Telemental health: videoconferencing in mental health services

The Royal Australian and New Zealand College of Psychiatrists defined telepsychiatry as ‘the use of communication technology to provide psychiatric services from a distance’ (Royal Australian and New Zealand College of Psychiatrists 1999). The technologies can include landline phones, mobile phones (using voice and/or texting), e-mail, social networking websites, illness-specific computer programmes (which are increasingly now web-based), ‘smart technology’ in the patient’s home (such as door sensors or GPSbased systems to monitor a person’s movements) and videoconferencing. Some of these can be used together and combined with face-to-face interactions with patients. This article focuses on the use of videoconferencing to provide clinical services. The term ‘telemental health’ is preferred because it encompasses interactions involving any mental health professional, not just psychiatrists. Many clinicians have experience of using video conferencing occasionally, usually for administrative and educational purposes, but a review undertaken by one of the authors for the Scottish Centre for Telehealth (Millar 2009) found few services using videoconferencing routinely for clinical purposes in Scotland. Unfortunately, the occasional users often reported poor experience, with difficulties booking and setting up equipment; poor room acoustics, lighting and furniture layout; and/or technical hitches with no or limited back-up. As a result, most services do not use videoconferencing regularly for clinical purposes. However, where these problems are addressed, and this article will provide some help to do this, regular users have a more positive view of the value of videoconferencing. Videoconferencing for clinical purposes has obvious potential for small, far-flung communities, such as those in the Highlands and islands of Scotland. Videoconferencing will also become increasingly popular in urban areas, because economic analysis needs to factor in: increasing costs of travel around congested cities; decreasing costs of technology; and increased travel times for clinicians. Carbon costs will also need to be taken into account. In addition, usage is likely to grow with improvements in reliability, quality and access. Clinical take-up of videoconferencing has been limited. In a survey of all psychiatrists in Scotland (Millar 2009), of the small number (26) commenting on their use of videoconferencing, 23% rated their experience as poor or very poor, 35% as ‘usable’ and 42% as good or excellent. Problems reported included inadequate access in psychiatric clinical areas, technical problems in setting up and maintaining a connection, lack of bridging facilities for multiple sites and a lack of technical support and training. This article briefly reviews the literature, discusses the main technical considerations, outlines an approach to cost–benefit analysis and gives practical advice in the context of descriptions of services regularly using videoconferencing.