Psychiatry Sets a Standard for Future Telemedicine Use

Many tools are becoming available to psychiatrists who need to strengthen their reach of care outside the office.

For many medical specialties, the start of the coronavirus disease 2019 (COVID-19) ushered in a new era of telemedicine.

In most, it equated to replacing medical appointments with an uninspiring virtual appointment—not truly adding anything more tailored to the service provided.

In psychiatry the pandemic forced opportunity to change the very crucial patient interaction. Psychiatrists could suddenly supplement classic therapy sessions with new technologies and programs that go beyond the basic video conferencing. The very necessary technology could help kickstart a difference in patients’ lives.

In fact, some industry experts have said the push to utilize telemedicine in psychiatry predated COVID-19 by about 3 years and will only now be accelerated by current events—with more and more technologies in development to help become an extension of the therapist or psychiatrist.

One such technology is produced by GoMo Health called BehavioralRx, a tool that leverages human motivation, activation, and resiliency to stimulate in-the-moment actions using individualized remote plans.

Bob Gold, Chief Behavioral Technologist, GoMo Health, said in an interview with HCPLive® the coordinated efforts of therapy also makes individual sessions—be they in person or over video—more productive.

The digital therapeutic is aimed at helping individuals with chronic and complex conditions in home environment, using a personalized approach involving proven cognitive and psychological techniques.

How It Works

“I don't need massive amounts of every data point on you that’s put through some algorithm that has very little chance of actually understanding what you're actually going to go through,” Gold said. “What we do is very different than what you may find in a traditional AI program, which is trying to get every data point of that year and predict how you're going to feel.”The GoMo system is able to interact with the user based on their individual circumstances. For example, if the user has known sleep issues or often suffers from depressive episodes at night, the platform will send late messages to aid the individual.

The key to the program’s effectiveness is that it is with the patient beyond the brief times they are meeting with a therapist or psychiatrist, especially since many mentally ill patients face worse situations at night, often in isolation.

“Giving them things to do and think about and activities that enable them to really apply the learnings that they were given by their psychotherapists,” Gold said. “So, they feel like they have support 24/7, it's very comforting.”

The GoMo platform also includes a virtual on-demand service. For example, each patient will answer questions, and if the technology shows that they are suffering from suicidal ideation, then the system will send tips and tools to help the patient—basically an on-demand mental health virtual coach.

“So, we're not predicting that you're going to have suicide ideation, we're not predicting that you may not show up to therapy session tomorrow,” Gold said. “We're getting you to actually answer when we're sending you these questions. And you're checking that they're happening to you or you're initiating via simple text something that's happening to you or we're responding. You’re informing us what you’re going through and we’re reacting to it.”

Diane Piagesi-Zett, MA, LRC, CRC, Director of the Sussex Community Support Team for Bridgeway Rehabilitation Services, explained how the GoMo platform has improved both patient conditions, but also has given therapists and psychiatrists a leg up on how to make sessions more productive.

Patient Retention

One of the main selling points for using more supplemental therapy tools is that they could ultimately lead to higher rates of patient retention.

The State of Telemedicine

This, Gold explained, is where telemedicine needs to generate change in healthcare: a system which better encourages patient retention and adherence means fewer adverse events, fewer therapeutic setbacks, and fewer financial burdens.John Torous, the director of digital psychiatry at the Harvard-affiliated Beth Israel Deaconess Medical Center, explained in an interview with HCPLive how supplemental behavioral mental health applications help improve the effectiveness of therapy, allowing patients to track symptoms and the therapist to present at-home targets.

“We're actually seeking to strengthen the therapeutic alliance for patient groups to the best understand what they're going through, what their experiences were,” he said.

For example, using supplemental applications could show real-time results of putting a bigger emphasis on quality of sleep or more exercise and how they impact the patient’s condition.

“We would customize the app for things that mattered to the patient,” he said. “When they would come back visit, we would look at that digital data together.”

Real-World Impact

While the transition to tele-video services has been rather smooth in psychiatry— likely more so than in other spaces—there are still some gaps that cannot be replaced online. Experts are still considering the difficult fact that physical exams or detailed cognitive therapy sessions, staples of the field, are significantly more difficult to conduct virtually.Gold said there is a perception of telehealth from both patients and major mental health advocacy groups about telehealth that is faulty and will not “move the needle” on a wider implementation of the practice by thinking of telehealth as strictly a video therapy session, when in reality that represents a small percentage of a patient’s life.

It's about introducing and engaging a patient in a “constant digital conversation,” he explained—a novel opportunity to extend the benefits of therapy beyond the short span of a weekly or monthly session.

“The idea is when you're building out a remote plan when you're thinking about executing and building a telehealth outpatient program,” he said. “It's about how do you integrate the digital and human care coordination. How are you reinforcing the principles? How are you responding to somebody?

“If you look at the issues facing these folks, they are panicking and ending up in the emergency room,” Gold said. “And after being admitted—going off the rails, having suicidal ideation, and just taking it out on their family.”

It’s a well-accepted fact these setbacks are happening to patients between their sessions—whether they be in-person or virtually. But only the latter practice can extend patients’ care.