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COVID-19 has accelerated the use of telehealth and technology in mental health care, creating new avenues to increase both access to and quality of care. As video visits and synchronous telehealth become more routine, the field is now on the verge of embracing asynchronous telehealth, with the potential to radically transform mental health. However, sustaining the use of basic synchronous telehealth, let alone embracing asynchronous telehealth, requires new and immediate effort. Programs to increase digital literacy and competencies among both clinicians and patients are now critical to ensure all parties have the knowledge, confidence, and ability to equitably benefit from emerging innovations. This editorial outlines the immediate potential as well as concrete steps toward realizing the potential of a new, more personalized, scalable mental health system.
During the COVID-19 pandemic, telepsychiatry—a “virtually perfect” solution to the immediate crisis of a global pandemic [
At the beginning of the pandemic, there was an almost overnight transition to video- and telephone-based assessments in mental health in many countries [
However, there is much more to telepsychiatry than just video visits and phone calls. Video and telephone approaches are often classed as “synchronous” telepsychiatry because the interaction, although distanced, is delivered in real time. Asynchronous telepsychiatry, by contrast, occurs when the clinician and patient interaction is separated by time as well as distance. Examples include use of apps for monitoring or delivering treatment, and use of smartphones and other mobile health apps [
Going forward, it is clear that telepsychiatry has the potential to offer much more than a simple replacement of face-to-face care, as a short-term solution to an immediate crisis. Telepsychiatry can now be used toward its true potential in radically increasing access to care as well as quality through an artful combination of synchronous and asynchronous technologies [
Retraining the workforce need not start from scratch. Synchronous telepsychiatry [
Enthusiasm may vary and individual clinicians differ in their openness to training. Many already feel they are competent enough, given their experience during the COVID-19 pandemic. The focus of their immediate management has used synchronous techniques, and clinicians may assume that skills can be translated directly from the in-person to virtual setting. Digital literacy among clinicians can also vary [
Clinicians are only part of the equation; we also need to improve access to technology for patients. A successful virtual or hybrid clinical interaction can only occur if both clinician and patient are able to access and navigate the tools being used. Access to devices and adequate connectivity represents one significant digital divide, but there is also a second barrier, in which patients have access to technologies but do not have the digital literacy, competence, or confidence to use them to their full potential. Offering training and skills building to patients to strengthen their competence and autonomy in using digital technology to support their health and their therapeutic relationship is critical to ensure access to help for those who need it the most [
Existing competency frameworks are comprehensive and detailed, but many have not actually been implemented. This makes them ideally suited for further testing, but less appropriate for broad implementation today. These competencies that have been outlined already could be adapted and amalgamated into a pragmatic time-limited approach that is acceptable to all levels of pre-existing skill and interest [
Synchronous and asynchronous telepsychiatry have many similarities. For example, their common goal is to enable a clear and therapeutic exchange of information, while preserving professional boundaries [
To meet these challenges, training will need to be evidence-based, relevant for the challenges of a post–COVID-19 world, and also engaging for clinicians. Competencies will need to measurable to assess change and there will need to be ongoing evaluation, including feedback from patients. Appetite and interest will vary, and practicing clinicians will already have gained sufficient experience during the pandemic to have progressed beyond the “Novice” stage; therefore, a two-level process aiming for the competency levels of “Competent/Proficient” and “Expert” (for those who wish) would be a helpful model. There is no doubt that developing a telepsychiatry teaching program is warranted, but it will be a challenging process. However, much of the hard work has been completed in developing guidance and a range of competencies. The pandemic has accelerated telepsychiatry into a commonly used, effective, and acceptable route for mental health consultation. Now is the time to complete the translational pathway and allocate dedicated research funding. We need to grasp this impetus and extend skills and competencies into the full range available, so we can offer the very best combination of approaches and treatments to our patients.
Examples of medical education frameworks.
Examples of teaching telehealth.
Examples of guidelines for professionalism, social media, and the internet.
KS and AC are supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility. AC is also supported by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration, and by the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health.
AC has received research and consultancy fees from INCiPiT (Italian Network for Paediatric Trials), CARIPLO Foundation, and Angelini Pharma, outside the submitted work. KS has no conflicts to declare. JT is cofounder of a mental health company called Precision Mental Wellness and Editor-in-Chief of