Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. Vellante assistance Carlo health Di Francesco mental in distance Covid-19 the in bridging technologies pandemic: edge cutting other and Telepsychiatry o h xhneo ai nomto o igoi,tetetadpeeto fdsae n nuis research where injuries, and services, diseases care of prevention health and technologies treatment communication of diagnosis, and for delivery information information using valid “the professionals, of care exchange is health the all telemedicine for by [2]. factor, Organization, critical briefings a Health clinical is World distance and information meetings the of for provision to the spaces According facilitating the virtual offer by for creating tools institutions, technology-based appropriate while for fact, and sharing, support In as data useful System well pandemic. and particularly Care this as during patients, Health the be providers for Mental can on care visits the health services consequences telemedicine and to health long-term patients access telemental both to physical of infection, Since lead support psychiatric of may treated. decompensate risk symptoms properly or the not worsen listed stress goals, increases anxiety, if also above its of may especially The development achieve reduced they health, the and hand patients’ and [1]. for loneliness one population factors diagnosed to the risk general previously yielding be the on systems, diseases may in may support conditions symptoms strategy social These depressive normal This friends. and been undermine and effective may has virus. family an shelter-in-place it from the of and hand, support of unavailability contact other current spread social the affecting reduced the the on now of Given but slow strategy is to health world. (COVID-19) worldwide public the disease a adopted around Coronavirus COVID-19, territories 2019 for cure and the medical countries China, 200 in than 2019 more December in identified Initially of knowledge mental the untreated Introduction professionals, of health mental amount numerous the era. among vast digital spread, how the to contribute by us mental can offered shows of crisis possibilities improvement situation pandemic the the The pandemic for perspectives be. COVID-19 future can The interesting illnesses mobile up CONCLUSION: (e.g., opens innovations intelligence) technological assistance. artificial other health-care and health with and data telepsychiatry members RESULTS: big family of reality, concerns. patients, integration virtual ethical to of The apps, and support related pandemic. limitations the risks COVID-19 for possible and this appropriate the advantages during and with providers examine feasible in along to particularly technologies settings, are literature cutting-edge therapeutic services other the health new and Telemental review these models telepsychiatry narratively innovative of of We into application role technology massive assistance. potential integrating the the health for discuss mental we need of social paper urgent management direct support this Nonetheless, the for the In obstacle social generates AIMS: insurmountable worldwide. reduced pandemic an healthcare. adopted The loneliness, determines mental distancing been determining of services. social has disorders, care this, psychiatric place mental with COVID- Along to in for for access needs. factors shelter cure health risk and medical mental of effective represent contact under-detection an also social and of could reduced unavailability isolation current of and the strategy Given distancing health world. public more the affecting a now around is 19, territories (COVID-19) disease and Coronavirus countries 2019 the 200 China, than in 2019 December in identified Initially BACKGROUND: Abstract 2020 21, May 1 ffiito o available not Affiliation 1 aei Verrastro Valeria , 1 noel Sociali Antonella , 1 ivniMartinotti Giovanni , 1 ln Picutti Elena , 1 1 n asm iGiannantonio di Massimo and , 1 ar Pettorruso Mauro , 1 Federica , 1 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. n aifcinatrhvn sdT e ie.Cmaal optet,atrafwtil,ciiin reveal clinicians trials, few a after patients, to comfort Comparably in increase times. an few report a TP generally patients used having fear, after and satisfaction (especially discomfort and without patients apprehension, language initial for reasonable native possibility a their Given the in is interpreter. assistance “protection”. psychiatric an of building receive feeling of rapport to a assistance of discussing seekers) instills the when terms session asylum honest, the and in and of refugees, TP open space immigrants, of more virtual and advantage be the time can important because travel and devices, Another decreases comfortable, their and more from time feeling subjects remotely waiting report difficult appointments’ to patients reduces Some clinicians care, allows [8]. to costs TP access improves of TP use evaluating patients, when the For safer Furthermore, feel also aggression. different may colleagues. physical with They other of and consult practice. risk hospitals) of flexibility any diversity and have without increased can homes, patients an clinicians clinician’s prisons, and outpatients) the (schools, appointments and and patient’s scheduling settings patients the in hospital different from employees, in both students, TP, working (prisoners, to advantages By populations several reported view. 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When providers, telepsychiatry with [3]. care as communities” health known their of and are education individuals continuing of health the the for and evaluation and and , Vsee [5]. Zoom , online , le jeans Blue- 2 and digital. , eescity eeetlhat,telehealth, health, telemental telepsychiatry, Doxy.me h rilswr eetdfrinclusion for selected were articles The , thera-LINK , TheraNest , Sim- Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. nteUAfrHPA nodrt aiiaeacs otlmdcn evcs[] oee,tepiayissue privacy the However, [5]. services telemedicine happened to it access as facilitate laws, to order protection in information HIPPA, with for an comply issued USA to have the a governments requirement FBI school-sessions, in some the several the pandemic, with invaded suspending COVID-19 fact, users developed waiver the In unidentified of entirety. emergency been some Because its have after in “zoombombing”. platforms others) guaranteed called such and phenomenon be of weakness cannot SimplePractice privacy the Bluejeans, recent but about In warned [5], Zoom, (HIPAA). information confidentiality Act (like and health Accountability security platforms the and opportune Portability of to Insurance variety equipment Health supplying a and are USA’s pathways who years the organizations connection as and [11]. such their Clinicians the laws, session adapt that [4]. protection in others the guarantee must by to [7]; services viewed interrupt essential or encryption health will therefore into, hacked and telemental is one easily [8]. security it be listen no connection, network not Internet might will concerning that the meeting anyone in nature, through ensure where technological speaking occurs and places videoconferencing of when rules public fact, is like privacy in issue setting, or maintain confidentiality conversation, clinical must Another the traditional himself hear the clinician can problems outside privacy The members to personal services family and about confidentiality health where educated conversations’ telemental rooms be ensure should using to Patients important from is data. rising sensitive It and privacy. information is health TP protect using about concern relevant A regarded been has presence enormous healing. physical issues an patients’ doctor’s with Privacy and a practice, years, practice that clinical thousand clinical medicine in two for part in of necessary professional important course traditions as to an the cultural approaches has Over often New proximity deep-rooted significance. 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Clinicians to time emotions vs well. hard actions and as a physical building screen nuances have take the may the up to across or limit picking artificial uncomfortable, with may in feel and contact conferencing can clumsy difficulties contact look personal video some and of during report feel cues loss clinicians may nonverbal clinicians the since detect relationship, disliking to of the reported ability terms of telemedicine decreased in of The effective nonusers particularly, patients. be and, to users services. found in-person Both was to TP Moreover, compared [9], outcomes. when telepsychiatry educational reliable about al. good and Concerns of valid et provision be Hilty and to care by found to review was access recent TP increase to a ability in acceptance, important efficacy, patient be to may clinicians regards for With rapport. exposure 3 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. rnils hrpss ee fivleetrne rmdrc otc hog ie rpoe ocompletely to CBT phone, or the video on through computer contact based OCD: direct from were for interventions, ranged approaches involvement group used of these based level been Therapists’ All (CBT) have Therapy principles. CBT. treatments metacog- Behavioural [24]; Videoconference-based Cognitive health delivery (BT-Steps), CBT, online treatment telemental Therapy-Steps Telephone-administered [12] tapping, first of Behaviour review meridian [23], the (CAVE), extensive lot training, discrimination to their Exposure a nitive In or disorder Vicarious that [25]. stigmatization the Computer-Aided highlighted barriers of of programs, these onset fear pa- overcome al. the to and of et potential from treatment shame Herbst the delay the as have treatment, long therapies in well to customary health resource as barriers telemental the several useful barriers, to patients a financial of lead be kind and could this could care logistic With strategies traditional as (OCD). 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Activation in in disorders satisfaction included cognition depressive [20]. were patients’ global who assessed in results patient’s , colleagues affected the and similar often only Pruitt is not 2019 reporting with which improves In TP functioning, abuse, TP cognitive of that substance his/her showed combination also review, and the meta-analytic but analyzed disorders a score, symptoms review in anxiety depression 2013 al., of et A depression, reduction Stanmore targeting the conditions. can are health apps services effects healthcare comorbid mobile The mental of delivering improvement adults. for older the TP of among and use depression care the of collaborative that symptoms underlined practice-based improve has intensity studies low- several A from the Evidence ones. than setting effects traditional side the drug-related collaborative [19]. telemedicine-based in less patients high-intensity than a reported in group model antidepressant which health taking care in [18]. patients telemental studies how studies several the evidenced by open study in reported many 2015 as more TP, therapist, in from improved a confirmed benefit diminished symptoms to of is presumably shown patients’ that support been a have and the disorders with ones, depressive with so with unsupported administered Patients do the treatments, they than computerized cost, effective that lower more clinical a seems much with people at are it also target Globally, people usually are biblio- more not There [17]. on reach do effect materials. and can based text-based guidance they approach, with primarily delivered although uses One generally depression; phone, not or are depression. email that for admissibility treatments via short treatments guidance the therapist’s internet-delivered determining the of of and purpose therapy forms the [16]. different with TP are of data There implementation the but the synthesize number depression, of to large for factors A attempted interventions influencing have [15]. technology-based and robust those examined is of disorders have depressive few meta-analyses of only treatment and the reviews in systematic TP of of use the supporting disorders evidence The psychiatric of treatment the in Telepsychiatry one. compelling a remains 4 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. h -B i o nii oi ain-hrps okn line nfc,asrn n tbepatient- stable and strong a fact, in alliance; also working treatment. they patient-therapist after OCD; solid period of a follow-up symptoms inhibit 6-month main with not the CBT the did throughout therapist-guided in stable Internet-based, i-CBT reductions an remained The significant patients, improvement 34 to this those of that led overcome to population observed Prevention a help up Response in could that and how, TP showed suggest Exposure [25] estimates [34]. al. stigma, care et and evidence-based Herbst cost receive or access, access including not barriers barriers. do to evidence- individuals in due disorders of Yet, health mental two-thirds common [33]. for treatment medicine standard gold based line, front the now is Psychotherapy to telepsychiatry methods via reduce TP Psychotherapy them help using may comfortable interventions web-based more using anonymous feelings. feeling additionally, when stigmatization an and, levels reported psychiatrist and satisfaction patients their functioning high many with strong exhibited social connect fact, Schizophrenia a and improve in with only clinical could approaches; Patients nonetheless, in telepsychiatry they [32]. improvement hospitalizations; to that prevention an prevent rates, relapse adherence and guarantee to adequate medication to patients and [31] their seems symptoms of improve al. engagement to psychotic kind et patients, patient-clinician of Kasckow this these exacerbation engage review, with the to their feasible help detect In may were TP well. approaches as outcomes. TP treatment Schizophrenia that with interventions videoconference-based patients concluded and in internet-based and tested telephone-based, involving been studies many has and summarized TP satisfaction of psychiatric patients’ use increased to The and access time, increased waiting TP group. patients’ using control method, and remotely, the communication. face-to-face costs with physician–patient held treatment the face-to-face treated were follow-up with and were sessions reduced group, compared groups follow-up experimental care, that, both the Six observed with group; directly researchers Skype sessions. control supplement Iranian [30] The and 3 a 60 application a first of and mobile al. as the Imo population experimental et the a for application) an in Haghnia consultations into treatments mobile Trial face-to-face PTSD divided Controlled in through were consultation (i.e. cognitive Randomized Patients face-to-face online recent tools and Veterans. and with a TP War media cognitive of difficulty In efficacy in other the the decline in for self-help. compared a was guided preference also downside internet internet-based the but The accessed to time, who and depression. over those to-face tasks and consumption among face- restructuring PTSD follow-up alcohol received months of of 6 who symptoms risk to and behavioural increased peers 1 reactions, an though A fear revealed even progress. interventions and programs treatment symptoms, Video-based symptoms greater affective insomnia. anxiety showed and on depression, therapy functioning improvements of social short-term severity ideation, internet primary therapist-assisted the suicidal produced the the in in of improvement All effectiveness reduction as immediate short-term large an internet a therapist. duration was a average the a there an with using that with with included determined programs, limited, studies communication They time which were evaluated asynchronous months. and design, framework three or authors behavioral of hybrid cognitive real-time a event, the a on with traumatic based meta-analysis were or combination interventions a their only, in of In modality model re-experiencing treatment the videoconferencing Post-traumatic [29]. by of a management hyperarousal characterized either the syndrome and in then complex avoidance services to tele-psychological a persistent first, of (PTSD), role at Disorder the the self-treatment [27]. analyzed in Stress [26] low-threshold [28] useful necessary a Dorstyn be when & or patients could only Bolton aggressive all OCD treatment, with face-to-face for offering ones the treatments approach the to health care as up telemental diversified move such that patients, a suggested of in- of been not types has context did some It self-stigmatisation, that and with shame obsessions. approaches included adherence of although sexual effect studies treatment inhibitory rate), efficient the the dropout most reduce improving lower could the hence contact and therapist’s that size auditory observed or effect a visual They (higher in clude therapist participants. resulted interventions the active health with for telemental contact symptoms All OCD involvement. in direct no decrease with programs computer automated 5 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. eeeiiecr a usatal nrae uigta ie t s a tl o iepedi 2017 in although widespread that, not concluded still 2027 was [41]. to TP use 2005 used its had from time, States subjects that United the of during in increased population psychiatrists substantially large of had 2% a care about examining only telemedicine article 2009, TP. ensure recent in health-care of and role A and underused: conditions with actual health globally patients the people mental is highlights of for comorbid TP This uneasiness of affected. protocols burden psychological those Treatment the of and reduce wellbeing physical may the pandemic. support the COVID-19 Psychological mem- both the family providers. patients, approach during of should support providers the the COVID-19 health-care for has appropriate It and and applications. feasible bers, clinical particularly promising are services. many services health health and Telemental mental prospects specific excellent with redistribute field geographically growing to and potential new a is TP to Psychiatry adjustments Computational called therapeutic been make has Discussion to This and individual. each treatment for individualize tailored to [40]. are that diagnosis, the relapses new allow early disease a will In reduce an endophenotypes data transdiagnostic make models. Learning measurable DSM/ICD to Machine traditional objectively analyze clinicians the these from Psychiatric to than psychiatry obtained outcome evidence-based Major clinicians treatment of of sub-classifications of the era re-classification the power allows founded predictive that biologically better technique have Intel- a suggests This analysis producing Artificial evidence of of Increasing aim Learning. use the Machine Disorders. the with of data from of specifically, specific benefit amounts PTSD, more to huge in opportunity and, found over unprecedented are (AI) and, disorders. VR the experience ligence spectrum of the have own face autism applications psychiatrists as his and best to today of act The anorexia, also Finally, builder nervous to [39]. yet active as life individual the world, such own each as his disorders, real allows into feel body-image the brings to It phobias, he in actions, changes setting. his experienced the of safe of already control time, Immersion a has regain is in [38]. he to equipment situations VR and emotions electronic protagonist traumatic savor special field. a and to utilizing representing health behaviors patient interact sounds, mental dysfunctional the can and the allows images person generated the for VR computer which promising in of with correct very set situation the are a or providers. simulation, for place (VR) care computer-generated reminders health Reality a with electronic as Virtual as touch provide well defined of in also as keep applications can consumption, to the They patients alcohol are Secondly, help potentialities and levels. can apps’ smoke stress and mobile tobacco and pharmacotherapy of starting sleep parameters, of Examples 38,3% management symptoms, health circa 2025. of track of by trend rate and billions growth the monitor 111,1 annual US to an estimated by by capacity an dominated characterized the is generating is which and Store, and market, Play self-harm 2019 apps Google in mobile-Health addressing addressing and global which 124 Store This of a Schizophrenia, App [37]. 449 Through Apple’s addressing Disorders identified, Use 282 were mental applications. Substance apps Depression, addressing and smartphone mobile 140 and addressing dedicated 1435 disorders 450 numerous 2019, specifically psychiatric problems, in other of towards conducted anxiety development found platforms attention the dedicated have to mediatic on technologies search led growing digital has the years problems Firstly, health recent in declinations. services, relevant tele-health to care CBT. Additionally face-to-face health to mental was CBT in rate Interestingly, videoconference-delivered technologies dropout prefer treatment. The New CBT to CBT. videoconference-delivered Anxiety affirmed in-person the participants Social of completed the patients improved those and of significantly of to alliance 83% 97% (PD) comparable a therapeutic since The with were Disorder (3%), SAD. group, scores low for Panic each its 22% very for and and OCD, symptoms PD treatment videoconference- severe for in the 50% reduction of to OCD, throughout significant feasibility for a mild 40% the was of with there rate examined remission that patients [36] determined adult They al. (SAD). 30 et Disorder in Matsumoto CBT [35]. delivered established was relation therapist 6 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. 1]Arm ,SsogS cwm H ta.PatclIse nDlvr fCiiint-ain Telemental Clinician-to-Patient the of 2017;135–145. Delivery : Center. in practice Issues Medical Practical clinical Academic al. in an et technologies in LH, Schwamm new Health S, promoting Sossong and J, Abrams Resisting [11] al. Psychiatry. et Rev. 2001;52:1889–1901. T, telepsychiatry. Int. Atkinson tech- of L, other competencies. case Gask and and Telepsychiatry C, models Psychiatry May practice [10] of best Review , International base evidence al. et : 2019;0:1–18. care S, integrated Suo for 2009;323–338. N, nologies Sunderji Research. Health DM, Tele-Mental Hilty Videoconferencing Gatekeepers. [9] in as Directions Clinicians Current Telepsychiatry: LK. of Richardson Use to [8] Barriers 2019;94:2510–2523. al. et Proc. MT, Health Clin. Mental Gentry Mayo in AJ, Incorporated McKean Technologies KE, Asynchronous Cowan of [7] Use of Review al. et 2018; J, Torous Care. L, Psychother. Li S, Pandemic. Chan COVID-19 N. [6] the to Clin. Response in Psychiatr. Delivery 2020;40202:1–3. Treatment Adolesc. Remote Psychosom. R. Child Caudill JH, Care. Wright Integrated [5] or devel- Collaborative health Child 1997; global 2017;26:637–645. for telematics. for Am. Telemedicine health strategy RJ. Health-For-All on Hilt consultation WHO’s [4] group of WHO support the in of Telepsychiatry. policy report to telematics Turn opment: health Necessary A A WHO. Health Pandemic: [3] Mental COVID-19 the the Reducing on 2020;2020. Paris in Psychiatry. From Telehealth Clin Viewpoint of J A Role E. The Corruble [2] al. et 2020;26:26–28. LE, COVID-19. Harding from MMHCL, Burden Snoswell X, Zhou [1] relationship therapeutic the health respect Mental foundation. TP. References technologies scientific of these their models that more. in which ensure much technology-driven for rigorous help and and appropriate remain to telemedicine most and role in-person asynchronous are strategic patients messaging, both in a which instant have combines identify field e-mail, professionals most to which Another include is and care, issue can newest Intelligence. important which technology of the Artificial An of of model and future: latter integration the “hybrid” data be, the in feasible big so-called care, can expand reality, a the illnesses to virtual for is destined mental apps, need is expansion mobile untreated urgent TP include of an healthcare. frontiers amount is mental exciting the of there vast models thus, innovative how internationally; with us and shows nationally patients among situation both both pandemic TP be of COVID-19 acceptance should cultural The programs the help to education formally increase way pandemic, medical a to present staff. continuing be required the medical may and considering this and are trainings and benefits, clinicians this, other residency Among to of schools, relation encouraged. trainings medical In implemen- di- TP. continuous in broader the of of and TP a risks and terms teaching to and focused development essential in benefits the Likewise, are TP, the Indeed, of guidelines of tools. awareness term. practice validation such detailed long reliable more of and more and short tation and protocols the broader standard in of a efficiency evaluation ensure therapeutic health to and reliability tele-mental needed agnostic The are all the studies clinicians. of of selected knowledge more half the few, However, era. than professionals, very digital health more by mental the undertaken for numerous by been among accounted offered had spread, clinicians possibilities to practice contribute 100 TP can that same crisis suggesting pandemic the [43], 2014, year in that visits addition, In [42]. 7 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. 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[28] and care efficacy of Stepped study CM. preliminary A Gilliam disorder: GJ, disorder: obsessive-compulsive Diefenbach obsessive-compulsive DF, for Tolin contact [27] therapist 2006;21:75–80. minimal Psychiatry. with Eur. Psychother. Self-help review. IM. A disorder. Marks cognitive compulsive internet-based D, an obsessive Mataix-Cols of [26] in efficacy prevention writing! just response talking, and 2014;83:165–175. No exposure Psychosom. al. 2006;67:703–711. with et Clinical N, Psychiatry. therapy Thiel Study: Clin. behavioral U, Compulsive J. Voderholzer Obsessive N, intake. Longitudinal Herbst Brown at [25] The sample the al. of et JL, symptoms Eisen and internet MC, features an 2010;27:470–475. in Mancebo Anxiety. utilization A, service Pinto Depress. and [24] treatment symptoms. to obsessive-compulsive Barriers with be- al. individuals between et of HM, satisfaction Wegarden sample Tele- NJ, client Telemed LeBlanc treatment J L, Marques post telehealth. 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Nonusers interactive Devore [15] and of Users AG, use of the Comparison Brega A of PL, evaluation Telemedicine: An Barton 1995;79–85. al. [14] Telecare. et Telemed AB, J obsessive- Summerfield service. for psychiatric CJ, applications acute Baht health P, telemental of Mclaren 2012;32:454–466. potential [13] The Rev. al. Psychol. et Clin. N, disorder. Stelzer compulsive U, Voderholzer N, Herbst [12] 8 Posted on Authorea 21 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159007666.69069059 — This a preprint and has not been peer reviewed. Data may be preliminary. 4]Mhor ,HsapH,SuaJ ta.Rpdgot nmna elhtlmdcn s mn rural among use telemedicine 2017; health Aff. mental in Heal. growth States. Rapid across al. variation et wide J, JAMA. beneficiaries, Souza medicare HA, 2005-2017. Huskamp Population, A, Insured Mehrotra ? 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