COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future.

The COVID-19 pandemic has dramatically transformed the U.S. healthcare landscape. Within psychiatry, a sudden relaxing of insurance and regulatory barriers during the month of March 2020 enabled clinicians practicing in a wide range of settings to quickly adopt virtual care in order to provide critical ongoing mental health supports to both existing and new patients struggling with the pandemic's impact. In this article, we briefly review the extensive literature supporting the effectiveness of telepsychiatry relative to in-person mental health care, and describe how payment and regulatory challenges were the primary barriers preventing more widespread adoption of this treatment modality prior to COVID-19. We then review key changes that were implemented at the federal, state, professional, and insurance levels over a one-month period that helped usher in an unprecedented transformation in psychiatric care delivery, from mostly in-person to mostly virtual. Early quality improvement data regarding virtual visit volumes and clinical insights from our outpatient psychiatry department located within a large, urban, tertiary care academic medical center reflect both the opportunities and challenges of virtual care for patients and providers. Notable benefits have included robust clinical volumes despite social distancing mandates, reduced logistical barrieres to care for many patients, and decreased no-show rates. Finally, we provide clinical suggestions for optimizing telepsychiatry based on our experience, make a call for advocacy to continue the reduced insurance and regulatory restrictions affecting telepsychiatry even once this public health crisis has passed, and pose research questions that can help guide optimal utilization of telepsychiatry as mainstay or adjunct of outpatient psychiatric treatment now and in the future.

Racial Disparity in the Clinical Risk Assessment.

Implicit bias has been shown to impact care in many medical specialties. However, few studies examine its impact on psychiatry. Psychiatrists, especially in the Emergency Room, must assess patients' level of dangerousness when determining an appropriate disposition. For a variety of reasons, clinical understanding of dangerousness may be highly vulnerable to implicit bias. This study aims to determine if there is implicit bias in a psychiatric emergency room setting when determining disposition. Patients were included if their race was recorded as White or Black and if their disposition was either admitted to the inpatient psychiatric unit or discharged to the community (N = 743). Analyses were performed to evaluate associations between race, age, gender and disposition. No statistically significant difference in admission rates between races was found. While this could indicate genuine racial parity, there are many factors that may have masked racial disparity and could warrant further study.