Many small communities throughout Ontario don’t have a local psychiatrist, so it can be challenging at times for people in these communities to receive psychiatric services. Telepsychiatry gives people in these communities the opportunity to interact one-on-one with a psychiatrist from another part of the province. Moreover, people with mobility issues need only to travel to a local Telehealth studio, rather than to a psychiatrist’s office.
We’ve had very positive reactions from people that have participated in one-to-one psychiatric patient videos. The patients feel very comfortable – in fact, we’ve had some patients tell us they’re more comfortable talking to the psychiatrist by video than in a face-to-face session. These patients say they feel less threatened and less challenged to speak about some of the more emotional issues that they’re dealing with, than compared to when the psychiatrist is physically present. The psychiatrists, as long as the video is of reasonable quality, feel they can see the body language and the non-verbal communications of the patient very well, and are able to manage the interview. Soon, OTN will add the Guest Link feature that enables a psychiatrist to treat a patient in the convenience of their home, when appropriate.
The patients feel very comfortable – in fact, we’ve had some patients tell us they’re more comfortable talking to the psychiatrist by video than in a face-to-face session.
Complementing this feedback is a study by Dr. Richard O’Reilly, et al. comparing a group of patients who were treated for over a year in Thunder Bay by a psychiatrist travelling up from London to Thunder Bay, and another group being treated in Thunder Bay by a psychiatrist in London via video. The clinical outcomes were measured and were the same, meaning that both modalities were equally as effective in delivering clinical care.
In Ontario, there aren’t enough psychiatrists to meet the demands for one-to-one care between a psychiatrist and patient. Suffice to say, waiting lists are long. A lot of other mental health professionals have evolved their skills to be able to offer long-term mental health care to people – there are mental health nurses, social workers, psychologists, GP psychotherapists, and a number of different healthcare professionals. There are, however, only some things that a psychiatrist can do such as making a medical diagnosis of the psychiatric illness and prescribe pharmaceutical treatment, if necessary. One powerful tool of telemedicine has been to support shared-care – so rather than every patient seeing a psychiatrist, patients have a mental health provider who looks after them and that provider has a shared-care arrangement with the psychiatrist. This could mean that once a week, or once a month, the psychiatrist will meet with the healthcare provider (or others in that organization) to review and do case conferencing about a variety of different clients that are being cared for in that organization. During this two or three hour meeting, many patient cases can be reviewed. The psychiatrist can give an opinion which helps educate and inform the primary care providers on how to optimize their management. This allows the primary care providers to carry on seeing the patient and have the expertise of a psychiatrist commenting/assisting with the care in a very timely and efficient way. In addition, a GP on the primary care team can prescribe medication recommended by the psychiatrist.
Addictions
We’ve had a lot of addictions specialists adopt telemedicine because much of addictions management involves narcotic medication management, and sometimes converting patients who are addicted to narcotics to methadone. There are very few physicians in the province who can prescribe methadone and who are trained to manage narcotic addiction. People in more remote parts of the province often cannot access a provider who is an expert in this, and therefore cannot be considered for specialized addiction treatment and potentially methadone maintenance care. With Videoconferencing, however, these providers have joined forces with local addictions service providers in more rural/remote parts of the province. They support the local team of nurses and mental health workers, who are providing care to people with addictions.
Other Methods: Store Forward Psychiatry
This is a relatively new mode of telepsychiatry, and was pioneered most notably by Dr. Peter Yellowlees. In this program the psychiatrist works closely with a remote mental health provider. That provider will do a structured interview with the client for 30 minutes and record it on video. The psychiatrist has a number of questions that the provider asks the patient. The video is then viewed asynchronously by the psychiatrist, sometimes with additional text information from the provider. That allows the psychiatrist to make a diagnosis and treatment plan that they recommend back to the primary care provider.
Learn more about OTN’s Mental Health & Addictions program.
