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      The hope and hype of telepsychiatry during the COVID-19 pandemic

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          Abstract

          During the COVID-19 pandemic, telepsychiatry services have received increased attention and had unprecedented growth worldwide. Governments have encouraged academic institutions, professional associations, entrepreneurs, and companies to provide telemedical and telepsychiatry services and relaxed existing rules and regulations. 1 Mental health professionals and companies are using Zoom, Skype, WhatsApp, Facebook, and other popular freely available platforms to provide online psychiatric services rather than developing a secured and dedicated hotline or mobile phone app with the help of digital health experts and IT professionals. Even non-professional personnel can provide so-called telepsychiatry services as there are no regulatory bodies in many low-income and middle-income countries, such as in Bangladesh. Though this type of basic telepsychiatry service is gaining popularity among mental health professionals and clients in Bangladesh, we should not underestimate the risk and long-term negative consequences of these unplanned, sporadic, and unsupervised services. Health professionals put their privacy and personal life at risk by sharing their phone numbers and social media profiles publicly for telepsychiatry services. 2 By sharing their personal information health professionals could be exposed to overwhelming numbers of intrusive and unproductive calls and messages. Telepsychiatry could be most helpful for people who are poor, refugees, 3 or living in remote and rural areas in Bangladesh. However, their access to telepsychiatry services might be limited by their inability to purchase a suitable device. Their access could be further restricted by having poor or no mobile network or internet coverage, being exposed to social stigma, and living in a financial crisis. The financial dynamics are becoming more complicated because economic collapse is forcing the vulnerable community to prioritise food over mental health care. There are insufficient data on the acceptability, reliability, and interoperability of digital health services, or the incentives of patients and professionals to use them. 4 The hype of telepsychiatry might create an extra burden to existing health-care systems as they will need to monitor and control telepsychiatry services. The accelerated investment of government and other stakeholders in telepsychiatry services might deprive other vital sectors in the health-care systems of funding. Telehealth is a disruptive process 5 and without appropriate supervision and monitoring, it can lead to negative consequences. The tendency to provide false and misleading information during teleconsultation is another threat to this emerging health sector in Bangladesh. Professionals should consider the different cognitive skills and knowledge of their clients to ensure their information is clearly and completely received. As telepsychiatry services gain popularity, the relevant policy makers and device manufacturers or service providers should recognise the digital divide and consider the ethical challenges of ensuring equitable access and privacy protection. Both the clients and professionals need training and practice to optimise the benefits of the service. Telepsychiatry services should be culture and context specific, keeping the clients at the centre of care. Governments and regulatory authorities should develop and enforce strategies and recommendations for appropriate, risk-based regulatory frameworks on telepsychiatry. Telepsychiatry can serve millions of people who have or are at risk of developing a mental illness during the COVID-19 pandemic and afterwards; however, the services need to be evidence based, organised, and sustainable.

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          Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom

          Background Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale. Objective The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015. Methods The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem. Results We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness. Conclusions Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale.
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            Did Bangladesh miss the opportunity to use telepsychiatry in the Rohingya refugee crisis?

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              Author and article information

              Contributors
              Journal
              Lancet Psychiatry
              Lancet Psychiatry
              The Lancet. Psychiatry
              Elsevier Ltd.
              2215-0366
              2215-0374
              23 July 2020
              August 2020
              23 July 2020
              : 7
              : 8
              : e50
              Affiliations
              [a ]Telepsychiatry Research and Innovation Network, Dhaka 1215, Bangladesh
              [b ]Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
              [c ]Child, Adolescent, and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
              [d ]Department of Computer Science, University of Toronto, Toronto, ON, Canada
              Article
              S2215-0366(20)30260-1
              10.1016/S2215-0366(20)30260-1
              7377699
              © 2020 Elsevier Ltd. All rights reserved.

              Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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