Telemedicine is the use of video-teleconferencing technology to facilitate encounters between medical providers and patients instead of the patient being seen in person by the provider.

Telepsychiatry is the use of telemedicine to provide mental health care, such as medication management and psychotherapy.

The use of video-conferencing for medical purposes began in the 1950s, when the technology first became feasible. However, at that time, telemedicine was used infrequently and only when in person care was not available. On of the challenges was that the technology was expensive and impossible to deploy on a broad scale. This continued to be the state of affairs until the development of the internet and cheap webcams, which made video-teleconferencing accessible to ordinary citizens in the home.

Despite the fact that the basic technology needed for telemedicine has been available for at least twenty years, telemedicine and telepsychiatry have seen relatively slow growth to date. The reasons for the slow adoption of telemedicine are primarily concerns about the confidentiality and security of internet based video-teleconferencing. In addition, regulators and clinicians expressed concern that telemedicine would not allow for adequate assessments as compared to in-person evaluations. Telemedicine was therefore hampered by a fear that it would result in inferior treatment. In the past, some insurance companies would not reimburse for telemedicine.

In the past five years, there has been growing acceptance of telepsychiatry as a valid and even essential method for providing mental health care. Particularly in states that have few psychiatrists (such as Minnesota, Montana) and in regions that are remote (northern California, west Texas, upstate New York), telepsychiatry has allowed for mental health care to reach patient populations that previously had no access to care. In addition, telepsychiatry gained more acceptance as being a necessary tool for providing mental health care to special populations, such as prison inmates. Nevertheless, prior to the Covid-19 pandemic, a certain bias against telemedicine and telepsychiatry persisted on the part of providers, insurance companies, and regulators.

Principium has been at the forefront of recognizing the potential of telepsychiatry. Principium has been offering telepsychiatry for almost ten years. Some patients have used telepsychiatry as their primary mode of treatment, while others have utilized it when traveling in order to be able to maintain their treatment session schedule. Principium has found telepsychiatry to be a safe and effective method for providing mental health care to those who face challenges coming to the office.

Once you have booked your appointment, you will be provided with technical information about how to access the treatment session. Principium uses a number of telepsychiatry platforms that can be accessed on a computer, tablet, or smart phone.

Telepsychiatry lends itself well to psychotherapy and to medication management. Psychotherapy can be individual, couples or family therapy. Telepsychiatry is utilized by our psychologists, psychiatric nurse practitioners, and psychiatrists.

At Principium, we prescribe medication electronically directly to your pharmacy. You do not need to pick up a paper prescription.

Currently, Principium is able to see patients who reside in the tri-state New York area (all of New York State, Connecticut, and New Jersey). Principium can also treat patients in Kansas. Principium has plans to expand coverage to California and Florida.

The initial evaluation can be conducted by telepsychiatry. If you are a good candidate for TMS or ketamine therapy, you would then need to arrange in-person appointments as these treatments require direct treatment in the office.

During the Covid-19 crisis, those needing suboxone can be treated by telepsychiatry. It is possible that at some point it would be required that you visit the office periodically, depending on state and federal regulations, which are rapidly evolving.

If you require ADHD treatment with medication, you are able to be treated by telepsychiatry and to receive your prescription.

In a telepsychiatry session, typically the doctor or therapist can only see your face or upper body. Since psychiatry is primarily focused on thoughts, feelings, and behaviors, this does not usually pose any problem for the provider using telepsychiatry. Often, patients access telepsychiatry from the home. As such, telepsychiatry has the quality of a “home visit.” The provider can often see the patient’s home and environment. This can help provide useful information. For example, if a patient is a hoarder, this might be readily apparent during the telepsychiatry session. If the patient is depressed, the psychiatrist might note that the home environment is disordered due to low motivation in the patient. Thus, in many respects, telepsychiatry can provide more information than would normally be obtained in an in-person visit.

Phone sessions can be useful and can accomplish many of the goals of a regular session (whether in-person or by telepsychiatry). However, a phone session cannot substitute for telepsychiatry for the initial evaluation. The first session is essential to develop a differential diagnosis (a list of the most likely conditions affecting the patient) and treatment plan. Being able to see the patient as well as listen to her is important for the initial evaluation. At Principium, initial evaluations must be by telepsychiatry or in-person.

In order to book an appointment, simply email the office at info@manhattantms.com or call 212-335-0236.