Implementation of Psychiatry through Telepsychiatry Process

Project summary

To comprehend the barriers to the implementation of telepsychiatry, it is important to note the challenges that are prevalent in the imposition of telehealth as a whole. As per the study on the barriers to implementing telehealth in rural areas, it is identified that access to the system is one major challenge. As per reports of global accessibility of high-speed internet in the rural areas apart from a few nations majority of the rural population do not have access to high-speed internet. In addition to this, Cowan et al. (2019) has stated the complexities involved in the policymaking and licensing of the system. Licensing may incur a heavy cost, however, the aspect of reliability and safety of patients is the significant barriers in policy-making for such a system. Moreover, Helleman et al. (2020) has stated that monitoring patient health through the system can be difficult and the provision of privacy and security of the same is a major concern in this regard.

Thus, in the case of telepsychiatry, the above-given factors are relevant, however, Lee et al. (2020) specifically in terms of telepsychiatry has stated that lack of infrastructure, clinical support and misinformation are some of the crucial challenges in the process of modernising telepathy by implementing telepsychiatry.  Accordingly, a reason provided by Spivak et al. (2020) seems to be relevant with the problem of establishing telepsychiatry is the comfort of staff or the psychiatrists in using telepsychiatry. It is noted that most psychiatrists are sceptical regarding the feasibility of the communication that will take place through digital mediums.

Outline

The research will first address literature relevant to tele psychiatrist and then ensure the implementation of psychiatry through the same. This research will accumulate evidence based upon the same and then affirm conceptual analysis accounting agendas reverting such. This research will then focus upon the methodologies utilized in raising the data analysis for evaluating the implementation of psychiatry as well as ensure the development of the same through telepsychiatry. Lastly, the research will ensure the methods utilized for data analysis along with procedures of ethical consideration.

Keywords

Psychiatry, telepsychiatry, tele psychotherapy and psychiatrist.

Database

MEDLINE and cinahl.

Inclusion criteria

• Peer-reviewed articles
• Genuine internet sources
• Sampled population

Exclusion criteria

• Non-peer reviewed articles
• Wikipedia

Aim and objectives

The project aims to illustrate the implementation of psychiatry through the process of telepsychiatry. The major objective of the research is to devise out the methods of telepsychiatry as well as visualize the forms of psychiatry, which could be well adjourned with the realms of telepsychiatry.

Research design

A descriptive research design has been adhered to for this research because a descriptive design phenomenon installed within case studies along with relevant theories could well be analysed.

Principal methods

The research will be accounted for through both qualitative and quantitative studies, as data-infused within the research shall infuse both numerical and non-numerical data’s. Besides that a secondary data collection method utilizing information through journals, articles and internet sources have also been acknowledged.

External research instrument

CASP

Data analysis

A descriptive data analysis has been accounted for the research because through this descriptive analysis constructive way for summarizing numerous points have been adjourned within the research.

Chapter 1: Introduction

Telepsychiatry is challenging as most of the professionals from different research studies have provided a common argument of the ability to access the actual needs and interests of a patient without physical analysis. However, considering the current advent in digital tools and techniques, the role of technology can be significant in modernising psychiatry, although, the concern here is the relevant and optimum use of the digital tools.

The implementation of telepsychiatry in the current era is essential considering the current environmental situation. An increase in outreach is a factor for the implementation of telepsychiatry along with the ability to integrate service, which is behavioural and primary health care. Moreover, with the inclusion of telepsychiatry as Looi and Pring, (2020) have stated that delays in care can be reduced as health care workers can assist multiple patients within a short period. Effectiveness in patients’ satisfaction is also evident as per various research as it is stated that patients may be more comfortable in expressing their issues from the convenience of their home. The health care workers on the other hand can be associated with multiple clinics without the need for transportation as it has been noted that telepsychiatry settings are begin used in nursing facilities, military treatment, schools and various other facilities.

Findings have suggested that using Telepsychiatry can be beneficial; however, it requires a proper framework and structure to be followed in order to gain maximum output. The major benefit of telepsychiatry as per Reinhardt, Gouzoulis-Mayfrank and Zielasek, (2019) is the ability to reach out to a large number of stakeholders. Accordingly, with the increase in outreach, it is estimated that access to mental health can be improved and health care providers can offer integrated health care service and primary care to stakeholders under high risk of mental health and care needs.

In this context, the implementation process and procedure are essential to discuss, which the framework for an organised practice as stated earlier, regarding the involvement of different stakeholders. As well as the regulation along with interventions for keeping intact, the ethical norms while practising telepsychiatry. Therefore, considering the United Kingdom in implementing telepsychiatry the policies and regulations in this aspect can be scrutinised. Thus, in this regard, it has been identified that there is a lack of proper regulation and policies addressing telehealth in the United Kingdom. The need for policy and regulation is for ensuring patient safety as the foremost requirement, however, the policies also ensure ethical practice that helps in avoiding malpractice such as data theft or hacking, which is usually related to digital processes. Thus, it is noted that both digital and non-digital providers in the health care service sector in the United Kingdom are required to abide by the current Health and Social Care Act 2008, which do not specifically distinguish between digital and non-digital health care providers. In the same context, it is significant to add that the regulation for data protection, which is General Data Protection Regulation (GDPR), is meant to protect stakeholder’s data. It is also applicable in the case of telehealth that highlights the use of data and information within the guidelines prescribed by the law in case of using the personal information of an individual (Peynetti Velázquez et al. 2020).

Therefore, based on the threats for data theft or malpractice, it can be stated that a proper guideline for ethical norms in the practice of telehealth is required as a whole, which can eventually integrate telepsychiatry.

In the process of implementation of telepsychiatry various issues related to the management of the system is evident. For instance, accessibility of the proposed health care service, framework or regulation of its management, the ability of the stakeholders in comprehending the service, gaining user satisfaction and the ability to enrol the health care workers within a structured process for practising telepsychiatry (Shore, Schneck & Mishkind, 2020). The benefits of implementing telepsychiatry are stated above, however, addressing the given issue is critical, therefore, it is noted that authorities have the concern of addressing and measuring telepsychiatry as a device that can quality begin usable for medical purposes. Compliance with medical regulations and device specifications has been notified in the policies currently available in the United Kingdom regarding medical assistance through digital mode. However, it is necessary that a global framework is implemented in this aspect as no such policy or regulation is currently evident in the global perspective.

Based on the environmental analysis the feasibility of the implementation of telepsychiatry can be determined and at the same time, the ability of the stakeholders of the UK in adapting to the service can be evaluated.

Political

The political structure of the nation is stable with policies that have signified its aim to develop the internal socio-economic shape of the country.

Economic

The UK is among the developed nations with a positive economic background, wherein the purchasing power of the community is positive in comparison to various European nations.

Social

The community in the UK is diverse and the consumer market is a huge market in the European continent. The nation has currently seen an increase in its older population, however, the community is well educated and inclusive in nature.

Technological

The government has made a significant investment in the technological front as increasing demand for digitisation of service and functions has allowed the country to venture more into technology.

Environment

The country has recently encountered certain environmental challenges, however, it seeks sustainable development and as a result, an integrated initiative of central and local authorities have been made in this regard.

Legal

Employment in a fair manner and equality is a key aspect of legal consideration, which is highly maintained in the UK. Moreover, compliance for consumer safety and well-begin is significant for service providers.

Based on the environmental analysis, it can be stated that the inclusion of technology in psychiatry is feasible as in the UK the governing bodies can sustain the same. Moreover, with a higher level of transparency in the implementation process ethical standards can be fulfilled in this aspect.

Thus, the following stiudy will analyse the implementation of the telepsychiatry in the United Kingdom’s Mental Health Foundation, which is an organisation based on developing mental health service and prevent mental health challenges within the stakeholders.

Moreover, the environmental analysis suggest that the implementation of the health process is cost effective and affordable for large organisation such as MHF UK, however, it will require assessment of public funding. Additionally, it can be said that organisational process of large and complex nature are currently data and information driven through technological tools, thus, the health process is technically possible with relevant know-how and tools. The solution is ethical in terms of integrating a large number of stakeholders to be able to access mental health service remotely and in a cost effective manner, however, there is a need for further ethical speculation. Lastly, the proposed solution can offer the intended outcomes as technological integration is highly in demand for industry change.

Statement of problem

The implementation of telepsychiatry can modernise the current or traditional practice of psychiatry. However, the process of implementation requires a legal binding along with the role of governing authorities to regulate the practice and inclusion of stakeholders to efficiently adapt to the change in the field of traditional psychiatry.

 

Chapter 2: Literature review

The following literature review is based on the illustration of the existing literature that can help in underpinning the framework or the guidelines that are essential in forming telepsychiatry for modern issues using technology at its best. In doing so, the study will analyse the ways to implement telepsychiatry in the best way possible that can ensure its optimum utilisation among the relevant stakeholders. Therefore, the study takes into account the existing data related to evidence-based practice, which is in concern with the application and t the same time its management with the health service organisations.

The focus of the study is the process of implementing telepsychiatry and the management problems involved in the process. Therefore, in order to gain the specific management issues in the field of telepsychiatry, it is important to note the overall scenario in the field of telehealth. Hence, Dart et al. (2016) have highlighted the issue of widespread implementation of telehealth and its accessibility by the overall stakeholders. This implies that connecting people through telehealth is a major challenge and gaining positive results is attributed with the same. Financial restriction and education along with training play a vital role in the implementation of the telehealth process in any region or nation. In the case of challenges for implementing telehealth, Shore, (2019) on the other hand, states that analysing the potential to use telehealth in a region and its compatibility with the stakeholders can help in the implementation process, however, it does not overcome the challenge of widespread implementation of the health process. Hence, based on the given arguments, it can be stated that in the case of telepsycharitry, a proper analysis of the environment and the compatibility check along with measurement of feasibility is required prior to its implementation.

The acceptance of the stakeholders also plays a vital role in the process of implementing modern psychiatry, as the patients may not rely on technological tools. Patients may be sceptic regarding the effectiveness of the process. Thus, the role of the health organisation is to demonstrate the effectiveness of telepsychiatry in providing a similar health benefit to the patients when checked in the traditional manner. However, there is evidence of patients begin satisfied with the service received by health care professionals through interactive video in the case of mental health problems, however, there is a lack of full integration of telepsychiatry. In this context, Shore, (2015) has highlighted a significant gap in the case of telepsychiatry, which is a lack of proper curriculum for students of health study to apply the treatment or access online interface to deal with a patient with mental health problems. Accordingly, the study also talks about the identification of the exact problems that can act as a barrier in the process of implementing telepsychiatry in the current era. In the same context, Gardner et al. (2020) has also referred to the lack of systematic assessment method to integrate telepsychiatry in regular clinical practice. However, Gajaria, Conn and Madan, (2015) mentions that the use of basic interactive technological tools is effective enough to provide the base for the health profession to offer basic treatment to the patient of mental health. However, it can be said that it is up to the health professional to verify whether the patient may also require a physical meeting based on the severity of the health problem.

Therefore, Chakrabarti, (2015) has suggested a preliminary approach to the implementation of the telepsychiatry process, wherein the objective of the training to the health care professional should focus on problem-based learning. This implies that active identification of the problems in the process of telepsychiatry can help in identifying the relevant solution under supervised clinical experience. In this regard, it is further suggested by Eggerth,  Hayn, and Schreier, (2020) that in the process of providing training to the health care professionals in the process of telepsychiatry, it is significant to develop clinical responsibility through role-play and simulation and confronting different levels of complex cases through a digital interface. This level of training can help the supervisors comprehend the effectiveness of technological interface in handling diverse cases through telepsychiatry. Accordingly, Hanlon et al. (2017) state that such training also requires proper development of technical know-how within the health care professionals. Such development can help the professionals to be competent in handling software and hardware, which can eventually be optimised to create a customised telepsychiatry system as per individual’s needs and wants.

Hence, based on the given statements, it can be further added that proper resources are also required for the effective implementation of telepsychiatry. According to Cottrell and Russell, (2020), apart from a patient’s co-operation, clinical support at the patient’s site and resourcefulness of the health care professional, which is the telepsychiatrist is essential. Thus, as stated above, there is a further gap, which is noticed in terms of well-developed systems in community care facilities, the ability of the telepsychiatrist to adapt with technological tools and the ability to self-assist with minor troubleshoots and ability to estimate its sustainability in a particular region.

Therefore, Perera, Gambheera and Williams, (2020) has clearly highlighted the aspect of the potential of the local community to be supportive or in alignment with the recommendation made by telepsychiatrist. This signifies the areas of begin able to identify the current gaps in the process of integrating telepsychiatry within the existing mental health service of a local area. In this context, it is stated that the type of services required through telepsychiatrists is supposed to be identified and accordingly the stakeholders are required to determine the feasibility of the services based on the needs and requirements of both the patient and the provider. A common advantage in this regard is the omission of transportation mostly for the stakeholders in the rural areas. As per Tyson, Brammer and McIntosh, (2019), this can be beneficial in terms of cost and time for the population in remote areas, however, Sabin and Skimming, (2015) argues that the population in remote areas may not comprehend the operating process of the system. Therefore, a proper transfer of information and education on the ways the system operates should be provided to the relevant population to ensure that the stakeholders are able to fully rely on the process of telepsychiatry.

The objective of the research is to evaluate the feasibility of implementing the process of telepsychiatry. Therefore, the role of evidence-based support of the medical process is necessary to determine. In this regard, Saeed et al. (2017) has mentioned that in the case of adults evidence-based supporting telepsychiatry is an effective service-delivery model, which is further emerging for catering for the mental health needs of children and adolescents. As per the author the feasibility of telepsychiatry is estimated by summarised data of several outcomes that are accessed from various studies (See appendix 1). Furthermore, the modernising of telepsychiatry can be illustrated by determining the current practices of the clinical process. Thus, according to Cowan et al. (2019) in the study of the development of telepsychiatry practices within children and adolescents, it is stated that the young age group may be compatible with the process of telepsychiatry as the current generation of youth is more accustomed to technology. In this context, Han, Mirowski and Kang, (2015) also have stated that a higher degree of use and interaction through technology by the current generation can allow the young patients to properly respond to the personal space and feeling of control allowed by videoconferencing.

There are instances of treatment among the young age group, wherein, children with ADHD or depression are treated through videoconferencing. However, Smith, Zhou and Watzlaf, (2017) argues regarding the challenges in terms of resistance posed by children with ADHD or similar mental illness. However, the aspect of uncooperativeness can be overcome by the support provided at the patient’s site and the resourcefulness of the service provider as discussed in the section above. This includes assistance to the patient by staff or the parents or guardians. However, Nagel and Penner, (2016) argues that treatment through telepsychiatry or videoconferencing requires proper approval, wherein the provider will determine the appropriateness of age group or the level of medical severity of a patient to ensure the feasibility aspect of the treatment through video conferencing or if there is any requirement for an in-person check-up.

Accordingly, the aspect of ethical consideration arises along with the factor of safety in the process of implementing telepsychiatry. Hilty et al. (2015) state that proper implementation or modernising the process of telepsychiatry will require various reforms in the current practice of psychotherapy and pharmacotherapy, apart from reforms, du Toit et al (2019) argues the safety impact of recommending medications through telepsychiatry is essential. Therefore, Naskar et al., (2017) refers to the factor of acceptability, which can be developed by RCT and formulation of guidelines to ensure proper effectiveness of telepsychiatry.  Acceptability requires alliance or integration of the primary care providers along with the parents and the patients while conducting a virtual visit. In addition to this, pharmacotherapy through videoconferencing is conducted in community-based care units, schools, mental health and daycare along with the outpatient setting. In this regard, it is noted that short-term effectiveness is evident in the case of pharmacotherapy delivered to ADHD patients through telepsychiatry. Moreover, several studies have further noted that RT of psychotherapy have been able to reduce childhood depressive symptoms treated under eight session of cognitive-behavioural therapy, wherein the service is delivered through video conferencing.

The objective of telepsychiatry is to enhance the current practice of psychiatry, Narasimhan et al. (2015) has defined telepsychiatry as the process of using two-way real-time communication audio and video to support psychiatric care in the event where participants are separated in terms of geographical distance. This helps in comprehending the major use or the purpose of implementing telepsychiatry, which is expanding the outreach of the clinical process. In the same context, Su et al. (2020) also highlight two major barriers in the implementation process of telepsychiatry, which is the provider’s lack of understanding of the technology and inadequate training for ensuing its widespread implementation.

However, based on the discussion above and in terms of evidence-based practice as illustrated earlier, similar studies such as the using telepsychiatry and health technologies to provide evidence-based care state that the effectiveness of the process is comparable to in-person care in terms of engagement of therapeutic nature, quality of care, reliability and clinical outcomes. As noted earlier, the study also states that specifically in the case of child mental health treatment especially ADHD, depression and PTSD telepsychiatry is highly effective. However, the management issues that attribute to the implementation process of telepsychiatry are mainly access to care, improved efficiency, and effective time management, professional communication, training and cost-effectiveness. Thus, based on the given management factors and their related issues Perdew, Erickson and Litke, (2017) has highlighted the problem of lack of psychiatrists at the national level and country-level in the USA alone (see appendix 2). Moreover, the number of community-based behavioural health care is also not adequate at the global level as per Taylor et al. (2016) and at the same time, full-time access to psychiatrists are not available in the majority of emergency departments. This signifies the need for more human resources along with increasing the outreach and fast connectivity, which is possible through the implementation of telepsychiatry.

Hence, Ray et al. (2015) mention the different benefits of telepsychiatry in delivering acute mental health or substance abuse care.

Access to mental health services:

The stakeholders can access the services from a remote location as the current evidence shows the increase of service consumption in the rural areas (see appendix 3).

Consumer convenience:

The cost of transportation along with effective time management can be gained as long waits in queues can be eliminated. Moreover, parents or care providers will be aware of the resources they need handy to access the services at times of emergency.

Increased coordination:

The significant benefit of implementing telepsychiatry is the improved communication of mental health centres. As per Kayyali et al. (2017), this implies the elimination of professional isolation and allowed to recruit and retain more mental health professionals to ensure widespread implementation of telepsychiatry.

Improving education and training for MH professionals:

With increased outreach, there will be more cases to handle, as several cases of mental illness remain undiagnosed. This signifies that professionals will have various cases and coordination of the overall mental health system can be improved. In addition to this, Salisbury et al. (2015) state the potential to reduce stigma through telepsychiatry due to the aspect of confidentiality or data security.

Consequently, in the process of identifying management issues related to the process of implementing telepsychiatry, it is stated by Soriano Marcolino et al. (2016) that organisational resistance can be one of the significant barriers to the implementation of telepsychiatry. Resistance to change is commonly evident as Ray et al. (2015) refer to the aspect of adaptability towards a new operating process. Therefore, Seto et al. (2019) recommend a linear process to follow while conducting change in organisational operations. The stakeholders due to lack of awareness of using technological tools or due to high cost may resist using telepsychiatry in the mental setting. Thus, based on the given factors for resistance, the need for training curriculum and educational programmes on using technology and integrating it with the service-delivery model is highly essential.

Further, studies have identified that child psychiatrists are not adequate in number and in the case of telepsychiatry the demand is increasing to provide service to the young or the adolescent population. Information provided in the research study for sustainability programmes for telepsychiatry has highlighted that 30% of the service is often used for children or adolescents. However, it is also seen that there is no significant increase in child psychiatrists since 1995. This data provided in the study clearly highlights the need for telepsychiatry. Standing et al. (2018) in this aspect has stated that there is a lack of education and training among mental health care professional, which creates a gap in specifically treating students or children with mental health needs. Crawford et al. (2016) state that cases of misdiagnosis occur due to lack of accessibility in the case of the younger population, however, telepsychiatry can act as the tool for need assessment to identify mental health needs by conducting programmes in school and community health settings.

It is noted that working with adults and children are challenging, yet, there is evidence of effective implementation. However, there is a significant concern about working with the elderly population. In this regard, Bradford, Caffery and Smith, (2015) has illustrated information gathered from various studies that there is a gap in the literature with ways to operate with the ageing population. Kayyali et al. (2017) state the issue of compatibility of the older people with technology as the said population do easily get along with technological tools, which marks the need for patient support at the patient’s site. On the other hand, there is a benefit for the care providers, which can enable the care provider to monitor the patient remotely using telepsychiatry. The older population encounters various mental problems, however, according to estimates made by Ortega et al. (2020) around 40% of the cases of the older population is undiagnosed. Therefore, this indicates that the population is not able to access the services to the fullest and there is a lack of awareness among the older population. Thus, based on the given information regarding the older population, it can be said that telepsychiatry intervention is actively needed here. However, the management concern of the given scenario is the ability to mobilise the population to be aware and be accustomed to the new or changed clinical system. Therefore, the potential solution for the same would be an in-person visit in the first place and continuous intervention from the overall stakeholders to support the older age group.

Although the benefit or the impact mentioned in the section above is clear along with the need established for the implementation of telepsychiatry, however, Neufeld, Doarn and Aly (2016) states that due to the need for reforming and the aspect of change of the overall mental health system can create complexities in the process of implementing telepsychiatry or modernising the same. According to Daniel and Sulmasy (2015), there is a gap in the regulations and legalisation of telepsychiatry. It is seen that there is a lack of policy framework, which results in further lack of a properly structured approach in the practice of telepsychiatry and at the same time, this issue is evident in the overall field of telemedicine.

As per Avanesova and Shamliyan, (2019) due to the authority of licensing of health care professionals is state-based in the majority of the countries, therefore, the potential of telehealth practice to deliver care across boundaries is a challenging endeavour. In the case of telemedicine, the world health organisation report states the need for active support of the local government and institutional support to assert the need for telemedicine. However, the institutionalisation of telemedicine as per the WHO report identifies that there is a lack of active support at the national level, which hinders a proper establishment of governance for telemedicine in both developed and developing countries. It is found from the world health organisation’s report that several countries reported the need for telemedicine regulations. Accordingly, after further speculations, it is noted that around 25% of the responding countries reported having national or local telemedicine policies or strategies. In addition to this, 20% of the countries are in the preliminary stage of implementing telemedicine policy, which is mostly the developing countries (see appendix 4). This signifies that a particular management issue can be attributed to inadequate cooperation or collaboration of the health agencies with governing bodies mostly in developing countries to fully implement telemedicine policy or strategy.

Further, it has been stated that by Kahn, La Marca and Mazzola, (2016) that telepsychiatry services vary with locations and accordingly the policies and governance of the system also varies. This diverse policy may influence the proper regulation of the system. However, Waller and Stotler, (2018) argues that diversity in the policy guidelines is required as the service needs of the stakeholders as per different regions may vary. In this regard, it is also necessary to have a common framework in order to formulate policies that can help in the global practice of telepsychiatry. On the other hand, researchers have raised concerns regarding the safety aspect, which is confidentiality and the aspect of keeping data security intact. This also implies that investment needs to make in terms of data security ensuring that user data is not manipulated for malpractices while conducting telepsychiatry. Related concerns regarding the clinical process are the creating of a platform that can help in integrating the vendors the service providers and the other stakeholders under seamless connectivity.

However, considering the current environmental situation mainly the pandemic crisis, it is found that certain agencies including the APA have formulated guidelines for current practices for telepsychiatry. Telemental health policies under the given guidelines are not uniform and at the same time, the licensing requirements are loosened. Based on the severity of health cases states have been permitted to conduct tele-mental practice on a temporary basis. However, the concern of insurance malpractice and challenge for the students is evident as the dilemma is the choice of practice whether it is through telepsychiatry or in-person (Telepsychiatry. Psychiatry.org, 2021). Therefore, the basic guidelines for the health care professional to perform the process of telepsychiatry is as per the existing scope of competence for campus psychiatrists, which is the usual practice they would have done in-person. This implies that if the professional do not have the required skills and know-how they are not supposed to do so (Aacap.org, 2021). Similarly, the professional will perform an action under a clinically supervised setting and at the same time, the physical location should be known to the health care professional in order to act in case of emergency (Nursing.ecu.edu, 2021).

The technical consideration under the given guidelines is significant as it considers the compliance criteria that are supposed to be met while the service providers are offering the health services. In doing so, it is important to conduct the process under a clinical setting and the interface for videoconferencing is supposed to be under parameters that are able to fit the security and service standard.  Apart from that, it is noted from the overall discussion that the potential of implementing telepsychiatry is immense and it has huge scope (Wspapsych.org, 2021). However, the limitation in terms of management issues is related to lack of legal framework, a complete action plan and collaboration of the national and international agencies to establish working governance to practice telepsychiatry globally by eliminating the various complexities. Therefore, it can be stated that the overall stakeholders need to collaborate to implement telehealth, however, the initial action is active training and education along with implementing change management practice to overcome the challenges associated with the process of establishing and modernising psychiatry.

Limitation of the study

From the overall review of the literature, it is noted that there inadequate research on the given subject matter. The discussion is based on the implementation of telepsychiatry and identification of platforms that can promote telepsychiatry. It can be said that various tools and ntechniques has been identified in the study above to implement telehealth, however, the major gap that is identified is lack of academic literature, which affects the knowledge and skills of the health care professional regarding its proper utilisation and another major gap that is identified is that lack of intervention of the governing authority to create and promote telepsychiatry under a structured framework.

 

Chapter 3: Implementation plan

Aims and objectives

Aims

• To establish a management framework for the practice of telepsychiatry
• To educate the stakeholders regarding the process of telepsychiatry
• To generalise the use of telepsychiatry
• To create a service model for the delivery of telehealth service

Objectives

• By integrating various stakeholders and agencies to collaborate
• By creating education and training programmes for the overall stakeholders
• By creating awareness and emphasising on making policies and guidelines for telepsychiatry
• By optimum use of resources and communication along with adequate distribution

Justification of the objectives using the SMART model

Thus, the objective of the project reflects the actions to be taken to achieve the given aims. Therefore, based on the model SMART the objectives stated above are feasible as it is relevant to the core issue of implementing telepsychiatry by mitigating the barriers for its practice.

Hence, it can be stated that the aims and objectives are specific to the core objective of the research. The organisational or management issue of the process of implementing telepsychiatry is the lack of a proper operational framework, which hinder its full practice. Therefore, it is important to integrate the overall stakeholder under a single umbrella to work in partnership so that the outreach of telehealth is increased and at the same time, a sustainable growth model is created. In addition to this, staffing along with a gathering of resources is also necessary to ensure that the health care professionals are able to learn the use of telepsychiatry. Therefore, training and educational programmes will be conducted in medical colleges and organisations to improve the skills and expertise of the health care professionals in the practice of telehealth. Examination of skills and know-how and the level of satisfaction can be measured through frequency or rating provided by patients, which can further help in identifying the gaps in the process, which fulfils the measurable aspect under the SAMRT objective model (Bjerke & Renger, 2017).

Accordingly, the goals and objectives are achievable as it requires proper communication and co-operation of the various stakeholders of the health care system. For instance, the partnership work with the government agency will help in creating community-based awareness regarding telehealth, which will eventually help to actively integrate telepsychiatry. In the same context, it can also be stated that the use of telepsychiatry can be fully implemented through policies and guidelines, which can guide or prescribe specific obligations for the psychiatrists to conduct their practice as per any given telehealth compliance policy, moreover, due to covid pandemic, temporary guidelines are already enforced, however, it requires more speculations.

The objective of the implementation is fully realistic as it can be realised from the fact that such research or project is needed in the overall health system considering the current environmental situation at the global level. Telepsychiatry is also a need for the stakeholders as the rural or remote areas do not receive an adequate proportion of mental health services. Therefore, catering to the mental health need through telepsychiatry is now recommended by most health professionals worldwide and at the same time, using appropriate technology the awareness among the stakeholders can be increased, which can eventually help in accessing the services of telehealth in rural and remote areas.  The aspect of timely achievement is challenging in the case of the current project, however, it can be stated that key milestones are a major part of the project that is required to be achieved to accomplish the overall aims and objective of the project.

Outcome

The aim and objective of the project are to ensure that it produces the essential awareness, which can eventually lay the foundation of implementing the education and training programme for initiating telepsychiatry practise using modern technological tools. Moreover, the major outcome of the project is that it may bridge the current gap in modernising psychiatry and generalise the use of technology and at the same time, increase the outreach of mental health services to promote healthy mental well-begin. The project will further help in creating a service delivery model, which can help to identify the different roles and the diverse stakeholders in the various operating activity of implementing telepsychiatry. In addition to this, it is necessary to state that the project can help health care students comprehend the use of telepsychiatry and gain a detailed insight into the overall scope of telepsychiatry and its sustainability.

 

Chapter 4: Project Milestone

Implementation plan and the key stages

Planning:

The overall resource requirements and their availability, which is mainly the data and information regarding the current research study, will be determined in the planning phase. The objective of the planning process is to communicate the roles and responsibilities of each project member along with the identification of deadlines and milestones to achieve.

Execution:

In the execution phase, each project member as per respective roles and duties will conduct the operating activities. These activities will include data gathering and compiling along with analysis of different data to verify its authentication. In the execution phase, the project leader will ensure that team communication is effective in order to further develop proper team coordination.

Controlling:

Followed by the execution phase the project activity will be monitored in the controlling phase. The project leader will check the activities and ensure that the tasks are completed within the project deadline. Moreover, the major objective of the controlling phase is to ensure that resources are used in an optimal manner with the least wastage and no exceeding of the project budget (Bjorvatn& Wald, 2018).

Closure:

The project closure will be based on the review of the project leader on the overall task and activities of the project to offer quality intact delivery of the project to board members.

Project obstacles and challenges

The key challenges that may arise in the given project are inadequate resources or data and information to provide detailed insight on the subject matter of the project. However, the available resources are relevant to the project as it enables to offer a detailed overview of the clinical process and its current need in the contemporary mental health system. The gap in literature can act as an obstacle in the project as there is not adequate research on the given topic. Regardless of the challenges, it can be stated that the use of technology and the growing need to address the use of remote clinical checks up to increase the outreach of the healing system can act as an opportunity for the project and offer a base to consider the full implementation of telepsychiatry in modern psychiatry practice.

Strength: ·         Relevant team ·         Availability of resources to conduct the research	Opportunity: ·         The rise in demand for telepsychiatry ·         The growing use of technology
Weakness: ·         Lack of awareness among various stakeholders ·         Lack of adequate research on telepsychiatry	Threat: ·         Inadequate control over the project deliverables ·         Lack of proper communication among the project team

Table 1: SWOT analysis

(Self-Created)

Project stage	Key activities	Timeframe (Weeks)	Milestone
Planning	·         Identification of project requirement ·         Establish the budget, milestones and deadlines ·         Determine the scope of the project	1-2	Assign roles and responsibilities
Execution	·         Manage the team ·         Determine the operating activity ·         Ensure proper communication	2-4	Stakeholder communication
Controlling	·         Determine the KPIs ·         Monitor change ·         Ensure optimum resource utilisation	1-3	Check project quality
Closure	·         Track and review the overall project activity ·         Document key data and information ·         Ensure service proper quality	1	Project delivery

Table 2: Project Timeline

(Self-Created)

Team building

Team recruitment for the project will be based on the determination of relevant skills and know-how, wherein, communication and technical skills are highly essential. However, in order to construct an effective and efficient project team PMIB model of team building will be considered (Miller et al. 2018). As the members of the team will be assigned roles and responsibilities relevant to their skills and expertise. Similarly, allowing team communication, which is an exchange of views and ideas within the team. Based on mutual consent members will identify working norms and will perform in a motivating environment will support from the project leaders.

Stakeholder analysis

Primary stakeholders	Secondary stakeholders	Key stakeholders
·         Board and the management ·         Project leader	·         Community ·         Approval committee	·         Project team ·         Health officials ·         Government agencies

Table 3: Stakeholder identification

Source: (Self-Created)

The role of the primary stakeholder is to scrutinise the project and administer the various task and activities within the project. The secondary stakeholders will engage in communication with the project team and the primary stakeholders, wherein the approval committee will identify any discrepancies within the project and the community along with the key stakeholders will provide information and data for the project.

Communication strategies

Communication strategies will be based on the core objective of improving the coordination level among the project members. Therefore, the use of online collaboration tools is considered as these tools are effective in providing seamless communication at any given point of time and also allows sharing data and information remotely. Apart from that, project members will be given chance to offer their individual views and opinions to identify any challenges and gaps, which can be rectified accordingly (Anderson et al. 2019).

Change management

The process of managing change in an ongoing project can be challenging, however, according to the model of change management, it is recommended that prior communication should be provided in the event of implementing a change (Dzwigol et al. 2019). Accordingly, it is also necessary for the project leaders to provide training to the project team to ensure that the members are able to adapt to any possible change.

Risk management and mitigation

The timely deliveries of the project can be a major risk factor for the project, however, implementing a proper monitoring regime can help in achieving the project task by the due deadlines (Muriana&Vizzini, 2017).

Ethical consideration

The project aims to implement telepsychiatry by using modern technological tools, thus, based on the principles of beneficence, the moral obligation is to highlight the possible harms of using telepsychiatry in a concisemanner in the overall project. Accordingly, implying the nonmaleficence principle of ethics, it can be said that the project does not consider any biased notion that displays telepsychiatryas a modern solution for traditional psychiatry rather the research uses evidence-based information to justify its claims and highlight the barriers of implementing telepsychiatry. In addition to this, the data and information used in the project are publicly available as most of the sources are web-based materials in relation to the core subject matter, which is at the same time, approved by relevant institutions (Arifin, 2018).

Chapter 5: Finance and rationale for funding

Cost breakdown

Training	1000
Technology	1600
Employee salary	2500
Transport	1100
Internet reimbursement	1000

Table 4: Cost breakdown

Source: (Self-Created)

The funding for the project is critical as the various stages of the project as provided in the table above is significant for the project success. Training for the staff is necessary to improve the skills and expertise of the team and technology is required to ensure seamless communication and operating activity is begin carried out in an efficient manner. Remuneration in form of salary should be provided to the employees for their contribution towards the project, which can help in enhancing the motivation and commitment level. Moreover, transportation cost is included as team members will require to mobilise and verify data sources and may even require to conduct an interview with primary sources for gathering data and analysing the same. Lastly, internet reimbursement is required a majority of the communication and research work will be carried through web sources and it can help in conducting and delivering the project faster.

The further cost-benefit of the project may relate to the valuation of improved quality of life due to the use of technology in modern psychiatry practice. Moreover, for consumers in remote areas the use of telepsychiatry can reduce the cost related to transportation and the given project will help in determining the feasibility of telepsychiatry in the current era allowing health care professionals to gain a deeper insight into the subject matter and consider the full implementation of the same.

The project can be further funded externally as it aims to produce results and will be freely available to relevant stakeholders and can be publishable in case the current research is approved under relevant academic discipline.

Chapter 6: Evaluation plan

Project objectives and goals

The major goal of this proposal is to furnish a constructive framework for the development of tele psychiatry as well as ensure the integration of stakeholders towards learning the complete process of tele psychiatry thus emphasizing policies and guidelines towards implementing it under rural sections. Besides this the major objectives of this project lies towards developing the awareness and utilization for tele psychiatry along with emphasizing upon the constructive use of resources. The goal of this proposal is to implement an efficient service model for the implication and modernizing of telehealth services as well as ensure a diverse management framework to induce tele psychiatry functions.

Evaluation questions

• How communication strategies can be improved among stakeholders so that education of tele psychiatry gets better versatile as well as barrier to access it might be linear ?
• How can coordination among stakeholders be improved for devising policies for adhering the process of tele psychiatry ?
• How can recruitment of team be better improvised for raising up of infrastructure along with viewing of complete use of resources?
• How cost breakdown could well be implemented and risk can well be mitigated to afford licensing along with implementing of rural population with tele psychiatry?

Evaluation methods

Curtailing the source of risks into timely delivery of the project like tele psychiatry majorly under rural sections an appropriate tool is to conduct a SWOT analysis for the same. In the opinion of Hill&Westbrook(1997), determining thestrength, weakness, opportunities along with the stigmas of threat upon a particular arena ensures enhancing the milestones of a project by sketching the positivity’s of the stakeholders as well as their insights into manifesting the project development. Analysing this fact it is to be assured that if SWOT analysis is to be conducted upon the regime where tele psychiatry is to be improvised the risks regarding the delivery of the project could be well curtailed as a foreseen illustration of threats under that regime has been accessed. Communication is widely important towards accessing the education of the stakeholders regarding the wide implementation of tele psychiatry and its resources as well as to develop the understanding of knowledge stakeholders incurs while manifesting policies for tele psychiatry. Evaluating the communication scenario could be amended by a Dropbox scenario for accumulating of feedbacks. The feedbacks accumulated from the stakeholders within the Dropbox shall be analysed to understand the knowledge stakeholders incur while manifesting of policies. Applicant tracking system is one of the highly effective tools for team building and its recruitment within applicants can be analysed based upon data provided and thus found matching or non-matching for a job source. This tool analyses the applicant’s background and lets a numerical percentage of the proportion matching with the job source which finally makes it much easy for recruiters to understand the value of each applicant. With an effective evaluation of the team building process scenario there would be constructive use of the resources as well as a methodical plan to develop the managerial framework regarding the implementation of tele psychiatry prospects. Parametric estimating will be one among the most effective ways to evaluate the project cost breaking down it under numerous fractions to deal with hovering rise of financials within the project. As the problem estimated was the heavy cost of licensing for the same thus with parametric estimating process the burden of this cost could well be curtailed down under varied fractions.

Gantt chart

Evaluating Cost breakdown	Week 1	Week 2	Week 3	Week 4	Week 5	Week 6	Week 7
Team building
Evaluating of communication tools
Analysing stakeholder education
SWOT analysis for reducing risk of delivery

 

Reporting mechanism and other methods to disseminate stakeholders

The only method which will be highly effective to construct the development of findings by the stakeholders is the establishment of program and policy brief’s. With the program and policy brief into effect there will policies under which the stakeholders findings could well be disseminated and analysed thus developing a well systematic managerial framework for the same. Researcher Kebede(2014), through publishing of the program and project briefs the stakeholders will adhere their findings based upon these brief’s as well as summarize their development articulating the major objectives of the project. This research also clarifies that the best method to address the progress of the complete project is to account a press release for the same which will further help into manifesting the target audiences regarding the delivery of the project. Thus accounting of this evidence it is better ensured that through a press release it might be one of the best project reporting mechanism as it helps the general public including the targeted audiences to gather information regarding the development of the project implementation.

Chapter 7: Mainstreaming the project

The exit strategy of the project will be based on a sustainable outlook, which is with the objective of working with the project in future and gaining knowledge from the current project for further application in the future of health care management.

In case the project is successful, the process of embedding the same into an organisation will be under a systematic model. In doing so, the project leader will engage in communication with the stakeholders. This implies that the findings of the research and the process of implementing the telepsychiatry system will be based on combined decisions and views of the stakeholders. Moreover, in order to embed the same into an organisation, it is necessary to consult with partners and stakeholders regularly for determining the effectiveness of the process identified in the research.

In addition to this, it is also important to monitor the sustainability aspect of the project, which is ensuring that the work conducted is able to provide lasting results or providing relevant health benefits. In case the findings and the aims of the project are fulfilled, the information can be transferred to stakeholders through communication mediums using web platforms or conducting programmes for awareness as it can help to increase the outreach and disseminated the result of the research more widely.

The project can be mainstream once the project is approved by a relevant health committee highlighting the feasibility of the project and its significance in professional health care management. In case the project is embedded in the organisation the major benefit for an organisation will be in terms of management, which is the ability to manage a large volume of patients and using technology will improve record-keeping and attending remote patients, without compromising the regular inflow capacity of the health organisation even at times of any environmental crisis. In terms of health benefits, it can be stated that the stakeholders with mental health issues can directly consult with the care professional through remote application and the care professional at the same time will monitor the health status remotely and serve the patient in case of emotional triggers and any mental issues.

The project is sustainable as it is based on the enhancement of the health care system, which is psychiatry using technology or technological tools. Thus, continuous practice and study on the subject itself open opportunities for the project to be implemented or utilised in health care studies for the health care professional to comprehend the use of technology for offering service to the overall stakeholders. As stated earlier, relevant or proper approval of the project in academic literature can help the project to be sourced for funding to further determine the type of technologies that is more relevant and accurate to conduct effective telepsychiatry.

Further, it can be recommended that the use of technology or integrating technology for health care in psychiatry needs to be included in the training and academic curriculum of the health care professionals for its better comprehension and implementation.

Chapter 8: Reflexivity

Using the Gibbs reflective model the overall experience of personal learning will be shared as it provides the framework that can help in illustrating different stages of personal learning and gathering of skills while conducting the project (Adeani, Febriani&Syafryadin, 2020).

Description

The project is based on the application of technological tools and techniques that can improve the practice of modern psychiatry. Thus, scrutinising the topic has led to the introduction and at the same time awareness of a different technology that has the potential to improve the health system as a whole. Therefore, I can state that the knowledge of these techniques will help in further conducting research on feasible technology that provides the convenience of service to the overall health care system. Moreover, I have gained knowledge on the potential of technology in improving the health care system, which I further believe will provide the platform for me to avail service through telehealth.

The project has a vast scope thus; I have gained the experience of positive factors that relate to the implementation of telepsychiatry and ways different stakeholders may react to the application of telepsychiatry. Apart from the subject matter, I would also like to state that working with a team has helped me to be a team player and achieve objectives as a team. In addition to this, I have experienced the significance of being professional to achieve project goals and objectives, which at the same time helps in delivering the project with proper quality.

Feelings:

I believe the experience that I have gained will help me to be more professional in future while I engage in a project or research work. Thus, I have an optimistic feeling towards the project, which makes me motivated.

I have also learnt the need of begin ethical while conducting any work in order to ensure that needs and interest of each stakeholder is duly addressed. Moreover, ethical consideration is important as I feel, it provides authenticity to the project and the general audience can rely on the information in order to make logical assumptions and decisions regarding the core topic of the project.

I further have the feeling that there should be more projects as such due to the rising demand for improving the health care system. Therefore, I feel that using technology and its proper management can help to create a sustainable model for the overall health care system. Accordingly, the project also identifies the management issues related to the implementation of telepsychiatry, which I feel is a learning opportunity as I have experienced the need for management practice to engage professionally in the field of health care practice. Moreover, the knowledge of management practice will help in creating more opportunities as I can opt for different service sectors within the health care system.

Evaluation:

The experience in terms of working in the project is majority positive, which is the ability to be a team player along with begin able to co-operate with different stakeholders and ability to collect information from different stakeholders and using the same for mutual benefit. In addition to this, I have also learnt that working in a team can also cause a conflict of interest and there is a potential for lack of co-operation and coordination with the project team members. Therefore, I believe that engaging in communication with team members and having leadership qualities can help in overcoming such barriers.

Analysis:

I believe that the major cause of the project went well is the proper division of work as the project leader assigned the roles and responsibilities as per individual skill and expertise, which helped in eliminating conflict and confusion. Thus, I have analysed when I deliver tasks based on my strengths and capabilities the quality is intact. Moreover, this approach also helps in time management as the training for the team members can be optimised and further stress is also reduced.

Moreover, each team member was allowed to offer their opinions and views, which is essential to ensure proper team communication and further work as a group.

Conclusion:

From the overall project, I acquired the knowledge of management and ways to assign roles and responsibilities and monitor work to met deadlines. However, I have noticed that to improve as a team player I need to work more with my communication skills as communication is a key to positive relation-building, which can also influence my future employability. Apart from that, the project has displayed the need for change and ways to adapt to change, thus, I feel that I am adaptive in nature, which is my strength; however, I need to be more flexible in my approach when it comes to the team project.

Action plan:

In the event of engaging in a similar project, I feel that I will be able to locate issues or barriers in communication with team members. Similar, critical appraisal of information is based on frameworks provided by relevant authorities highlighting certain guidelines under any given guidelines if the information is justified then the information or data can be published or provided for public consumption. Similarly, I have also learnt that using management tools is essential to manage a project team, which can help in time management that as meeting deadlines or delivering the project under a stipulated timeframe.