Telepsychiatry a Boon In Rural Canada

Psychiatrist Douglas Urness, M.D., of Ponoka, Alberta, is a passionate practitioner of telepsychiatry. Urness will switch on his television screen and view and listen to a patient located in a hospital or clinic videoconferencing center in rural Alberta.

Patients and doctors using the system can interact in real time between approximately 100 videoconferencing centers in the province. The network began in 1996 using six sites and has subsequently expanded in collaboration with regional health authorities and through a provincial initiative called Wellnet.

Urness has been doing telepsychiatry with patients half time for seven years.

What are some of the pros and cons of doing psychiatric evaluations via telepsychiatry? How do patients feel about it? How about legality? Costs? And for what kinds of patients is a telepsychiatric evaluation appropriate? Urness attempted to answer these questions at the annual meeting of the Canadian Psychiatric Association, which was held in Halifax, Nova Scotia, in late October and early November.

Input was also provided by Richard O’Reilly, M.D., a psychiatrist with St. Joseph’s Health Care in London, Ontario, who is researching the effectiveness of telepsychiatry while providing telepsychiatry services to a community in northern Ontario.

One of the biggest advantages of telepsychiatry is that “you are knocking down geographic distances between psychiatrists and patients,” Urness explained. This means not only that psychiatrists are made accessible to persons in rural areas, but also that the risks psychiatrists face in trying to physically visit patients in rural areas are reduced. “Last year, a psychiatrist from Edmonton tragically died while flying to a remote community in northern Alberta,” Urness said.

Videoconferencing speeds up the “getting to know you” phase of a doctor-patient relationship, Urness has found. True, “you cannot shake patients’ hands or smell them via videoconferencing,” he admitted. But because you lose these sensory inputs, you tend to pay more attention to what patients have to say.

If a third person is in the room during videoconferencing, certain patients—often seniors and adolescents—may be reluctant to open up and talk honestly. Nonetheless, not having a third person present can be risky in certain situations. For instance, one psychiatrist present at a telepsychiatry session related how a patient he was seeing via videoconferencing started destroying chairs in the room, and there was no one to stop her from doing so. “I felt powerless,” he admitted. One way to reduce such dangers, O’Reilly said, is to have a nurse stationed in a room next door to where the patient is being videoconferenced. That is what he does.

How Patients See It

“I don’t like telepsychiatry!,” one patient complained to Urness at the start of a videoconferencing session. “And I don’t think I’d like you even if I met you in person.” On the whole, though, patient satisfaction with videoconferencing has been extensively studied and consistently appears to be quite high—about 90 percent—although patients, in general, do appear to have a slight preference for face-to-face contact.

As far as legality issues are concerned, even though psychiatrists and patients do not have personal contact in videoconferencing, the technique is legal in Canada. A psychiatrist must be accredited in the province where he or she delivers telepsychiatry and in the province where the patient is located.

Weighing Cost Concerns

Videoconferencing may cost somewhat more per patient session than a face-to-face session because of the expense of the equipment used. Yet, Urness pointed out, “you can see a lot more patients with telepsychiatry in the same amount of time, which helps justify the costs of the technology.” Also, it is cheaper to provide evaluations via videoconferencing than to fly a psychiatrist to a rural area for that purpose, Urness added.

Telepsychiatry can be successfully used with various types of patients, he noted. It also can be used reliably to assess symptoms of various mental and behavioral states—for example, anxiety, depression, obsessions and compulsions, and schizophrenia.

However, it is not very good at revealing certain types of psychiatric conditions—for instance, negative schizophrenia symptoms. And it is not appropriate for patients who are agitated or violent, Urness stressed.

Telepsychiatry in Canada, as in the United States, is usually funded through grants, and it is often difficult to keep programs going after the grants run out, Urness said. Nonetheless, Canadian telepsychiatry has been picking up momentum in the past few years. Eighteen telepsychiatry programs now operate in Canada and serve patients in such far-flung places as Newfoundland and the Northwest Territories. ▪