The RCPsych Article of the Month for October is ‘Digital psychiatry and COVID-19: the Big Bang effect for the NHS?‘ and the blog is written by author Subodh Dave, Seri Abraham, Roshelle Ramkisson, Shevonne Matheiken, Anilkumar S. Pillai, Hashim Reza, J. S. Bamrah and Derek K. Tracy published in BJPsych Bulletin.

One thing is certain. Life will never be the same again after this devastating pandemic caused by Covid19. But in this new norm, not all is bad. Certainly, clinical psychiatry and the interaction of psychiatrists with patients and with colleagues has become significantly better despite the challenges of digital exclusion and digital poverty. For once there is real choice, for patients as well as for psychiatrists. A parallel pandemic of digital psychiatry has imploded across the globe, and so virtual consultations have become a reality.

As the country went into a lockdown, the only way to connect with psychiatrists in different parts of the UK was through remote means. Within this group of authors, an emerging idea was, does the literature support this ‘new’ type of working? It seemed quite alien to us to work in this way, because although consulting by telephone was known to occur it was sporadic, ill developed and was not counted as ‘currency’ by commissioners of services. Video consultations were even more rudimentary in development.

A casual conversation (over Zoom we hasten to add) resulted in much enthusiasm over wondering where literature would lead us. Is it effective, let alone cost-effective? What are the potential  regulatory barriers, technological hurdles and human factors to digital working? What do patients think about seeing their psychiatrists virtually, and not physically? What are the pitfalls? All these things matters hugely in our over-regulated world, but there was no doubt that there was a surge of universal enthusiasm amongst the group who authored the article. We were open to business again for routine reviews! The dread of sitting at home twiddling thumbs receded, and SCRABBLE could stay on the dusty shelf for a bit longer.

The video platforms Zoom and MS Teams have become ingrained in our every day professional lives. How on earth did we live without them before? The novelty of saving travel time, running late because there are no hospital car parking spaces, the flexibility of working from home (and yes, we have all seen an occasional baby stray into the frame or heard a dog bark and accepted it as part of the new norm), being able to share slides and rating scales virtually, using the chat facility to share links to websites – these have all been part of that digital journey many of us have adopted. Not to talk of course of doing our bit for climate change by reducing our collective carbon footprint.

Digital psychiatry is unstoppable. What we need is the technical framework for patients and for clinicians to enable this, and for the government to ensure that this is not just the preserve of the privileged, rather it reaches out to all communities.  ut we cannot just lay the responsibility on others. The College is at a good place to ensure that standards and a governance framework are set for remote consultations, that trainees can have the same supervision that they would have in face-to-face clinics, and patients can feel comfortable and trusting with this method of assessment or review. But digital advances are not just about virtual consultations. The newly established Digital Special Interest Group should take a lead in ensuring that digital technology whether related to digital apps or Artificial Intelligence informed treatment algorithms, is leveraged appropriately to improve patient outcomes. That would be a real trendsetter!

Subodh Dave and colleagues argue that the changes wrought by COVID-19 need not all be negative. The validity and utility of digital psychiatry has been well demonstrated over many years but not widely appreciated outside particular geographic areas which adopted it of necessity. Now, however, its widespread use within the NHS appears ineluctable. The authors synthesis the evidence, discuss institutional and individual barriers to wider implementation, its limits and disadvantages, and consider what the future holds. While every innovation has its critics, the new mixed model of remote and in-person working brings benefits to patients and services which deserve to outlive the pandemic.

Dr Norman Poole,

BJPsych Bulletin Editor in Chief