentially negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which video conferencing appeared non-inferior to in-person care in clinical effectiveness.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
- Arkin GGZ, Amsterdam, The Netherlands
| | - Clara Rademacher
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
| | - Matthijs Blankers
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
| | - Jaap Peen
- Arkin GGZ, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Arkin GGZ, Amsterdam, The Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ranade K, Kapoor A, Fernandes TN. Mental health law, policy & program in India – A fragmented narrative of change, contradictions and possibilities. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Das S, Manjunatha N, Kumar CN, Math SB, Thirthalli J. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital. Asian J Psychiatr 2020; 48:101886. [PMID: 31835142 DOI: 10.1016/j.ajp.2019.101886] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/22/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is a need of continuity of care research in psychiatric disorders to deal two important issues such as accessibility of psychiatrists, and travel. AIMS This pilot was designed to evaluate the acceptability, feasibility, possible clinical effectiveness and cost benefit of video based tele-psychiatric aftercare (TAC) clinic from an academic hospital. METHODS Fifty selected patients were recruited to provide direct video-consultations (DVC). RESULTS This study shows higher score on acceptability, satisfaction and respect to privacy on these TAC. DISCUSSION AND CONCLUSIONS This is first pilot study as one of the patient friendly and less expensive continuity of care.
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Affiliation(s)
- Soumitra Das
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Digital Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - C Naveen Kumar
- Digital Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suresh Bada Math
- Digital Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Cowan KE, McKean AJ, Gentry MT, Hilty DM. Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clin Proc 2019; 94:2510-2523. [PMID: 31806104 DOI: 10.1016/j.mayocp.2019.04.018] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
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Affiliation(s)
- Kirsten E Cowan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Essentia Health, Duluth, MN
| | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
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Young JP, Achtmeyer CE, Bensley KM, Hawkins EJ, Williams EC. Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics. J Rural Health 2018; 34:359-368. [PMID: 29363176 DOI: 10.1111/jrh.12293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Effective behavioral and pharmacological treatments are available and recommended for patients with alcohol use disorders (AUD) but rarely received. Barriers to receipt and provision of evidence-based AUD treatments delivered by specialists may be greatest in rural areas. METHODS A targeted subanalysis of qualitative interview data collected from primary care providers at 5 Veterans Affairs clinics was conducted to identify differences in provider perceptions and practices regarding AUD treatment across urban and rural clinics. Key contacts were used to recruit 24 providers from 3 "urban" clinics at medical centers and 2 "rural" community-based outpatient clinics. Providers completed 30-minute semistructured interviews, which were recorded, transcribed, and analyzed using inductive content analysis. RESULTS Thirteen urban and 11 rural providers participated. Urban and rural providers differed regarding referral practices and in perceptions of availability and utility of specialty addictions treatment. Urban providers described referral to specialty treatment as standard practice, while rural providers reported substantial barriers to specialty care access and infrequent specialty care referral. Urban providers viewed specialty addictions treatment as accessible and comprehensive, and perceived addictions providers as "experts" and collaborators, whereas rural providers perceived inadequate support from the health care system for AUD treatment. Urban providers desired greater integration with specialty addictions care while rural providers wanted access to local addictions treatment resources. CONCLUSIONS Providers in rural settings view referral to specialty addictions treatment as impractical and resources inadequate to treat AUD. Additional work is needed to understand the unique needs of rural clinics and decrease barriers to AUD treatment.
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Affiliation(s)
- Jessica P Young
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | - Carol E Achtmeyer
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.,Primary and Specialty Medical Care Service, VA Puget Sound Health Care System - Seattle Division, Seattle, Washington
| | - Kara M Bensley
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Eric J Hawkins
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System - Seattle Division, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
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Kim JE, Dager SR, Jeong HS, Ma J, Park S, Kim J, Choi Y, Lee SL, Kang I, Ha E, Cho HB, Lee S, Kim EJ, Yoon S, Lyoo IK. Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey. PLoS One 2018; 13:e0190630. [PMID: 29304155 PMCID: PMC5755833 DOI: 10.1371/journal.pone.0190630] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
Repeated exposure to traumatic experiences may put professional firefighters at increased risk of developing posttraumatic stress disorder (PTSD). To date, however, the rate of PTSD symptoms, unmet need for mental health treatment, and barriers to treatment have only been investigated in subsamples rather than the total population of firefighters. We conducted a nationwide, total population-based survey of all currently employed South Korean firefighters (n = 39,562). The overall response rate was 93.8% (n = 37,093), with 68.0% (n = 26,887) complete responses for all variables. The rate of current probable PTSD was estimated as 5.4%. Among those with current probable PTSD (n = 1,995), only a small proportion (9.7%) had received mental health treatment during the past month. For those who had not received treatment, perceived barriers of accessibility to treatment (29.3%) and concerns about potential stigma (33.8%) were reasons for not receiving treatment. Although those with higher PTSD symptom severity and functional impairment were more likely to seek treatment, greater symptom severity and functional impairment were most strongly associated with increased concerns about potential stigma. This nationwide study points to the need for new approaches to promote access to mental health treatment in professional firefighters.
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Affiliation(s)
- Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Stephen R. Dager
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Hyeonseok S. Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jiyoung Ma
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Shinwon Park
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yera Choi
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Suji L. Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Ilhyang Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Han Byul Cho
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States of America
| | - Sunho Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Eui-Jung Kim
- Department of Psychiatry, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
- * E-mail:
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Aboujaoude E, Salame W. Technology at the Service of Pediatric Mental Health: Review and Assessment. J Pediatr 2016; 171:20-4. [PMID: 26743496 DOI: 10.1016/j.jpeds.2015.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/30/2015] [Accepted: 12/03/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
| | - Wael Salame
- Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
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van Rensburg SH, Klingensmith K, McLaughlin P, Qayyum Z, van Schalkwyk GI. Patient-provider communication over social media: perspectives of adolescents with psychiatric illness. Health Expect 2016; 19:112-20. [PMID: 25581724 PMCID: PMC5055215 DOI: 10.1111/hex.12334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Social media is an increasingly dominant platform for communication, especially among adolescents. Statements from professional bodies and a growing body of empirical evidence support a role for social media in improving provider-patient interactions. In psychiatry, particular concerns exist about the suitability of this style of communication. Very limited data are available exploring how patients would like to incorporate social media into their communication with their psychiatric providers. METHODS We conducted a qualitative study with 20 adolescents attending the Yale Psychiatric Hospital Intensive Outpatient Programme. Interviews were analysed using inductive thematic analysis. RESULTS Participants highlighted how social media could allow for constant access to a mental health provider, provide a less anxiety-provoking mode of communication, and allow for them to be monitored in a more on-going fashion. However, participants also identified many potential risks associated with these applications, including the potential for anxiety if a provider was not able to respond immediately, and a sense that online interactions would be less rich overall. DISCUSSION Our findings suggest that adolescents are open to the idea of communicating with mental health providers over social media and are able to describe a number of instances where this could be of value. The risks participants described, as well as concerns raised by existing literature, indicate the need for further work and protocol development in order for social media to be a feasible tool for communication between providers and adolescents with psychiatric illness.
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Affiliation(s)
| | | | | | - Zheala Qayyum
- Department of Psychiatry and in the Yale Child Study Center, Yale University, New Haven, CT, USA
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Affiliation(s)
| | - John Sujit
- Schizophrenia Research Foundation; Chennai; India
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