Relevance of the Indian telemedicine guidelines 2020 in psychogeriatric care: A critical appraisal

Abstract

Older people with psychiatric illnesses face unique challenges in terms of clinical, sociocultural, and environmental factors. The Ministry of Health and Family Welfare, Government of India (MoHFw, GOI), has released telemedicine guidelines in April 2020, closely followed by a telepsychiatry operational guidelines as a collaborative effort of the National Institute of Mental Health and Neurosciences, Bengaluru, and the MoHFw, GOI. The current article presents a critical analysis of the provisions in these guidelines relevant to psychogeriatric care. The gray areas in the existing protocols which may hamper their applicability and accessibility in older adults include digital connectivity, continuity of care, patient autonomy and capacity assessment, medical comorbidities, evaluation of dementia, confidentiality, and teleconsultations in the institutionalized elderly. Preexisting challenges are seen to be compounded by the coronavirus disease 2019 pandemic, in addition to the onset of newer psychosocial and clinical adversities. The article also highlights certain recommendations for possible modifications of the guidelines in future. The telepsychiatry guidelines provide a paradigm shift in mental health care. However, the lacunae involved in the care of vulnerable groups such as the geriatric population based on these guidelines need to be reconsidered by all levels of stakeholders supported by evidence-based research.