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Mental Health Treatment by Video Growing

October 9, 2006

DALLAS — Psychiatrists, often in need and hard to find in rural areas, are increasingly turning to video to treat their far-flung patients, illustrating one of the latest growth areas of telemedicine.

Anthony Presciano said he probably wouldn’t get treatment for his post-traumatic stress disorder if he had to drive the 60 miles through heavy traffic to see his therapist in Dallas.

Instead, the 60-year-old Vietnam War veteran travels less than 15 miles from his north Texas home of Argyle to a suburban clinic in Denton where he “sees” his doctor on a video screen.

“Once the telemedicine session starts, it’s no different than a face-to-face,” said Dr. Umar Latif of the Dallas VA Medical Center, which has been offering psychiatric sessions over video for more than a year.

Video medical treatment increasingly is filling the gap in regions of the country where specialists are in short supply. And mental health appointments work especially well over video, enabling therapists to reach many patients who otherwise might not get help, experts say.

There are no figures on the number of doctors using telemedicine or telemental services, which can include appointments by video screen or telephone. But American Telemedicine Association spokesman Jonathan Linkous said the practice has been growing each year.

In Pennsylvania, the rural Central Greene School District has been using telepsychiatry since last fall to treat troubled students.

“Some of our students would travel long distances to come to the clinics,” said superintendent Jerome Bartley. “We have a great shortage of any kind of psychiatric outlets for students.”

In New Mexico, video hookups are used in the offices of primary care doctors to support interventions on alcohol or drug abuse by conferencing in drug treatment specialists, said Richard Sheola of ValueOptions, a company that offers telepsychiatry under government contracts in six states.

At the University of Texas Medical Branch at Galveston, where telemedicine has been operating for years – starting with state prison inmates – about one-third of the program’s 60,000 appointments each year are for mental health treatment.

And in rural Georgia, the state’s largest health insurer, Blue Cross, is building a telemedicine network linking rural hospitals and clinics to teaching hospitals. Included in that are three telepsychiatry centers where doctors treat small-town patients by long distance.

“We saw the need when we surveyed rural sites. We asked, ‘What do you need, as far as specialists?’ Psychiatry was the No. 1 need that we found,” said Blue Cross spokeswoman Cindy Sanders.

“I think that it has virtually unlimited potential,” said Dr. Terry Rabinowitz, medical director of telemedicine at University of Vermont College of Medicine. “Not only can we help folks in underserved areas in the United States, but with little – comparatively speaking – investment, we can do consultations worldwide.”

Of course, long-distance psychiatric treatment isn’t perfect.

Gerald Koocher, president of the American Psychological Association, said therapists must feel certain they can deliver a quality service over video and make sure there’s a way to get emergency help to a patient if needed.

“I wouldn’t recommend treating someone suicidal remotely,” he said.

Also missing is the personal touch that comes from being in the same room as your doctor and talking face-to-face.

Dr. Myron Weiner, who works at the University of Texas Southwestern Medical Center in Dallas, notes it’s hard to assess someone’s mood from a video screen. Facial expressions and gestures don’t come across well.

But from Weiner’s perspective, that’s really the only drawback.

“We can’t give the patient a tissue when they need it being not in the room, but that’s about all,” said Dr. Steven Hyler, who coordinates telepsychiatry consultations for New York state’s Office of Mental Health.

Weiner, a geriatric psychiatrist, treats 65-year-old April Pike, a woman worried about possible memory loss. She says she quickly got comfortable with her long-distance treatment as soon as she realized how easy it was.

Pike talks to her doctor via video from a rural health clinic in Talihina, Okla., 200 miles from Dallas.

During her appointment, she opens up about her worries, like the trip she made to the refrigerator only to forget what she was going for. Weiner has good news for her. A brain scan taken earlier looks normal.

“That’s good,” she says with a smile. “I appreciate hearing that.”

On the Net:

American Telemedicine Association: http://www.atmeda.org




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