While telemedicine was launched years ago, doctors have been apprehensive to use it because of legal issues. Where do we stand when it comes to telemedicine for mental health?
Coronavirus, lockdown, social distancing, economic slowdown — words that are part of our daily chatter now — have not only reoriented our day-to-day routines but also silently uprooted our mental peace.
“In these testing times, we must first understand that strict measures are in place for our protection and safety,” says Dr Sudhir Khandelwal, a Senior Consultant in Psychiatry at the Holy Family Hospital in New Delhi, and formerly the Head of the Psychiatry Department at the All India Institute of Medical Sciences, Delhi.
He continues, “It is very different from a curfew that is imposed upon in a city during a deteriorating law and order situation.”
For some of us, the confinement has brought mental calm through slower lifestyles, spiritualism, and meditation. But the pandemic has unleashed uncertainty for most of us — regarding health, jobs, and food— gushing in anxiety, panic, sleeplessness, depression, loneliness and boredom. Early evidence from national surveys from China, Iran, and the USA have also confirmed widespread psychological distress during COVID-19.
These signs are further aggravated among those of us who were suffering from other mental health issues before the pandemic. It has added to our plight and shattered the frail mental health care system in India. More than 10 per cent of India’s 1.3 billion population suffers from mental health disorders.
Dr Khandelwal says, “Mental illnesses are chronic conditions affecting millions, many of whom are on medication. The COVID-19 lockdown effectively deprived them of these visits with their clinicians. Many had difficulty in obtaining their medication.”
In this scenario, telemedicine has regained importance as a fast yet physically distanced way to provide care.
By definition, telemedicine is providing healthcare using information and communication technology such as text, audio, video, images etc. As Indians, we have reached the moon and Mars, but not our own remotest populations. While telemedicine was launched years ago, doctors have been apprehensive to use it because of legal issues. Also, some Indian states have issued notices stating that this mode of medicine is not advisable.
In view of the Coronavirus outbreak, the Medical Council of India has recently sped up the update to Telemedicine Practice Guidelines. While this revision has lots of positives in terms of being patient-friendly, simple, and comprehensive, several aspects such as data privacy remain blurry.
In the space of telemedicine for mental health, Dr Sudhir points to institutions like NIMHANS Bengaluru, AIIMS New Delhi, IHBAS Delhi, and how they have taken swift steps in the right direction with the COVID-19 pandemic in mind. For instance, doctors at NIMHANS have developed guidelines for telepsychotherapy services, introduced IVRS-based Telephone Outpatient Services, and started a 24×7 toll-free helpline for psychosocial support and mental health services during disasters.
While the potential of tele-mental health services is immense, “it can only be accessed by people who are net savvy,” exclaims Dr Khandelwal. “But this is not true for a large part of the Indian population. There is a huge digital divide in India.”
Furthermore, “many times, there are concerns about prescribing some medicines online. Until April 2020, Clonazepam, an anti-anxiety drug, was not allowed to be prescribed by telemedicine under the NDPS Act,” says Prof Dr B N Gangadhar, Director and Vice-Chancellor at the National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru.
While this has now been allowed by the Medical Council of India, other challenges deserve attention.
One of the strengths of in-person pyscho-counselling is the face-to-face interaction with people with emotional disturbances. “In this regard, the effectiveness of telepsychiatry in the initial consultation with the mental health professional remains to be examined,” adds Dr Gangadhar.
However, telemedicine for mental health can still be helpful for follow-up consultations in video/audio mode, he feels. Not only will it reduce the transportation burden in these times of COVID-19, and ensure safety of patients and doctors from the virus, it will also let people get their concerns addressed from the comfort of their homes.
While most hospitals still do not have tele-mental health programmes, and much remains to be done, COVID-19 has presented a blessing in disguise for accelerating development in this area. Taking the lead, telepsychiatry consultations on apps such as Practo, Lybrate, InnerHour, and YourDost have spiked. Whether telemedicine for mental healthcare will retain its value in a post-COVID world, remains to be seen.
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So, what can be done in the meantime?
While we figure out the new normal for tele-mental healthcare, families of people with existing mental health issues are bound to play a critical role. They can engage in many healthy pastimes like yoga, meditation, or gardening, and offer support as well as companionship to one another.
“Emotional reassurance to the vulnerable members of our families can go a long way in offering support. It is also important that family members refrain from escalating each other’s concerns,” says Dr Gangadhar.
(Edited by Shruti Singhal)