Telepsychiatry Reduces Barriers and Increases Mental Health Care Access

Psych Congress Steering Committee Member Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry, Encino, California, discusses the impact telepsychiatry has had on access to mental healthcare, including removing barriers. In this interview with Meagan Thistle, associate digital editor, Psych Congress Network, at Psych Congress 2021 in San Antonio, Texas, Dr Kaftarian also explains whether or not specific mental health disorders are contraindicated with telepsychiatry.

In part 2, Dr Kaftarian explores why telehealth is “here to stay” and why he hopes government officials will continue to have an open policy about telehealth.

In part 3, Dr Kaftarian describes the advances in medical records as a shareable resource and how market forces are driving telehealth. He also discusses what clinicians can learn about their patients that they may not have gathered on-site in an office. 

Read the transcript:

Meagan Thistle, associate digital editor, Psych Congress Network:  Welcome. We're at Psych Congress sitting down with Ed Kaftarian. If you would like to introduce yourself?

Edward Kaftarian, MD, CEO:  My name is Dr. Edward Kaftarian, and I'm a psychiatrist and a Psych Congress Steering Committee member and CEO of Orbit Health Telepsychiatry.

Thistle:  Thanks for sitting down with us.

Dr Kaftarian:  Thank you.

Thistle:  Today, we're going to be talking about telepsychiatry. We'll start off with what overall impact has telepsychiatry had on access to mental healthcare?

Dr Kaftarian:  It's had great impact on access, especially during the pandemic. When everyone's isolated in their homes and there's no ability to go to a doctor's office, telepsychiatry essentially saved the day.

Thistle:  Have you found that more people are seeking treatment for mental health disorders because of telepsychiatry?

Dr Kaftarian:  I haven't done any studies on this, but I can tell you from personal experience that a lot of people that I think would have ordinarily not sought access, are seeking access. It's not just for psychiatry. For example, when I talked to patients, they ask me, "Hey, is there a therapist that I can talk to as well?

That is allowing people to come out of their shell, especially people who have been ashamed of their mental illness, or people who have not had the resources or ability to access the resources, they are finding it easier and more convenient honestly to get a telepsychiatry appointment and also other types of mental health appointments.

Thistle:  Great. You mentioned some barriers. Do you want to elaborate on some of the barriers that people might have had before telepsychiatry was an option?

Dr. Kaftarian:  The barriers to care are many. Distance is a barrier. Traffic is a barrier. People's reluctance to come and sit in a waiting room is a barrier. There were barriers for telepsychiatry as well that are being basically brought down. The barriers for telepsychiatry was the attitude around it.

Prior to the pandemic, I would go and lecture to various university hospitals and other groups about the benefits of telepsychiatry. I would always get that one person in the audience that would say, "Hey, isn't it better to do on-site care? Don't you lose something with telepsychiatry?" Because of that reluctance that maybe you're losing something, people were not as willing to embrace telepsychiatry.

Now, after the pandemic, it's a no-brainer. People are beyond that point at which they're saying that it's better to have an on-site doctor. Most people are. There are still those that are holding out and saying that telepsychiatry is inferior. Now, I would say that there are some disadvantages to telepsychiatry, but there are also disadvantages to on-site care.

It's all about trying to provide access to care as well as quality. With access, sometimes people just don't have access to on-site care. Would you rather have them not have any care, or care remotely? I'd say it's better to have care.

Thistle:  Have you found that there's any mental health disorders that might not be a good option to use telepsychiatry for because you did mention that there's some disadvantages to it? Is there anything that you would say, maybe would be better on-site?

Dr Kaftarian:  I would say that as a general rule, there's no specific mental disorder that telepsychiatry is contraindicated for. The more medical the disorder gets, like the more complicated medically the patient is, probably the better it is to have on-site care. Although even then, I see many patients that are medically complicated as well and we can do a telehealth visit, no problem.

When you start to get into disorders that are very neurological in basis...I'll give you some examples. Somebody who has perhaps a conversion disorder, for example, where you are not quite certain what's medical and what's mental health. Somebody who loses function of a limb and you think it might be psychological in nature, and it's a conversion disorder.

There are some tests that you can do in person that can determine whether it's something that has to do with physical functioning or mental health functioning. In general, the more medically complicated, the more I'd like to see efforts made to have that person seen in person.

Once again, I wouldn't say that that's a general rule that if somebody has medical complications, they can't be seen via telehealth.

Edward Kaftarian, MD is a nationally recognized psychiatrist and leader in the field of telepsychiatry and healthcare technology. Trained at the Johns Hopkins Hospital, he is board-certified in Psychiatry, Forensic Psychiatry and Addiction Medicine. Dr Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist, senior psychiatrist, medical director, and director of pharmacy. He is the founder of California’s Statewide Prison Telepsychiatry Program, which is the largest correctional telepsychiatry program in the world. Dr Kaftarian is currently the Chairman and CEO of Orbit Health Telepsychiatry, a company that provides telepsychiatry services to jails and prisons.