The greatest promise of telepsychiatry is providing a feasible alternative for the existing and grossly scarce mental health services. The health systems around the world are grappling with huge numbers of persons with mental disorders who require professional care and extremely small numbers of mental health care providers. Epidemiological studies across the world have shown that mental health disorders are highly prevalent with some estimates as high as lifetime prevalence of 49% in the adult population.[6
] Even the older studies such as NIMH-Epidemiological Catchment Area study[7
] done in the US reported lifetime prevalence of psychiatric morbidity of 322/1000 population. Epidemiological studies conducted in India report varying prevalence rates, ranging from 9.54 to as high as 370 per 1000 population.[8
] The two major meta-analyses from India place the prevalence rates at 58.2 per 1000 general population[9
] and at 73 per 1000 general population, with a rural morbidity at 70.5 and urban morbidity at 73 per 1000.[10
] It has been further asserted that the prevalence of mental disorders reported in epidemiological surveys can be considered lower estimates rather than accurate reflections of the true prevalence in the population.[8
] Despite the high prevalence of mental disorders in the community and recognition of the ensuing disability due to these disorders placing these in the first 10 major illnesses contributing to the disability-adjusted life years, service provision for their diagnosis and management is appalling. In 2002, the mental health resource mapping in India revealed that 2219 psychiatrists were available nation-wide,[11
] while the more recent estimates put the figure at 2800 – a dismal marginal increase. This is in stark contrast to the estimated requirement of 9696 professionals.[12
] The number of psychiatrists, psychiatric nurses, psychologists, and social workers are 0.2, 0.05, 0.03, and 0.03 per 100,000 population, respectively, and the total psychiatric beds are 0.25 per 10,000 population.[13
] Only 29% of mental health needs are met by the available manpower. Furthermore, this small scale of infrastructure and human resources are unequally divided with huge urban–rural discrepancies.[13
] Most mental health care is based in institutional settings and not in community setting. Moreover, there is no link between the tertiary care and the primary care. People living under socioeconomic deprivation have the highest need for mental health care but lowest access to it, thus further compounding the mental health gap.[14
Such a gross mental health gap appears to be insurmountable in the near future with measures such as expansion of existing resources (increasing the number of training institutes and upgrading and strengthening the existing ones, increasing psychiatric training component during under-graduate course, and training of primary health care workers) alone as these have practical difficulties in implementation and have a long gestation period. At this juncture, with the multiple problems of unmet needs, scarce resources, urban–rural and tertiary and primary care divide, and no easy and tangible solutions, the ongoing technological advancements in India (India being considered an information technology giant) are a blessing. Appropriate use of technology for delivering mental health services can be a turning point in the mental health care system.
Hence, it becomes imperative that we review and apprise ourselves with the existing developments, shortcomings, and challenges in the field of telepsychiatry and debate its potential in our setting. For this purpose, we have extensively reviewed the existing literature on telepsychiatry/tele-mental health. Though telepsychiatry in its broader sense includes various technologies utilized for the purpose of delivering mental health at a distance, the literature has focused more on video-conferencing as a mode of communication. Such an approach hinders exploring other existing technologies which might prove to have more utility in a variety of settings. Keeping in mind these limitations, we have initially presented the modes of communication used in telepsychiatry followed by a more comprehensive review of the literature including studies using different technologies, though as mentioned earlier, literature appears to be biased in favor of video-conferencing. For the review of literature, the keywords ‘telepsychiatry,’ ‘tele-mental health,’ ‘telemedicine,’ ‘video-conferencing’ and ‘psychiatry,’ ‘internet’ and ‘psychiatry,’ ‘electronic mail/e-mail’ and ‘psychiatry,’ ‘synchronous,’ ‘asynchronous,’ ‘feasibility,’ ‘acceptability,’ ‘satisfaction,’ ‘reliability,’ ‘clinical outcome,’ and ‘cost-effectiveness’ were used in various combinations. We included review articles and meta-analyses besides individual studies. We excluded studies that did not describe the delivery of educational, clinical, or supervisory services through any mode of telepsychiatry (pertained mainly to ‘internet’ and ‘e-mail’).