Treating Serious Mental Illness Through Telehealth

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In part two of this video series, Psych Congress Steering Committee Member, Craig Chepke, MD, FAPA, adjunct associate professor of psychiatry, Atrium Health, adjunct assistant professor of psychiatry, UNC School of Medicine, and medical director, Excel Psychiatric Associates, Huntersville, NC, addresses the use of telehealth in treating patients with serious mental illness as well as incorporating a hybrid approach for long-acting injectable administration.

Catch up on Part 1: The Impact of Omicron on People WIth Serious Mental Illness
Watch Part 3: The Importance of Collaborative Care in Treating Mental Health Disorders

Read the Transcript:

Dr. Craig Chepke:

One important topic that we discussed is one that no one's been able to get away from the past, almost two years, and that's the use of telehealth. We had some of the participants in our roundtable, who had a long history of being telehealth clinicians, and had been advocates of it for many years prior to the pandemic. And then there were other people, honestly, such as myself, who really were somewhat adverse to telehealth prior to the pandemic. For me, I felt that it could never replace the in-person visits, and so, why would I want to do that? And like many of us, overnight, in March of 2020, I became a full telepsychiatrist overnight. And I've gotten to a place where I've realized there are specific benefits for some people. And in some circumstances, telehealth can potentially be advantageous, compared to in-person treatment.

And so, one of the things we talked about is, how do we figure out how to navigate this? The response of the individual patients, I think, is key. And again, we talked mainly about people with SMI, and that's a challenging population to work with, no matter the modality. I think, a lot of clinicians out there might think that it would be difficult to maybe impossible, to really do a good job of treating patients with SMI through telehealth. And what we concluded is that telehealth definitely, can be efficacious in the treatment of people with SMI.

For instance, there again, can be some advantages in certain circumstances. For instance, people with schizophrenia, who have very prominent negative symptoms. What I found anecdotally, and there is some evidence to back this up as well that we were able to discuss that, people with negative symptoms may feel less threatened by being a little bit more distant, and having a layer of abstraction through the virtual connection, as opposed to sitting a few feet apart from us, in our office. With any patient there's a provider, there's obviously, a power dynamic differential, and some people with negative symptoms, they find it challenging to make the socially expected eye contact, to just be in the room with a person, be expected to interact, it feels too overwhelming. And the virtual distance can open that up and make them feel less anxious in some cases. And they may actually be more comfortable, and treatment can be more successful in some of those cases. That's just one example.

In terms of how it can help with LAIs, well, I mentioned that obviously, you can't administer an LAI virtually, which is true, but we were able to find kind of a hybrid approach there, in some cases. For instance, someone might have a appointment with their clinician scheduled on the day that they are due to get their LAI treatment, but that doesn't mean it has to be all in-person. One thing we've done is a hybrid approach. The person can come into the office, get their injection, and then, they can go back to, whether it's their vehicle or go back home, and then conduct the actual interview with the clinician virtually.

So it's kind of a best of both worlds approach. They get what they have to have in person, in person, but then, to limit the infection risk, again, mostly during these surges, when we really want to limit, as much as possible, the face to face contact, then that part can be conducted virtually.

So there's ways again, that telehealth may not be completely replacing the technology, that it completely replaces in person care, but it can augment it in certain ways. And the final result can be greater than the sum of any of the parts together.