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Wed May 7, 2014

Telepsychiatry Brings Emergency Mental Health Care To Rural Areas

Originally published on Tue June 10, 2014 8:59 am

North Carolina is facing a very big mental health care challenge — 28 counties across the state do not have a single psychiatrist. That's despite the fact that in recent years, emergency rooms in the state have seen more patients with mental health, developmental disability or substance abuse problems.

So the state is trying telepsychiatry. When a patient comes into an emergency room, they can be connected via a two-way video connection with a psychiatrist. A recent study by the nonpartisan North Carolina Center for Public Policy Research found that the method is having some success in providing more timely treatment.

One of the psychiatrists, Dr. Sy Atezaz Saeed, told NPR's Robert Siegel that that's very much like being face-to-face with a patient.

"When you ask patients about this experience, most of them will tell you that after a few minutes of some hesitation, they even forget that they are talking to the doctor via this monitor," Saeed, the chairman of the psychiatry department at the Brody School of Medicine at East Carolina University, says.

The program uses a secure teleconferencing system to connect doctor and patients rather than services like Skype.

Saeed answered more questions about the differences, privacy concerns and the long-term effects.


Interview Highlights

On whether it's feels different for the psychiatrist

Usually people would think as if there is a loss, but really — just like for the patient — once I have been involved with this visit after a few seconds, I will even forget about the fact that it's coming via telepsychiatry. [But] I would not want to do a clinical visit via telephone.

On how telepsychiatry can work in the long term

It's not only possible, there are places that are doing it. There was a very interesting study that was done a few years back where patients who were being seen via video conferencing were given the option — about a year into it — by their therapist to come back on campus and meet with their therapist. And more than half of them declined.

On privacy concerns

I'm very clear in my very first contact with the patient that the conversation is not being recorded. If a visit is being recorded for some educational purpose or research purpose, we have to go and explain to the patient why this is being recorded and the patient must sign the release for that.

The only person that may be listening in is an emergency department nurse. Because sometimes situations arise where the patient expresses some thoughts which lead us to the concern of harm to the patient or others. And if I say, 'Well, you know, you need to be admitted,' and the patient says, 'No, thank you, I don't want to be,' there are times that I have a legal obligation of admitting someone, even against their will. So I need someone on that other end.

On building rapport

There are different types of examinations. So when I'm seeing someone in an ongoing fashion, absolutely, a rapport is needed. But there are times that we get called in to see a patient for a consult and this is the only visit that ever takes place.

The project that we are talking about, that's only a consultation project. So we get to see a patient only once. ... And that patient then gets referred to someone else. Now that someone else, if they elect to see this patient via telepsychiatry, that therapeutic alliance would still develop. And there is nothing out there that says you can't do that via video conference.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

Here's a measure of what North Carolina's state health secretary calls one of the state's biggest and most important health care challenges. Twenty-eight counties across the state do not have a single psychiatrist. And that's despite the fact that in recent years, North Carolina ERs have seen an increase in reported admissions of patients diagnosed with mental health, developmental disability or substance abuse problems. So, the state is trying telepsychiatry, links between hospital emergency departments and psychiatrists. Dr. Sy Saeed is head of the psychiatry department at the East Carolina University, and he says it works.

DR. SY SAEED: The patient encounter is very much like as if I was face to face with a patient. The only difference being that this is being transmitted via video conference. And the interesting thing is that when you ask patients about this experience, most of them will tell you that after a few minutes they forget they are talking to the doctor via this monitor.

SIEGEL: For you, how different is it seeing a patient on a video screen as opposed to actually having the patient in front of you? What do you lose by not being there in person?

SAEED: Well, usually, people would think as if there is a loss. But really, just like for the patient, once I have been involved with this visit after a few seconds, I would even forget about the fact that it's coming via telepsychiatry.

SIEGEL: We're talking on the one hand here about patients admitted to emergency rooms and getting a psychiatric evaluation much more quickly than a lot of rural North Carolina hospitals have been able to do. Is this a way to actually manage your relationship with a patient whom you might see once a week for a few weeks?

SAEED: Yes. It's not only possible, there are places that are doing it. And there was very interesting study that was done a few years back where patients who were being seen via videoconferencing were given the option to come back on campus and meet with their therapist face to face, and more than half of them declined.

SIEGEL: You're taking that as a good sign that they were satisfied with the long-distance relationship, not that they didn't care to meet the psychiatrist in person?

SAEED: Yes.

SIEGEL: The North Carolina Center for Public Policy Research acknowledges that telepsychiatry really hasn't caught on all that quickly. And one barrier to patient acceptance that they write about is worries about privacy.

SAEED: That question comes up sometime. I'm very clear in my very first contact with a patient that the conversation is not being recorded. If a visit is being recorded for some educational purpose or research purpose, we have to go and explain to the patient why this is being recorded and the patient must sign that release from that.

SIEGEL: At the risk of exhibiting of some paranoid symptoms, let me pursue privacy with you further here. What if I thought as a patient, I trust Dr. Saeed. It's the Edward Snowden of the IT department at East Carolina University Medical School whom I don't trust. Who are the other people who are dealing with all this equipment and are they going to handle my records with great care?

SAEED: Well, that's a very reasonable question. The only person that may be listening in is an emergency department's nurse. Because sometimes situation arise where the patient expresses some thoughts, which lead us to the concern of harm to the patient or others. So, I need someone on that other end and call them and say, well, you know, here is what I would like you to do.

SIEGEL: People think of psychiatry as a branch of medicine that more than most others requires some rapport between doctor and patient, that there is something important about conversation in proximity. I guess you would say no.

SAEED: Well, there are different types of examinations. So, when I'm seeing someone in an ongoing fashion, absolutely, a rapport is needed. But there are times that we get called in to see a patient for a consult. The project that we are talking about, that's only a consultation project. So, we get to see a patient only once and that patient then gets referred to someone else. Now, that someone else, if they elect to see this patient via telepsychiatry, that therapeutic alliance would still develop. Because a therapeutic alliance with people develop, as you well know and do that in your day-to-day job, is that we build that relationship by listening to people and they listening to us. The patient experiences some empathy, some warmth, and there is nothing out there that says that you can't do that via videoconference.

SIEGEL: Dr. Saeed, thank you very much for talking with us.

SAEED: Oh, thank you for noticing our work. I appreciate it.

SIEGEL: That's Dr. Sy Saeed, who is the chair of psychiatry at the Brody School of Medicine at East Carolina University, talking about North Carolina's project to embrace telepsychiatry. Transcript provided by NPR, Copyright NPR.

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