By Beryl Lieff Benderly
A patient arrives in the emergency room of a small hospital
in rural Tennessee in acute need of psychiatric evaluation.
The attending physician lacks the specialty training
to evaluate whether the patient is at risk for suicide
or harm to others—requiring hospitalization—and
the nearest psychiatric hospital is located more than
an hour away. What should the physician do?
In the past, a mobile crisis team would have been dispatched
over mountainous roads for an hour's drive to make
an evaluation. Today, a high-speed video teleconference
between a member of the crisis team and the patient—in
real time—takes place instead.
This accelerated evaluation procedure, as described
by Susan Dimmick, Ph.D., a project manager at the Oak
Ridge Associated Universities, in Oak Ridge, TN, is just
one of the many applications of communications technology
now available to deliver mental health and substance
abuse care efficiently. More than two dozen presenters
shared their expertise at a recent conference, "E-Therapy,
Telehealth, Telepsychiatry, and Beyond," hosted
by SAMHSA's Center for Substance Abuse Treatment
(CSAT) in December.
Sheila M. Harmison, D.S.W., L.C.S.W., Special Assistant
to the CSAT Director, moderated the conference, which
drew researchers and service providers from across the
Nation and from Canada to discuss a wide range of innovative
programs that use e-mail, text messaging, Web sites,
and voice-over-Internet telephone in addition to video
teleconferencing. These technologies overcome barriers—including
distance, physical immobility, and other disabilities,
and social stigma—that prevent many Americans from
receiving needed mental health care.
Examples of these services include:
Low-income, inner-city mothers who are in recovery
from substance abuse stay in daily contact with their
counseling program via e-mail.
Children in remote Alaskan villages receive mental
health treatment via video teleconference from providers
located in facilities hundreds of miles away.
Middle school, high school, and college students
participate in personalized substance abuse interventions
over the World Wide Web.
Military veterans with post-traumatic stress
disorder who live on sparsely settled Indian reservations
in South Dakota and Wyoming receive mental health treatment
via video teleconference.
Persons undergoing cognitive
behavioral therapy for anxiety disorders
use palmtop computers to receive messages of reinforcement
and assess their own
levels of anxiety while they go about their daily activities.
Alcoholics in recovery attend group therapy sessions
via streaming video and voice-over-Internet from the
privacy of their homes.
"Technology can assist in our larger goal to assure
a life in the community for everyone," said CSAT
Director H. Westley Clark, M.D., J.D., M.P.H. The goal
is not to substitute traditional treatments for mental
and addictive disorders, he emphasized. "The goal
is to leverage the impact of people-based services."
The use of new communications technology in treatment
for these disorders is in its infancy, Dr. Clark continued.
"And there does appear to be a reluctance to adopt
Qualified mental health and substance abuse professionals
must make use of these new technologies. Charlatans and
quacks are trying to exploit the Internet and entice
the unwary into many questionable so-called therapies,
Dr. Clark cautioned. "If we in the orthodox community
refuse to go ‘into the ether,' others will
have no compunction." In other words, research
needs to go forward vigorously to evaluate the usefulness
of the various technology-assisted treatment approaches.
"We have to determine if e-therapy is a reliable
resource for substance abuse and mental health treatment,"
said Dr. Clark. "I think it is."
Kathryn Power, M.Ed., Director of SAMHSA's Center
for Mental Health Services, also addressed the conference.
"E-health, properly researched and implemented,
holds great promise for improving the mental health of
millions of Americans nationwide," she said. Not
only is e-health incorporated in the goals of the SAMHSA
Mental Health Transformation initiative, but through
the use of these technologies excellent mental health
care is delivered, and research accelerated.
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As equipment and service costs continue to decrease
and the availability of high-speed broadband connections
continues to increase, mental health and substance abuse
practitioners find themselves with many advanced options
for audio, video, and text technologies.
Wireless connections now match the speed of broadband
cable modems, said Brent Carter, a product development
officer for Verizon Wireless, in his presentation.
Advanced encryption and other security measures allow
wireless communications to meet the privacy and confidentiality
requirements of mental health and substance abuse professionals,
added Donald "Desi" Arnaiz, M.A., President
of Virginia Systems, Inc., and an engineer for Comcast.
"Everything that you require for the Health Insurance
Portability and Accountability Act—HIPAA—is
available to you now."
Mental health and substance abuse treatment providers
and other health care providers, however, must be sure
to use equipment correctly. When selecting devices, for
example, they must make certain that they obtain proper
security technology. "Most people don't protect
their wireless systems, but care providers must take
that extra precaution," said Mr. Arnaiz.
Other recommendations include choosing devices appropriate
to the intended purpose and making sure that all devices
work together. Correcting errors in the integration of
devices is in fact his company's "biggest
headache," Mr. Arnaiz said. For practitioners to
have a successful program, they must also spend time
learning to use the equipment.
Some adaptations in treatment techniques will also
be needed to meet the demands of technology, noted Ron
Adler, Chief Operating Officer of the Alaska Psychiatric
Hospital. His experience with the hospital's TeleBehavioral
Health video teleconferencing system convinced him that
the benefits vastly outweigh the costs in both time and
money. "Build this system and the funding will come and
the patients will come," he urged conference participants.
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