The Telemedicine Practice Guidelines (March 25, 2020) and the Telepsychiatry Operational Guidelines provide a framework for psychiatrists to offer teleconsultations safely, ethically, and effectively. Here’s a streamlined version focusing on key aspects relevant to psychiatrists:

Key Considerations for Psychiatrists

1. Legal Framework
   • Telepsychiatry is valid under the Mental Healthcare Act (2017) and the National Medical Commission (NMC) Act (2019).
   • All ethical and legal obligations of in-person care also apply to teleconsultations.
2. Who Can Provide Telepsychiatry?
   • Registered Medical Practitioners (RMPs) with a valid license in psychiatry (MD/DPM).
   • Psychologists and counselors can assist but cannot prescribe medications.
3. Modes of Consultation
   • Video consultation: Ideal for first consultations, diagnosing severe mental illnesses, or conducting psychotherapy.
   • Audio or text consultation: Suitable for follow-ups or less complex cases.
   • Mixed modes (e.g., asynchronous data sharing followed by a live session) are also permissible.
4. Consent
   • Implied Consent: When a patient initiates contact (e.g., booking an appointment).
   • Explicit Consent:
     • For caregiver-initiated consultations.
     • When sharing prescriptions or patient data.
   • Can be obtained via written, audio, video, or text formats.
5. Assessment and Documentation
   • Identification: Verify patient identity (e.g., name, age, address) and introduce yourself with your name, qualification, and registration number.
   • Emergency Screening: Quickly identify psychiatric emergencies like suicidal ideation, acute psychosis, or withdrawal symptoms and refer for in-person care if necessary.
   • Records: Maintain detailed documentation of history, diagnosis, prescriptions, and interactions (physical or digital format).

Prescribing Guidelines for Psychiatrists

1. Medication Categories:
   • List O: Over-the-counter medications like vitamins and supplements.
   • List A:
     • Common psychotropics (e.g., SSRIs, SNRIs, antipsychotics like risperidone).
     • Prescribable via video consultation for first-time evaluations; any mode for follow-ups.
   • List B:
     • Medications for follow-ups only (e.g., refills or add-ons for chronic mental health conditions).
   • Prohibited List:
     • Schedule X and NDPS drugs (e.g., benzodiazepines, opioids) cannot be prescribed via teleconsultation.
2. Prescription Format:
   • Include patient and doctor details (name, age, gender, registration number).
   • Write medications in capital letters, preferably using generic names.
   • Clearly state dosage, frequency, and duration.
   • Mark the prescription as “Generated via Telemedicine Consultation.”

Handling Emergencies

• Suicidal or Violent Patients: Provide immediate counseling, advise life-saving steps, and facilitate in-person referrals.
• Substance Withdrawal: Stabilize with first-line care (e.g., thiamine) and refer for detoxification if necessary.
• Risk of Harm: Involve caregivers and prioritize patient safety. Use discretion to determine suitability for teleconsultation or in-person care.

Ethical and Practical Tips

1. Confidentiality:
   • Protect patient data. Use secure platforms and avoid sharing information without explicit consent.
   • Clearly inform patients about the limitations of privacy when using online platforms.
2. Billing:
   • Charge for teleconsultations as you would for in-person sessions.
   • Provide invoices to avoid professional misconduct allegations.
3. Using Technology:
   • Choose reliable, secure platforms (e.g., telemedicine apps, not public social media platforms).
   • Document all interactions to mitigate medico-legal risks.

Conclusion

Telepsychiatry enables psychiatrists to expand their reach and provide care to underserved populations. By adhering to these guidelines, psychiatrists can ensure ethical, effective, and patient-centered mental health services. Always prioritize safety, confidentiality, and professional judgment in all teleconsultations.

Stay ethical, stay safe!