When Portola-based family physician Christopher Stanton started using telepsychiatry consults with UC Davis, he was skeptical but desperate for help for his patients. With the nearest mental health clinic over an hour away, and county and state funds to support mental health services in his area limited to once-a-week sessions with a counselor, many of his patients went without the specialty care they needed.
But a pilot telepsychiatry program with UC Davis that used videoconferencing technology to talk with primary care doctors and their patients have turned Stanton into a telepsychiatry fan.
"I thought people would have a hard time relating with a psychiatrist through video, but patients bonded very well, and the response was overwhelmingly positive," said Stanton, who provides care at Eastern Plumas Health Care. "My younger patients were especially enthusiastic about the telepsychiatry sessions, probably because they were raised with television and radio and don't differentiate as much between reality and what's on the screen.
Over the past 10 years, the use of videoconferencing, secure e-mail messaging, store-and-forward applications and the Web has increased substantially nationwide, offering new ways to provide mental-health services to urban, suburban and rural patients. While e-mental health services will never replace face-to-face care, the technology improves access, especially for patients who reside in rural communities or other physicianshortage areas.
"Our telepsychiatry studies in rural clinics found significant improvement in adults and children treated over a three-month period for attention deficit hyperactivity disorder, impulsivity and related conditions," said Don Hilty, associate professor of psychiatry and behavioral sciences who is a leader in telepsychiatry consultations and training. "It also had a significant economic benefit to the local areas from the extra clinical revenue of families receiving treatment in their own community."
UC Davis psychiatrists offer telepsychiatry consultations and training to patients and physicians at some 40 sites within UC Davis Health System's primary care and rural network. The group averages 500 consultations a year and also offers a variety of continuing medical education courses, from updates on anxiety to disaster mental health care training.
Future studies will explore the effectiveness of store-and-forward video clips of interactions between primary care physicians and their patients for long-distance diagnoses, and the use of telemedicine technology to reach specific patient populations, such as ethnic minorities and patients who have psychiatric disorders combined with other serious medical conditions.
"Telepsychiatry and e-mental health services are here to stay," said Peter Yellowlees, psychiatry professor in residence, director of academic information systems and interim vice provost for information and educational technology. "Technology enables psychiatrists to diagnose conditions and provide short-term treatments when face-to-face psychiatric visits are not possible. It also decreases travel time, reduces stigma and increases access to care and information. We can only expect the applications to grow as research in the field matures."
Yellowlees is developing virtual reality and 3-D modeling videos to help students and practitioners better understand hallucinations and other psychotic behaviors of the mentally ill. He also sees the technology as a powerful tool to link national and global experts for education and consultation in response to disasters, and envisions a day when data derived from facial and voice-recognition systems may help in diagnostic screening.
"By embracing information and communications technology, practitioners truly have the potential to improve health at the local, regional and worldwide level," he said.