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Tips for Making the Most of Telehealth From a Psychiatrist Who's Figuring It Out, Too

I am a London-based psychiatrist who has worked in routine and emergency psychiatry both in Boston and in London.

In these unprecedented times of global lockdown, sky-rocketing anxiety and mental health needs, the main weapon we as mental health professionals have in our arsenal is technology.

And it seems to be holding up pretty well despite the strain on bandwidth from everyone sitting in and binging movies and TV shows.

An email flashes up on my laptop and it is from a fellow healthcare worker on the front lines of the fight against COVID-19. She is many hundreds of miles from where I am and there is no way in a lockdown I could help her or offer medication or therapy advise apart from using telemedicine.

She asks, “When can you see me, I am having a meltdown. I need help.”

I look at my diary and have a free hour coming up.

“How about we jump online right now?” The patient is crying on the phone and thankful for a fast response to her crisis. Well, this sounds like an emergency to me.

I feel like a hero but my sister reminds me I’m just sitting behind a screen and to not to get delusions of grandeur. The ER doctor I am about to speak to is the real hero.

Times are tough and everyone is hurting. These are my top tips to get the most from your online appointments with your psychiatrist.

The number one thing to do is try to relax. I know it is easier said than done.

In normal times, patients almost never defer to video sessions. They feel more comfortable face-to-face, and so I start by letting new patients have a quick informal chat to get acclimated to this new way of communicating to a doctor and to settle their nerves.

I also make it a point to reassure them that we are alone and there is no one listening to them or next to me or outside my study.

I tell them that my dog is at my feet but he won’t be breaking confidentiality. Humor can go a long way to build rapport!

I establish that video sessions can sometimes be even better if you are shy, experience social phobia or have agoraphobia. As this crisis broke out a month ago, patients were already refusing to come into clinic because of their fear of coming into contact with the coronavirus. So what better way to get your assessment done when the risk of infection without travel or a face-to-face consult is exactly zero?

If you are very sensitive it can feel like a “colder” form of interaction, especially in the first few sessions, but a skilled MD will be able to put you at your ease relatively quickly and with each session this is likely to improve and get easier as you build rapport.

In this day and age, hopefully roommates and relatives will understand to give you some space if you need it to speak with your doctor.

The other advantage is you can literally do the session in your pajama or “comfies,” no dressing up is necessary, get your tea or hot chocolate ready and prepare to talk about yourself for an hour.

For many this can be incredibly cathartic, and if there was ever a time to get help it’s surely now, with a lot of us at home with time to work on what is important to us. Mental health, I would suggest, should be high up on our list of priorities.

You could schedule a morning or evening appointment, whatever suits your mood or when your friends, family or kids are doing other things.

If there are any negatives, it’s that body language can be harder to read when the data stream can buffer and if the connection is poor. I suggest we take turns talking so we don’t trample over each other’s words. Each word or sentence can be very important.

For those who experience psychosis or deal with paranoia, privacy is an understandable worry, but most online video software uses advanced encryption, which should help ease your mind.

Patients often ask before they decide on the consults, what is the point? Can we still assess, diagnose and treat. The answer is a definitive yes.

In an hour I can quickly understand, at the very least, your key symptoms, figure out the likely DSM-V diagnosis and have your medication sent to our partner pharmacy who will then be able to courier or post it out to you. 

If you are referred to therapy after a psychiatric assessment, I encourage you to stick to it, stick to the plan your therapist has for you and the date and time of your appointment. It can be part of your schedule, which is vital for many people’s mental health right now.

This is truly 21st century medicine.

Embrace it.

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Getty image via Moon Safari