Telepsychiatry in the digital age: bridging distance, enhancing access, and reimagining mental health care-a perspective from Türkiye

Abstract

Telepsychiatry has transitioned from a supplementary modality to a sustained component of contemporary mental healthcare, driven by technological advancement, workforce shortages, and the COVID-19 pandemic. This narrative review synthesizes current evidence on clinical effectiveness, service models, technological integration, and ethical–legal considerations, and contextualizes these domains through institutional implementation experience in Türkiye. Across major diagnostic groups, including mood, anxiety, psychotic, neurodevelopmental, and substance use disorders, published studies generally indicate comparable outcomes and patient satisfaction to face-to-face care when delivered within structured clinical frameworks. We further articulate the theoretical foundations of clinical equivalence, emphasizing language-mediated therapeutic mechanisms, alliance formation in video-based settings, and behavioral factors influencing adherence. The manuscript introduces a system-level perspective for Türkiye, positioning telepsychiatry as a capacity-extending model within geographically uneven workforce distribution. Institutional applications, including disaster response, postpartum screening pathways, and hybrid specialty clinics, illustrate context-sensitive implementation strategies. Emerging innovations such as digital phenotyping, artificial intelligence, and virtual reality are discussed alongside regulatory, equity, and data governance considerations. We conclude that telepsychiatry represents not merely an emergency substitute but an increasingly integrated and policy-relevant model of care.

Keywords

telepsychiatry / digital mental health / virtual care models / psychiatric teleconsultation / health technology innovation

References

[1] World Health Organization. Consolidated telemedicine implementation guide. World Health Organization ; 2022.

[2] OECD. Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023.

[3] Yılmaz S, Koyuncu Aydın S. Why is Turkey losing its doctors? A cross-sectional study on the primary complaints of Turkish doctors. Heliyon. 2023; 9:e19882.

[4] El Hayek S, Nofal M, Abdelrahman D, Adra A, Al Harthi M, Al Shamli S, et al. Telepsychiatry in the Arab World: A Viewpoint Before and During COVID-19. Neuropsychiatr Dis Treat. 2020; 16:2805-15.

[5] Moulaei K, Sheikhtaheri A, Fatehi F, Shanbehzadeh M, Bahaadinbeigy K. Patients’ perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients. BMC Med Inform Decis Mak. 2023; 23:261.

[6] Lin LA, Casteel D, Shigekawa E, Weyrich MS, Roby DH, McMenamin SB. Telemedicine-delivered treatment interventions for substance use disorders: A systematic review. J Subst Abuse Treat. 2019; 101:38-49.

[7] American Psychiatric Association. Psychiatrists Use of Telepsychiatry During COVID-19 Public Health Emergency. American Psychiatric Association ; 2021.

[8] OECD. A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, OECD Health Policy Studies. Paris: OECD Publishing; 2021.

[9] Liebson E. Telepsychiatry: Thirty-Five Years’ Experience. Medscape Psychiatry Ment Health eJournal. 1997.

[10] Stuart J. Little Hans and Freud’s self-analysis: a biographical view of clinical theory in the making. J Am Psychoanal Assoc. 2007; 55:799-819.

[11] Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry. 2016; 6:269-82.

[12] Shore JH, Hilty DM, Yellowlees P. Emergency management guidelines for telepsychiatry. Gen Hosp Psychiatry. 2007; 29:199-206.

[13] Nieder TO, Renner J, Sehner S, Pepić A, Zapf A, Lambert M, et al. Effect of the i²TransHealth e-health intervention on psychological distress among transgender and gender diverse adults from remote areas in Germany: a randomised controlled trial. Lancet Digit Health. 2024; 6:e883-93.

[14] Karaş H. Kitlesel Travmalarda Telepsikiyatri. In: Yüksel Ş, Başterzi AD, editors. Kitlesel Travmalar ve Afetlerde Ruhsal Hastalıkları Önleme, Müdahale ve Sağaltım Kılavuzu. Ankara: Türkiye Psikiyatri Derneği Yayınları; 2021. pp. 259-63.

[15] Colombo D, Fernández-Álvarez J, Patané A, Semonella M, Kwiatkowska M, García-Palacios A, et al. Current State and Future Directions of Technology-Based Ecological Momentary Assessment and Intervention for Major Depressive Disorder: A Systematic Review. J Clin Med. 2019; 8:465.

[16] Mental health [Internet]. World Health Organization; [cited 2024 Aug 21]. Available from:https://www.who.int/health-topics/mental-health#tab=tab_2

[17] Hanehalkı Bilişim Teknolojileri (BT) Kullanım Araştırması, 2023 [Internet]. Tüm hakları saklıdır; [cited 2024 Aug 21]. Available from:https://veriportali.tuik.gov.tr/tr/press/49407

[18] ATA’S QUICK-START GUIDE TO TELEHEALTH DURING A HEALTH CRISIS [Internet]. [cited 2024 Aug 24]. Available from:https://www.jshfirm.com/wp-content/uploads/2020/04/ATA_QuickStart_Guide_to_Telehealth_4-10-20.pdf

[19] Karaş H, Kucukparlak I, Erkan A, Oral ET, Vahip S. TÜRKİYE PSİKİYATRİ DERNEĞİ TELEPSİKİYATRİ UYGULAMA REHBERİ. Türkiye Psikiyatri Derneği; 2022.

[20] T. C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. KRONİK HASTALIKLAR İÇİN UZAKTAN SAĞLIK HİZMETİ SUNUMU KILAVUZU. 2022.

[21] Shaker AA, Austin SF, Storebø OJ, Schaug JP, Ayad A, Sørensen JA, et al. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health. 2023; 10:e44790.

[22] Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health. 2013; 19:444-54.

[23] Zimmerman M, D’Avanzato C, King BT. Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment. J Affect Disord. 2023; 323:624-30.

[24] Echelard J. Use of Telemedicine in Depression Care by Physicians: Scoping Review. JMIR Form Res. 2021; 5:e29159.

[25] Berryhill MB, Halli-Tierney A, Culmer N, Williams N, Betancourt A, King M, et al. Videoconferencing psychological therapy and anxiety: a systematic review. Fam Pract. 2019; 36:53-63.

[26] Gareayaghi A, Tatlıdil E, Şişman E, Polat A. Post-Earthquake PTSD and the Role of Telepsychiatry: A Six-Month Follow-Up Study After the 2023 Kahramanmaraş Earthquakes. Medicina (Kaunas). 2025; 61:1097.

[27] Ruskin PE, Silver-Aylaian M, Kling MA, Reed SA, Bradham DD, Hebel JR, et al. Treatment outcomes in depression: comparison of remote treatment through telepsychiatry to in-person treatment. Am J Psychiatry. 2004; 161:1471-6.

[28] Bauer MS, Krawczyk L, Miller CJ, Abel E, Osser DN, Franz A, et al. Team-Based Telecare for Bipolar Disorder. Telemed J E Health. 2016; 22:855-64.

[29] Farrell A, George N, Amado S, Wozniak J. A systematic review of the literature on telepsychiatry for bipolar disorder. Brain Behav. 2022; 12:e2743.

[30] Kasckow J, Felmet K, Appelt C, Thompson R, Rotondi A, Haas G. Telepsychiatry in the assessment and treatment of schizophrenia. Clin Schizophr Relat Psychoses. 2014; 8:21-7A.

[31] Rotondi AJ, Haas GL, Anderson CM, Newhill CE, Spring MB, Ganguli R, et al. A Clinical Trial to Test the Feasibility of a Telehealth Psychoeducational Intervention for Persons With Schizophrenia and Their Families: Intervention and 3-Month Findings. Rehabil Psychol. 2005; 50:325-36.

[32] Rotondi AJ, Sinkule J, Haas GL, Spring MB, Litschge CM, Newhill CE, et al. Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness. Psychol Serv. 2007; 4:202-24.

[33] Clarke CS. Telepsychiatry in Asperger's syndrome. Ir J Psychol Med. 2018; 35:325-8.

[34] Palmer NB, Myers KM, Vander Stoep A, McCarty CA, Geyer JR, Desalvo A. Attention-deficit/hyperactivity disorder and telemental health. Curr Psychiatry Rep. 2010; 12:409-17.

[35] United Nations Office on Drugs and Crime. World Drug Report 2024. 2024.

[36] Kamma HK, Alabbas M, Elashahab M, Abid N, Manaye S, Cheran K, et al. The Efficacy of Telepsychiatry in Addiction Patients: A Systematic Review. Cureus. 2023; 15:e38133.

[37] American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Telepsychiatry and AACAP Committee on Quality Issues. Clinical Update: Telepsychiatry With Children and Adolescents. J Am Acad Child Adolesc Psychiatry. 2017; 56:875-93.

[38] Stephan S, Lever N, Bernstein L, Edwards S, Pruitt D. Telemental Health in Schools. J Child Adolesc Psychopharmacol. 2016; 26:266-72.

[39] Sisman E, Cerit C, Polat A. Hidden cracks from the largest earthquake of Türkiye: secondary traumatic stress among psychosocial support teams. Eur J Psychotraumatol. 2025; 16:2510155.

[40] Golkaramnay V, Bauer S, Haug S, Wolf M, Kordy H. The exploration of the effectiveness of group therapy through an Internet chat as aftercare: a controlled naturalistic study. Psychother Psychosom. 2007; 76:219-25.

[41] Buğrahan Gürcan M, Yıldız M. Online Group Therapy Experience with Schizophrenia Patients During the Pandemic Period. Alpha Psychiatry. 2021; 22:328-9.

[42] Mahmoud H, Naal H, Cerda S. Planning and Implementing Telepsychiatry in a Community Mental Health Setting: A Case Study Report. Community Ment Health J. 2021; 57:35-41.

[43] Telepsikiyatrinin avantajları ve uygulaması ile ilgili zorluklar [Internet].Progress In Mind; [cited 2025 Jun 13]. Available from:https://turkey.progress.im/tr/content/telepsikiyatrinin-avantajlari-ve-uygulamasi-ile-ilgili-zorluklar

[44] Basavarajappa C, Grover S, Dalal PK, Avasthi A, Kumar CN, Manjunatha N, et al. Perceived advantages and disadvantages of telepsychiatry - An online survey of psychiatrists in India. Indian J Psychiatry. 2022; 64:93-7.

[45] Bobkov A, Cheng F, Xu J, Bobkova T, Deng F, He J, et al. Telepsychiatry and Artificial Intelligence: A Structured Review of Emerging Approaches to Accessible Psychiatric Care. Healthcare (Basel). 2025; 13:1348.

[46] Hasan M. Virtual reality in telepsychiatry is a new horizon for immersive mental health therapy. Middle East Curr Psychiatry. 2024; 31:76.

[47] Security Issues [Internet].American Psychiatric Association; [cited 2025 Jun 13]. Available from:https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/security-issues

[48] USTA MB, ŞAHİN İ. COVID-19 Pandemic and Child and Adolescent Mental Health. Turk Klin COVID 19. 2020; 1:136-40.

[49] Psychologists reaching their limits as patients present with worsening symptoms year after year [Internet]. American Psychological Association; c2026 [cited 2025 Jun 13]. Available from:https://www.apa.org/pubs/reports/practitioner/2023-psychologist-reach-limits