Telepsychiatry Operational Guidelines (2020) of India I Telemental Health 2020 I Telepsychotherapy

Telepsychiatry in the form of interactive videoconferencing has become a critical tool in the delivery of mental health care in this contemporary world. To enable this telepsychiatry services Psychiatrist shall comply with licensure laws by enrolling in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956 / NMC Act, 2019. Further, all psychiatrists intending to provide online consultation need to complete a mandatory online course within 3 years of its notification by the Board of Governors, in supersession of the Medical Council of India.

Telepsychiatry Operational guidelines 2020 - Available online at https://indianpsychiatricsociety.org/...

This report represents a collaboration between the National Institute of Mental Health and Neuro Sciences, Bangalore and the Indian Psychiatry Services to create a resource guide in telepsychiatry for practicing psychiatrist. These guidelines focus mainly on interactive videoconferencing-based psychiatry services.

This is a telepsychiatry resource guide intended for psychiatrists practicing in India. The guidelines focus primarily on video-based telepsychiatry services, unlike the telemedicine guidelines that included audio and text-based consultations as well. The guidelines aim to empower psychiatrists across the nation to initiate and implement telepsychiatric services. The guide emphasizes that the psychiatrist should be observant of the provisions of laws (MHCA 2017, especially) pertinent to the
practice of medicine and mental health.

Psychiatrists should also uphold professional clinical standards while practicing telepsychiatry, similar to the traditional in-person psychiatry practice The guidelines outline the medico-legal issues that may arise during the online consultation and lay specific suggestions to avoid such concerns. The guidelines reiterate that the professional should avoid advertisements about the practice in social media and online platforms. A framework for setting up telepsychiatry services with hardware and software technology standards is outlined. The guide advises choosing telemedicine software, which is simple, user friendly, and effective. Clear suggestions are provided to maintain the basic medical record in either physical or virtual form. In accordance with the existing laws, a structured format is provided that would help to maintain patient health records for first and subsequent visits. The need to obtain explicit consent from the patient before recording the consultation is emphasized. Importantly, the step-bystep operational procedure to be followed before, during, and after telepsychiatry consultation is elaborated in detail. The guidelines also provide a specific format for caregiver-initiated consultations. The caregiver initiating a psychiatric consultation is common in our country. This provision in the guidelines would avoid unnecessary professional and legal dilemmas while rendering the needed service and streamlines the provisions of the Telemedicine practice guidelines.

The guidelines specify the clinical scenarios where the telepsychiatry consultation needs to be stopped, and the concerned person is to be referred for in-person assessment and management. The role of a psychiatrist during the collaborative telepsychiatric consultation between a psychiatrist and a health worker is explained. The importance of availing adequate information and arriving at a provisional diagnosis before prescribing psychotropic medications is reiterated.

The guidelines classify the available psychotropic medications into groups/List O, A, B, and C in accordance with the Telemedicine practice guidelines. This simplifies and enables the psychiatrist to choose a specific drug for the denoted purpose. Telepsychotherapy is also encouraged after initial in-person detailed assessment. A set of guiding principles are provided for practicing telepsychotherapy.

The release of the telemedicine and telepsychiatry guidelines has come as a timely measure during this COVID pandemic as it will help to reach the unreached during the restrictions. These are not to be seen as an alternative to lack of human resources but an essential first step in ensuring the equitable distribution of available resources. These guidelines might provide impetus in taking health service delivery to service user’s doorstep.