Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital

Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis

Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.

Opioid use disorder and role of yoga as an adjunct in management (OUDARYAM): Study protocol for a randomized controlled trial

Background

The proposed research aims to test the effects and mechanisms of a six-month yoga-based intervention as an add-on to standard treatment in opioid use disorder (OUD) by conducting a randomized controlled study with the following primary outcome variables: 1) clinical: abstinence (opioid negative urine test), and reductions in pain and craving, and 2) mechanisms: reward circuit activation in response to opioid visual cue craving paradigm, activation in response to a cognitive control task, and resting state functional connectivity through fMRI, and plasma beta-endorphin levels. Secondary outcome variables are perceived stress, anxiety, sleep quality, cognitive performance, pain threshold, buprenorphine dosage and side effects, withdrawal symptoms, socio-occupational functioning, vedic personality traits, heart rate variability, serum cortisol, and brain GABA levels through magnetic resonance spectroscopy (MRS).

Methods

In this single-blinded, randomized, controlled, parallel-group superiority trial with 1:1 allocation ratio, 164 patients with OUD availing the outpatient/ inpatient clinical services at a tertiary mental healthcare hospital in India will be enrolled after giving informed consent. Consecutive consenting patients will be randomly allotted to one of the two groups - yoga arm (standard treatment + yoga-based intervention), or waitlist group (standard treatment alone). Allocation concealment will be followed, the clinicians, outcome assessors and data analysts will remain blind to subject-group allocation. A validated and standardized yoga program for OUD will be used as an intervention. Participants in the yoga arm will receive 10 supervised in-person sessions of yoga in the initial two weeks followed by tele-yoga sessions thrice a week for the next 22 weeks. The wait-list control group will continue the standard treatment alone for 24 weeks. Assessments will be done at baseline, two weeks, 12 weeks, and 24 weeks. Data from all randomized subjects will be analysed using intent-to-treat analysis and mixed model multivariate analysis.

Dissemination

Findings will be disseminated through peer-reviewed publication, conference presentations, and social media.

Trial registration number

The trial has been registered under Clinical Trials Registry-India with registration number CTRI/2023/03/050737.

Teleconsultations for mental health: Recommendations from a Delphi panel

Introduction

The use of teleconsultations for mental health has drastically increased since 2020 due to the Covid19 pandemic. In the present paper, we aimed to analyze the advantages and disadvantages of teleconsultations for mental health compared to face-to-face consultations, and to provide recommendations in this domain.

Methods

The recommendations were gathered using a Delphi methodology. The expert panel (N = 21) included professionals from the health and ICT domains. They answered questions via two rounds of web surveys, and then discussed the results in a plenary meeting. Some of the questions were also shared with non-experts (N = 104).

Results

Both the experts and the non-experts with teleconsultation experience reported a general satisfaction concerning teleconsultations. A SWOT analysis revealed several strengths and opportunities of teleconsultations for mental health, but also several weaknesses and threats. The experts provided a set of practical recommendations for the preparation and organization of teleconsultations for mental health.

Discussion

Teleconsultations for mental health have the potential to allow access to care for patients in remote and isolated areas. Thus, their use will unlikely be discontinued after the end of the pandemic. In this context, we suggest that the collaboration among clinicians, researchers, and interface designers is crucial to improve usability and user experience for both clinicians and patients. The importance of teaching teleconsultation skills and informing the public on the features of teleconsultations (e.g., data privacy/security) is also highlighted.

Level of patient satisfaction with online psychiatric outdoor services

BACKGROUND

The COVID-19 global pandemic exposed gaps in the treatment of common physical and mental disorders that had to do with things like lockdowns, poor convenience, fear of contracting COVID, and economic constraints. Hence, to address these treatment gaps while also limiting exposure to the COVID-19 infection, telemedicine in the form of telephone and internet consultations has increasingly become the recourse around the world. Our center adopted this trend and also launched a telepsychiatry initiative in order to better cater to the needs of patients with pre-existing mental health disorders and to ensure regular follow-ups and compliance with prescription regiments.

AIM

The present study aimed to assess the level of patient satisfaction with the online psychiatric services/telepsychiatry.

METHODS

The sample consisted of 100 patients with pre-existing mental health disorders. This was a cross-sectional study lasting 6 months. The DigiDoc app by Hospital Information Software (HIS) software, which is used to manage a patients appointment schedule, relevant clinical and lab details, along with follow-up prescriptions, was used to follow the selected patients for the purpose of this study. This software also provides a digital platform for video calls for online consultation. The Client Satisfaction Questionnaires-8 (CSQ-8) was employed to collect patient data for analysis.

RESULTS

The mean total CSQ-8 score of the study sample was 21.015.80 (832), which corresponds to a low-to-moderate level of satisfaction with online psychiatric services/telepsychiatry. Most patients (45%) reported low satisfaction levels, followed by 37% who reported moderate levels of satisfaction. Only 18% of patients reported higher satisfaction with telepsychiatry.

CONCLUSION

Despite the psychiatrists ability to provide adequate professional advice and psychoeducation through online psychiatric services, patients level of satisfaction proved moderate-to-low. This suggests a need to design standard protocols and guidelines in the search and provision of consultation services on online psychiatric service platforms that could help enhance patients levels of satisfaction.

An audit of initial six years of 5885 telepsychiatric direct video consultations: Findings from "benefits of savings" analysis and the effect of COVID-19 pandemic

Background

Telepsychiatric direct video consultations (DVCs) meant for continuity of care began in 2017 and continued during the coronavirus disease 2019 (COVID-19) pandemic. Telemedicine-based consultation gained its long-due importance during the COVID-19 travel restriction, despite its existence for a long. The authors intend to share the utility and growth of the initial six years of live telepsychiatric DVCs from an academic hospital in India and also plan to understand the effects of the COVID-19 pandemic on its growth and report findings from an innovative "benefits of savings" (BOS) analysis from these clinics.

Methods

A first six years of medical audit of the files and registers of telepsychiatric DVCs from two kinds of continuity of care clinics during 2017-2022 is performed. An analysis of 4991 (84.8%) live DVCs is successfully conducted for 1570 patients from the 5885 scheduled appointments. Year-on-year (YOY) growth and BOS analysis of successful DVCs from these clinics were performed.

Results and Discussion

The growth suggests a gradual increase in DVCs yearly. The BOS analysis suggests its increased acceptability, feasibility at both user and provider ends, and possible cost-effectiveness of these video clinics. YOY analysis suggests a natural growth of these clinics than from the effect of the COVID-19 pandemic, except for an initial surge in 2020 and 2021 and observing stabilization effect by 2022.

Conclusion

In the authors' understanding, this is the largest study of providing DVCs from India, irrespective of any medical/surgical specialty. The video/remote clinics could be an alternative model for regular follow-ups in ensuring the continuity of care among patients with psychiatric disorders. These clinics also saved significant travel time, travel distance, and travel costs for the patients that could have occurred for their in-person consultations.

Maximizing Pharmacological Treatment Adherence of Children and Adolescents: A Randomized Controlled Study

The aim of the current randomized controlled study was to evaluate treatment adherence of children and adolescents who visited an outpatient psychiatry clinic and started medication for the first time, with telehealth application. This study was performed with parents of patients who visited the clinic from October 1, 2020, to March 31, 2021. Data were collected using a personal information form, Medication Control Form, and Morisky Medication Adherence Scale via telephone after verbal and written consent were obtained. It was found that 96.7% of participants in the experimental group had high medication adherence, whereas 93.3% of participants in the control group had low medication adherence. Results show that telehealth application is effective in maximizing adherence to treatment among children and adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 16-24.].

Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: A systematic mixed studies review

Remote, or tele-, consultations became a necessary form of mental healthcare provision during the COVID-19 pandemic. As the prevalence of mental health problems rises, they may have a role in future mental health services. We aimed to review the literature on patient and provider perspectives on factors influencing the implementation of remote consultations for community-dwelling people with mental health conditions. We searched five electronic databases (PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO) for empirical research up to July 13th, 2022. Only studies of synchronous, interactive remote consultations conducted via video, phone, or live-messaging between patients and providers were included. Two reviewers independently assessed the quality of included studies using the Mixed Methods Appraisal Tool. We integrated qualitative and quantitative data from 39 studies into a single mixed-methods synthesis. We mapped reported factors to the domains of the Consolidated Framework for Implementation Research (CFIR). Acceptability was generally high among participants, despite concerns about the quality of care and the perceived impeded therapeutic relationship. A prominent facilitator was the increased accessibility and convenience of remote consultations, while lack of appropriate infrastructure and low patient comfort and competence were among the most prevalent barriers. This review highlights the importance of patient preferences and provider buy-in to the future of remote consultations.

The therapeutic relationships, empathy, and satisfaction in teleconsultation for substance use disorders: Better or worse than in-person consultation?

CONTEXT

Telemedicine has become one of the essential modes of healthcare delivery. Different aspects of the physician-patient relationship during tele and in-person consultation need to be studied.

AIMS

This study aimed to compare perceived empathy and therapeutic relationship between tele and in-person consultation and assess the patient's satisfaction during teleconsultation for substance use disorder (SUD).

METHODOLOGY

We consecutively recruited 100 adult patients with SUD, registered to the tele-addiction service between June and September 2020, and experienced both video and in-person consultations. We assessed therapeutic relationships, perceived empathy (for teleconsultation and in-person consultation), and patients' satisfaction (with teleconsultation) with specific scales. We compared the scores of the therapeutic relationship and physician empathy scales for tele and in-person consultation.

RESULTS

The mean age of the patients was 35.5 (±10.4) years. Sixty percent had alcohol, followed by opioids (42%) and cannabis dependence (24%). Sixty percent of patients had comorbid tobacco dependence. Telehealth satisfaction (TSS) rating shows around 40% of patients had difficulty accessing the telehealth service and 7% felt their privacy was poorly respected. The mean total therapeutic relation (STAR) (t = -14.4; P <.001), positive collaboration (t = -12.8; P <.001), positive clinical input (t = -11.9; P <.001), and total Patient's Perceptions of Physician Empathy (PPPE) score (t = -8.4; P < .001) were lower in the teleconsultation than in-person consultation group. TSS was positively correlated with positive collaboration, positive clinician input, and STAR total score.

CONCLUSIONS

Our study suggests a stronger therapeutic relationship and higher physician empathy during in-person consultations. Poor accessibility and privacy concerns were critical challenges in telehealth service. TSS and therapeutic relationships positively influence each other.

Current telepsychiatry practice in India - An online survey of psychiatrists

CONTEXT

Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines released in 2020 have provided legal backing for telepsychiatry practice.

AIMS

To understand the current telepsychiatry practices in India.

SETTINGS AND DESIGN

An online survey was conducted after ethics approval by the IPS Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose email address was available with the society, were sent the survey link by email.

METHODS AND MATERIAL

Information about existing telepsychiatry consultation practices in India was collected between June and July 2020.

STATISTICAL ANALYSIS USED

Frequency, percentages, mean, and standard deviation were calculated.

RESULTS

340 responses were analyzed. Nearly three-fourths of the responders used smartphones (n = 260, 76.47%) for audio consultations (n = 196, 57.65%). Among those who were using a dedicated software (n = 36), one-third used the Zoom software (n = 12, 33.33%). Nearly three-fourths (n = 218, 73.4%) provided prescriptions with their registration number on a letterhead in the form of an email or text message. Two-thirds of the responders (n = 228, 67.06%) felt that in-person consultation is better. Many preferred a combination of voice, video, and text including emails (n = 134, 42.01%).

CONCLUSIONS

This online survey showed that the use of technology has caught up with the practicing psychiatrists. Many are practicing telepsychiatry either formally or informally in India and are comfortable and satisfied with the telepractice.

The prescriptions of psychotropic medications in telepsychiatry: An online survey of psychiatrists in India

CONTEXT

Over the years, telepsychiatry services have expanded in many institutes. The Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines (TPOG) released in 2020 have been received by the fraternity with a mixture of apprehension, relief, and dissatisfaction on the list of drugs provided in Lists O, A, B, and C. Many psychiatrists have raised the issues of having a consensus in the formulation of List A.

AIMS

To draw consensus on the medications that can be listed in Lists O, A, B, and C in TPOG-2020.

SETTINGS AND DESIGN

This was an online survey with ethics approval by the Indian Psychiatric Society Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose E-mail address was available with the society, were sent the survey link by E-mail.

METHODOLOGY

Opinions and suggestions on Lists O, A, B, and C of TPOG-2020 and reasons for the suggestions were collected.

STATISTICAL ANALYSIS USED

Frequency, percentages, mean, and standard deviation were calculated. T-test and Chi-square tests were used to see the influence of demographics on the concurrence of the lists.

RESULTS

Responses from 340 responders were analyzed. Majority of the responders agreed that List O (277, 85.5%), List B (263, 82.4%), and List C (223, 69%) are apt except for List A (162, 50.3%).

CONCLUSIONS

This online survey showed that majority of the responders agreed to the lists except for List A. The approach taken to include the medications in List A, which was to include the essential drugs, has various benefits. However, the lists are not final, and the results of this survey may become an impetus to modify the list in the next edition of TPOG.

Video consultations with “Paper and Pen” health record: A path-breaking solution to troubleshoot acceptability of telemedicine practice in developing countries

Telemedicine is the delivery of health care from a distance. It also includes research and evaluation of such services using health data which are stored in "Electronic Health Record" (EHR) platforms. EHR has proved to be useful in monitoring health care delivery but setting up of such platforms is tedious and resource-consuming in developing countries. With the recent surge of telemedicine utility during the COVID-19 pandemic, telemedicine has emerged to be pivotal in reaching stranded patients needing care without EHR-based practice. The practice of patient health record (PHR)-based teleconsultations in India has demonstrated how a conventional "paper and pen" method can be combined to popularise telemedicine utility. Thus, use of PHR-based system to maintain health records would prove to be a pragmatic solution for physicians in low-resource settings to improve their reach to a larger population in need for the future.

Perceived advantages and disadvantages of telepsychiatry - An online survey of psychiatrists in India

CONTEXT

Telepsychiatry is being practiced in India for many years but was formalized only in 2020. It has many advantages and disadvantages.

AIMS

This study aimed to understand the perceived advantages and disadvantages of telepsychiatry practices in India.

SETTINGS AND DESIGN

An online survey with ethics approval by the Indian Psychiatric Society (IPS) Ethics Review Board. All psychiatrists who are members of the IPS and whose email address was available with the society were sent the survey link by email.

METHODOLOGY

Information about existing telepsychiatry consultation practices in India and perception of advantages and disadvantages by the practitioners were collected between June and July 2020.

STATISTICAL ANALYSIS

Frequency, percentages, mean, and standard deviation were calculated.

RESULTS

Responses by 340 responders were analyzed. Majority of the responders felt that telepsychiatry would provide easy accessibility to mental health services (n = 283, 83.24%) and would lead to less exposure to infections (n = 222, 65.29%). Half of the responders (n = 177, 52.06%) felt that there would be an increased doctor shopping resulting in poor care and nearly three-fourth (n = 245, 72.06%) felt that mental health professionals would fall into a problem while dealing with a suicidal or a homicidal patient. Some expressed that the inability to do physical and central nervous system examinations could lead to missing out comorbidities. About one-third (n = 117, 36.56%) felt that the patient recording the consultation would be a legal issue.

CONCLUSIONS

This online survey showed that psychiatrists perceive many advantages and some disadvantages in practicing telepsychiatry.

Emotional Health Status of Postgraduate Students of Periodontics in India During COVID Health Crisis-A Questionnaire-Based Study

Dental students, especially postgraduate students present a higher risk of getting infected because of their close contact with the patients during this pandemic. The objectives of the study include (a) the reasons for postgraduate students’ altered emotional status during coronavirus (COVID-19) infection. (b) To assess the kind of infection protocols adopted. (c) To assess the impacts of postgraduate students’ emotional status on treating patients with periodontal problems during the COVID-19 lockdown period from March 2020 to December 2020. The emotional status of postgraduate students was assessed in 2 phases that are at the initial phase of COVID infection and lockdown and the second phase when the lockdown was prolonged. Questionnaires were distributed to the Postgraduate students of periodontics all over India to assess their level of awareness of COVID infection, type of infection control measures followed during the pandemic period, as well as the outpatient turnout during the lockdown period. Results of this study stated that more than 80% of students addressed the decline in the number of patients to surgical clinics, 76.3% of postgraduates were worried about themselves and their families due to the pandemic situation. Surprisingly, 74.3% of them even worried about losing their expertize or skills due to a long lockdown period. Dental postgraduates all over India are willing to treat their patients during the period of a pandemic but in strict compliance with infection control guidelines. This study assessed the emotional responses of the postgraduates during the pandemic through the questionnaire and concluded that all the professionals are ready to resume their clinical activities with adequate guidelines provided.

Video consultations from an Indian academic hospital: First 3 years of experience from telepsychiatric after-care clinic

Background Continuity of care for psychiatric disorders by conventional in-person consultation by psychiatrists is associated with several challenges. There is a need to develop alternative models of specialist care. We studied our 3 years' experience of live video consultations (VCs) from the tele after-care clinic to patients with psychiatric disorders at an Indian academic hospital. Methods We did a file review of 669 VCs provided to 213 patients in the first 3 years (2017-2019) from the telemedicine centre of a tertiary care academic hospital. We analysed details of sociodemography, clinical profile, tele after-care consultations and outcome. Results Two hundred and thirteen patients (55% men) were enrolled for the tele after-care clinic. The mean (SD) age of the patients was 42.2 (17.29) years and a majority were educated till high school and beyond. Patients with severe and common mental disorders constituted 60.1% and 40%, respectively. Among the total 669 appointments, 542 (81%) VCs were successfully provided; of the remaining, 125 were cancelled and 2 were aborted due to a medical emergency. Medication prescriptions were unchanged in 499 and modified/totally changed in 47 VCs. Conclusion Our large study shows that telepsychiatric after-care is a useful alternative method which can supplement in-person follow-up. Barriers such as distance, cost and medical illness can be overcome using tele after-care clinics for regular follow-ups in stabilized psychiatric patients. There is a need for prospective studies, preferably, randomized controlled trials comparing effectiveness of tele after-care with in-person consultations to assess treatment outcomes.

Telemedicine in Geriatric Psychiatry: Relevance in India

Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.

Telemedicine-assisted stepwise approach of service delivery for substance use disorders in India

Restricted access to healthcare during COVID-19 pandemic warranted an urgent adaptation of telemedicine practice. We describe a synchronous, stepwise (telephonic, video, and in-person consultation) direct-care model. From 18th May to 31st August 2020, 128 new and 198 follow-up patients received consultation. Eighty-nine percent of new patients required video-consultation. Sixty-eight percent of follow-up cases were managed by telephonic consultation. A third of new and a fifth of the follow-up patients had to be called for physical consultation. Limited access to and understanding of the technologies, potential breach in privacy, and restrictions imposed on online prescription of medications posed significant challenges.

Telephonic follow-up during COVID-19 to maintain continuity of care for persons with psychiatric disorders

We describe the utility of telephonic aftercare services (including liaising with primary healthcare providers) rendered to persons with psychiatric disorders (n = 1049) during the lockdown period of COVID 19 pandemic in India. Such consultations can be continued even after the COVID 19 period for suitable patients.

Telemedicine practice guidelines of India, 2020: Implications and challenges

Telemedicine Guidelines of India, 2020 promises to pave a road map for regularization and diversification of teleconsultation services across the country. This guideline is the need of the hour, especially during the current coronavirus disease pandemic. All modes of communications (text, audio, video, etc.) between the service provider and user are included in the broad rubric of the guidelines. Scope, inclusions, exclusions, and restrictions are clearly specified in the guideline. Medications are grouped and listed for the specific type of consultation, and restricted drugs are notified. This guideline especially helps mitigate the gaps in legislation and reduces the uncertainty while providing a practical, safe, and cost-effective framework to improve healthcare service delivery in this article; the authors discuss the implications of this new guideline and the challenges during the implementation of teleconsultation services across the country.

Protocol of a Multi-centric Randomized Controlled Trial to Evaluate Efficacy of Telephone-Based Psychosocial Interventions on Future Suicide Risk in Suicide Attempters

BACKGROUND

Persons with previous history of a suicide attempt are at increased future risk of death by suicide. These vulnerable individuals, however, do not seek receive or seek help from mental health services. Telephone-based psychosocial interventions are potential strategies in augmenting mental health care in such persons.

METHODS

We aim to compare the efficacy of telephone-based psychosocial interventions (TBPI) with routine telephone reminders in persons with recent suicide attempts using a multi-site, parallel group, rater-blind, two-arm randomized controlled trial design in 362 participants. In the first group, participants will receive three sessions of TBPI comprising of brief supportive interventions, problem-solving strategies, and reminders for adherence to prescribed mental health treatment at weekly intervals. In the second group, participants will receive three telephone reminders for adherence to prescribed mental health treatment at weekly intervals. We will follow up participants for 6 months. Primary outcomes are suicidal ideation scores on Beck's Scale for Suicide Ideation and number of repeat suicide attempts. Secondary outcomes are scores on Beck's Hopelessness Scale, Beck's Depression Inventory, Connor-Davidson Resilience Scale and Visual Analogue Rating Scales for acceptability of interventions. Outcomes will be assessed at 1, 3, and 6 months after receiving telephone interventions or reminders.

RESULTS

The trial is currently underway after prospective registration under Clinical Trials Registry of India and has recruited 260 participants till August 15, 2020.

CONCLUSION

This study has potential to generate evidence on additional strategies for use along with standard mental health treatments in management of high-risk suicide behaviors.

Mobile health applications for mental illnesses: An Asian context

Advances in digital technologies have created unprecedented opportunities to assess and improve health behavior and health outcomes. Evidence indicates that a majority of the world's population, including traditionally underserved populations and low- and middle-income countries, has access to mobile technologies (phones, tablets, mobile devices). Given the widespread access to mobile technology worldwide, health behavior-change tools delivered on mobile platforms enable broader reach and scalability of evidence-based assessment and interventions, especially for addressing the growing burden of mental health disorders globally. The purpose of this article was to present a qualitative review of mobile mental health applications in an Asian context. We searched on-line databases and included 22 articles in this review. We have identified mobile health applications that address eight categories of mental illnesses. These applications were developed in only six countries and regions in Asia. Future studies from more diverse countries for diverse cultures should be conducted to examine the advantages and disadvantages of mobile health technology.

Telerehabilitation in Psychiatry

The COVID-19 pandemic has interrupted the usual mechanisms of healthcare delivery and exacerbated symptoms of mental illnesses. Telemedicine has morphed from niche service to essential platform, with newly released guidelines that cover various aspects of tele-mental health delivery. Rehabilitation services, which incorporate a range of psychosocial interventions and liaison services, have been significantly impacted too. They are currently more institute-based than community-based in India. However, recent legislation has mandated that community-based rehabilitation options be available. While a large treatment gap for mental health issues has always existed, telemedicine provides an opportunity to scale services up to minimize this gap. Community-based rehabilitation can be delivered over various platforms, from text to phone to videoconferencing, and various devices. Telemedicine is cost-effective, and enables delivery of services where existing services are inadequate. The recent guidelines allow other healthcare workers to be involved in mental health service delivery. Hence, in addition to direct delivery of services, telerehabilitation can facilitate task-shifting, with mental health professionals mentoring and supervising existing human resources, such as ASHA workers, VRWs, DMHP programme staff, and others. Tele-rehabilitation also poses challenges - not all needs can be met; access and privacy can be a problem in resource-scarce settings; liaison with existing services is required; and organisations need to plan appropriately and re-allocate resources. Digital access to welfare benefits and interventions must be expanded without disadvantaging those without internet access. Yet, many rehabilitation interventions can be adapted to telemedicine platforms smoothly, and task-shifting can broaden access to care for persons with disability.

Patient's Perspectives of Telepsychiatry: The Past, Present and Future

Access to mental health care has significant disparities due to treatment gap, more so particularly for the remotely residing, physically vulnerable, aging populations. Adoption of technology will enable more people to receive specialty care addressing distance, transportation and cost-related barriers to treatment engagement from the comfort of home. Telemedicine has been regarded as "electronic personal protective equipment" by reducing the number of physical contacts and risk contamination for patients during COVID-19 crisis. This review aimed to give a broad view of patients' perception of the use of telepsychiatry in terms of clinical outcome, cost-effectiveness, and solutions to address patients' challenges with the adoption of technology. Over the years, telepsychiatry, both in synchronous and asynchronous modalities, had shown to improve patients' adherence to treatment, follow-up rates, and clinical symptoms, overcome stigma and discrimination, and save cost expenses accessing health care with better satisfaction and usability outcomes. Its utility is widespread such as in delivering care emergency evaluation, crisis intervention, conducting neuropsychological assessments, psychotherapy, promoting lifestyle modification, enhancing self-efficacy, and overcoming patients' linguistic and cultural barriers to care. However, patients' privacy and confidentiality and psychiatrists' legal liability remain as matter of major concern in digital platform. To keep up with the pace of technology and patients' expectations, a more agile approach is essential to develop, improve, and evaluate telepsychiatric interventions.

Geriatric Telepsychiatry: Promoting Access to Geriatric Mental Health Care Beyond the Physical Barriers

Psychiatric illnesses are an important contributor of morbidity and mortality in older adults. There is increase in older adults with psychiatric disorders paralleling their growth in absolute numbers. This leads to challenges in mental health care and service delivery. Several barriers that exists in our community hinder older adults from receiving mental health care. Additionally, lack of adequate human resources in geriatric mental health care compounds the problem. Telemedicine, though not new in other fields of medicine, is relatively new in the practice of psychiatry in India. This is probably due to lack of clear guidelines and regulations regarding the same in India. There is a recent increase in teleconsultations in India similar to other developed countries due to ongoing COVID-19 pandemic. The recent telepsychiatry operational guidelines have made telepsychiatry a legitimate and official practice in India. Challenges specific to older adults in the form of low digital literacy, sensory issues, and cognitive impairment can be overcome by adopting telepsychiatry services in coming years. Concerns related to security and safety of telepsychiatry require further evaluation.

Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines, India-A Commentary

Recent advancements in technology, access to smartphone, and gains achieved in increased internet speed and data transfer have expanded the scope of health care service delivery through the digital platforms. In India, telemedicine services remain poorly adopted and integrated due to various barriers. The important reasons are lack of legal and administrative clarity in using technology for service delivery and inertia from health service providers to adopt newer developments. However, during coronavirus disease (COVID-19) pandemic, these equations are changing. The Telemedicine practice guidelines released in March, 2020, and Telepsychiatry operational guidelines released in May, 2020, appear to remove these barriers and promote equitable access to health care. In this article, the authors discuss the scope of these guidelines.