Psychogeriatric SOS (services-on-screen) - a unique e-health model of psychogeriatric rural and remote outreach.

Mental health service delivery to rural and remote communities can be significantly impeded by the tyranny of distance. In Australia, rural and remote mental health services are characterized by limited resources stretched across geographically large and socio-economically disadvantaged regions (Inder et al., 2012; Thomas et al., 2012). Internationally, rural and remote area mental health workforce shortages are common, especially in relation to specialist mental health services for older people (McCarthy et al., 2012; Bascu et al., 2012). In countries that are geographically large and/or under-resourced, the psychogeriatric needs of the rural and remote populations are often addressed by a variety of multidisciplinary clinicians, from primary care, adult mental health, and generalist aged care, or by a small number of psychogeriatric clinicians, sometimes supported by visiting psychiatrists, or some form of teleconferencing (Harte and Bowers, 2011; Mars, 2013). The world literature on e-health solutions specifically focused on older adult mental health is quite sparse (Ramos-Rios et al., 2012). It appears that a significant need remains in geographically large countries and in under-resourced regions for an innovative, efficient and effective e-health model of outreach to enhance existing old age mental health services, whatever may exist. Efforts to enhance rural and remote mental health service delivery via teleand video-conferencing, electronic health records, information-based websites, and helplines have demonstrated limited success (Hilty et al., 2004), and although clinically-focused e-health solutions are faster, more economical, and at least as effective as transporting patients and/or clinicians over large distances, the uptake of these services has been surprisingly low (Moffatt and Eley, 2011; Mars, 2013). In Australia, this has led to the proposal that a more powerful solution might be to focus on providing timely support, advice, supervision, training, and education to existing local rural and remote clinicians – to empower them to better manage their patients’ psychogeriatric needs at a local level (Access Economics, 2010). Psychogeriatric SOS (services-on-screen) is a clinician-to-clinician e-health solution that provides multidisciplinary psychogeriatric expertise to clinicians in rural and remote areas of New South Wales (NSW), Australia. The model is based on an integrated, multidisciplinary, team management model of psychogeriatric care currently used in inner city Sydney (St Vincent’s Hospital Psychogeriatric Mental Health and Dementia Service), adapted for rural and remote clinicians, and delivered via web-based technology. It provides isolated rural and remote clinicians with the support of a virtual multidisciplinary psychogeriatric team, to assist them to manage their older patients with mental health problems and dementia locally, and as the lead clinicians. We believe Psychogeriatric SOS has the potential for application well beyond the clinicians of rural and remote NSW, and beyond psychogeriatrics; and through this editorial we are seeking broad consultation, expert opinion and comment regarding the model whilst in its infancy.