The Ethical Use of Telepsychiatry in the Covid-19 Pandemic

Julia Stoll, John Z. Sadler and Manuel Trachsel published a new article on telepsychiatry ethics during the COVID-19 pandemic.

Introduction
In a statement to the press, Dr. Hans Henri P. Kluge, World Health Organization (WHO) Regional Director for Europe, stressed that it is important not to lose sight of the mental health implications of Covid-19 for everyone, noting that “[i]t is absolutely natural for each of us to feel stress, anxiety, fear, and loneliness during this time” (1). If mentally healthy individuals react with fear and stress to the Covid-19 pandemic, it is not difficult to imagine that such reactions make those who have mental disorders especially vulnerable to harm.

Challenges for Patients With Mental Disorders in Times of Covid-19
Yao, Chen, and Xu (2) listed four reasons to explain why patients with mental disorders may be at particular risk in the Covid-19 pandemic. First, patients with mental disorders may be at increased risk of infection because they are less aware of the dangers or because they adhere less to official measures. Second, poor symptom recognition combined with stigmatization means that Covid-19 infection may not be detected as quickly, and treatment following infection may be compromised by various psychiatric comorbidities. Third, patients with mental disorders may be more vulnerable to the public panic and anxiety triggered by the pandemic, which may aggravate the symptoms of the underlying mental disease. Finally, face-to-face outpatient treatment may be impeded as a result of various government measures, including quarantine. Importantly, the undersupply of services for patients with mental disorders not only increases existing healthcare inequities but potentially facilitates the spread of Covid-19 through increased infection and difficulties with adherence with public health restrictions among these patients (2). How can continuous care for patients with mental disorders be guaranteed within the confines of social distancing?

Telepsychiatry as a Possible Solution
Telepsychiatry has been discussed as a possible solution for the care of patients with mental disorders (3, 4) and is increasingly used worldwide during the Covid-19 pandemic (5). Telepsychiatry is already well established in some countries like Australia and Canada and the effectiveness of telepsychiatry, as well as the satisfaction of its users, has been shown in various studies (6–8).

Especially in a crisis like the Covid-19 pandemic, the treatment of patients through telepsychiatry shows some specific advantages: Because telepsychiatry services maintain social distance, they eliminate the risk of infection for both patients and therapists; the patient can remain at home, and the therapist can work from their home, office, or practice. In this way, psychotherapy can be maintained or initiated even under quarantine. Patients who would otherwise attend for outpatient psychotherapy can continue their treatment remotely with the same therapist, so ensuring continuity of care and potentially improving compliance and adherence. Telepsychiatry makes even brief crisis intervention possible when physical distance prevents inpatient treatment, so potentially reducing the number of hospitalizations during the Covid-19 pandemic.

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Giovanni Spitale

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