[NYAPRS Enews] HC: Telepsychiatry Makes Care a 'Video Screen Away'

[Matt Canuteson]

Mental Health Help For Patients Is Just Video Screen Away

Physicians Turn To Technology For Virtual Home Visits

By BILL MURPHY Houston Chronicle   September 10, 2008


Fred Ramirez, a psychiatric nurse, watches a patient as she relates that
her medicine hasn't been completely effective.

 

He notes the tremors in her hand, studies her face and, in the end,
agrees with her.

 

All this happens with patient and counselor separated by 400 miles -
Ramirez in his office at JSA Health in Houston and the patient at a
clinic in the West Texas town of Big Spring.

 

Welcome to the burgeoning field of telepsychiatry, where couches in
psychiatrists' offices have given way to video screens.

With a shortage of mental health workers in Texas and nationwide,
patients needing treatment are relying on counselors hundreds, if not
thousands, of miles away.

 

Children in El Paso, ranchers in West Texas and thousands of state
prison inmates are among the patients availing themselves of
telepsychiatric services.

 

"Telepsychiatry will rapidly become the fastest-expanding segment within
psychiatry as a whole," said Avrim Fishkind, president and chief medical
officer of JSA Health, which specializes in emergency telepsychiatric
evaluations for emergency rooms, rural mental health centers, schools
and jails. 

 

"Psychiatrists cannot possibly cover the 4,700 medical emergency rooms,
inpatient units and intensive care units in the United States. In one
day, I saw patients in four different Texas clinics that would have
required me to drive over 600 miles in my car in a single day."

 

Fast-growing sector

Telepsychiatry is among the two fastest-growing sectors of telemedicine,
said Jon Linkous, chief executive of the American Telemedicine
Association. (The other is the monitoring of chronically ill patients
through video conferencing.) 

 

Telemedicine's growth, he said, can be seen in the number of
videoconferencing hubs set up mostly by hospitals. There are 200 hubs,
where doctors and specialists treat patients, at 3,000 clinic, schools
and prisons nationwide.

 

The growth of telepsychiatry in Texas, in part, is related to the
shortage of mental health workers - 184 of Texas' 254 counties have an
inadequate number of counselors, according to the Texas Department of
State Health Services.

 

Of the nation's five most populous states, Texas has the fewest number
of psychiatrists, psychologists and social workers per 100,000 people,
according to a report by the Hogg Foundation for Mental Health, based in
Austin. This worker shortage is much more pronounced in the state's
rural and border areas.

 

El Paso, with a population of about 610,000, has only a few child
psychiatrists, said Christopher Thomas, a child psychiatry professor at
the University of Texas Medical Branch at Galveston. An El Paso
community health clinic sought help in providing child psychiatry
services from UTMB, which runs one of the largest telemedicine services
nationwide.

 

UTMB child psychiatrists oversee the El Paso clinic's psychiatrists who
normally treat adults. They evaluate children during video conferences,
diagnose disorders and prescribe medications if they are needed.

 

Staff in El Paso then take over cases and consult with UTMB's
psychiatrists when necessary.

 

With good video equipment, a psychiatrist can see nearly everything
necessary for an optimal evaluation, Thomas said. He'll zoom in on a
child's hand to confirm it is trembling or move the camera to see how a
mom or an El Paso clinician reacts to a child's remarks.

 

"It's not really different from seeing patients face to face. And it
helps reduce barriers and improves access to care," Thomas said.

 

UTMB also provides child psychiatry services to school districts,
including several in the Rio Grande Valley as well as telepsychiatry for
some women's shelters in East Texas.

 

Going the distance

The West Texas Centers for Mental Health and Mental Retardation provide
services to a relatively small number of people spread out in 23
counties covering 25,000 square miles. Staffing its 15 mental health
centers isn't easy, said Janet Payne, West Texas Centers director of
mental health services. 

 

"It's hard to get psychiatrists to come out here - West Texas," she
said. "We're out in the middle of nowhere."

West Texas Centers lacks the staff for round-the-clock care.

 

In February, it contracted with JSA Health to conduct emergency
telepsychiatric evaluations at any time. JSA also supervises whether
medication is helpful to patients and provides some counseling to
patients in some remote areas.

 

Before JSA came on, people in mental health crises would go to emergency
rooms, where they typically were treated not by psychiatrists, but ER
physicians. These physicians often would commit patients to mental
health units because they were unwilling to risk sending them home,
Payne said.

 

"Maybe we really didn't need to put some of these people in the
hospital," she said. "JSA has been a godsend in treating these people."

Texas is considered a leader in telemedicine and telepsychiatry because
both are widely used to care for 170,000 inmates in the state prisons
and state jails.

 

The Texas Department of Criminal Justice contracts with two leaders in
telemedicine, UTMB and the Texas Tech University's Health Science Center
to provide and oversee health care at its facilities.

 

Joseph Penn, director of mental health services for UTMB's Correctional
Managed Care, said 30 to 60 percent of inmates in most state prisons
suffer from mental disorders.

 

With a shortage of psychiatrists nationwide, the majority of
psychiatrists choose to live in urban and suburban areas, and most
aren't choosing to work with inmates, he said.

 

Many prisoners are evaluated by UTMB psychiatrists working out of a
videoconferencing hub in Huntsville. They prescribe medication and
supervise cases. Therapists at prisons handle counseling sessions, Penn
said.

 

Psychiatrists would conduct fewer evaluations if they met with inmates
within prisons because security correctional officers take a long time
to move inmates in and out of clinics - security regulations must be
followed, Penn said.

 

"We can have a (telepsychiatrist) provider see 15 inmates in the morning
and 15 in the afternoon," he said. "If he were seeing them at a prison,
he'd be lucky to see five in the morning and five in the afternoon."

 

Supporters of telepsychiatry tick off a host of benefits: 

* No driving: Psychiatrists can see many more patients via video
teleconference than by driving to remote clinics or prisons. 

* Fast: Patients in underserved and remote areas who might go untreated
can receive counseling and often much more quickly than by visiting a
clinic. 

* Low costs: It's cost-effective. Transportation costs for patients and
psychiatrists can be greatly reduced, and psychiatrists don't bill state
prisons, say, for travel time. 

 

http://www.chron.com/disp/story.mpl/headline/metro/5992958.html 

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