Academic journal article South African Journal of Psychiatry

Telepsychiatry in South Africa-Present and Future

Academic journal article South African Journal of Psychiatry

Telepsychiatry in South Africa-Present and Future

Article excerpt

Telepsychiatry is one of the most longstanding telemedicine disciplines, having started over a century ago with the inception of the telephone; its modern form dates from about 1960. Telepsychiatry uses information and computer technology for diagnosis, therapy, follow-up, forensic purposes, pharmacotherapy management, psychiatric education, etc. Telecommunication links between a remote site and another to which a request/referral is made, allow data transfer (e.g. of videoconferencing images, history, reports and teaching material). Links range from telephone lines to rapid-transfer wireless links. Two or more persons at different locations (typically, a psychiatrist and a patient) most frequently use interactive videoconferencing for the provision of psychiatric expertise not otherwise available at the sender's (i.e. patient's) location. Enormous progress in telepsychiatry and all forms of telemedicine has been made recently, owing to rapidly decreasing costs of computing power, and larger data transfer capacity and storage, which allow telepsychiatry to provide unprecedented access to mental health services, and especially in rural areas. (1)

Videoconferencing v. face-to-face

Psychiatry is so firmly associated with face-to-face interaction that telepsychiatry's successes are insufficiently appreciated. Many comparisons have been made between telepsychiatric videoconferencing and face-to-face interactions, with the former usually achieving similar, or better, results. Patients are equally or more satisfied with telepsychiatry, and generally there is better follow-up. (2) Comparisons, when the same psychiatrist used both modalities, show similar success rates for cognitive behaviour therapy and psychotropic medication administration. Differences in compliance for both the medication plan and follow-up appointments have favoured telepsychiatry. Comparing video-conferencing, telephone consultations and conventional face-to-face methods, satisfactory assessment was possible with all three modes for depression, using the Montgomery-Asberg Depression Rating Scale. (3) Telepsychiatry has also been successful in child psychiatry, depression, dementia, schizophrenia, suicide prevention, post-traumatic stress, panic disorders, substance abuse, eating disorders and smoking prevention. (4)

Applications of telepsychiatry

Telephonic interaction has a long history in telepsychiatry, and still remains important, as recent studies in the USA attest. In one report, 15% of such calls were 'urgent' and 1.5 % were 'emergencies'. In the UK (and many other countries, including South Africa) patients with mental illness are often cared for by primary health care (PHC) providers5 for whom a supplementary telepsychiatry service (even telephonic) can be most valuable for complex and acute situations. Additionally, telepsychiatric videoconferencing can be used for interacting with patients and also for administration, pharmacological management, education, training and research activities. (6) Depression has often been managed successfully via telepsychiatry, especially in elderly white men with substantial physical and behavioural health comorbidity. (7) Telepsychiatric treatment for comorbid depression with either a problematic cannabis or alcohol dependence has been shown to be equally or more effective (for outcomes after a year) than traditional interventions. (8) Other conditions amenable to telepsychiatric management include sleep disorders and postpartum depression.

Forensic and prison psychiatry

Many reports describe forensic and prison telepsychiatry. Investigations in the USA to establish competency to stand trial, using a standard test via videoconferencing, established it as 'a reliable method of assessment', (9) and patients were equally satisfied with telepsychiatry and face-to-face interaction. Overall, telepsychiatry was considered fully acceptable, whether for civilian proceedings (such as commitment) or to determine fitness for a criminal trial. …

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