Welcome | Networking | Long Range Plan | Links | Membership Application
Issue: Telemedicine offers a way to bring specialist help to rural Alaska
Status: Discussion draft
Discussion: Many rural communities lack realistic access to child psychiatrists and child psychologists; the two specialists who have the training to diagnose and treat childhood mental disorders.
According to the state's 1993 Alaska Youth Mental Health Needs Assessment, rates for serious emotional disturbance among children and youth in some rural communities may run as high as 25 percent. Yet, a recent review of state records indicates that some school districts, such as Saint Paul, have not identified any students as SED, and no school district has an acceptable record of identifying students with a mental disorder or SED.
Part of the problem is access to professionals with the training needed to diagnose and treat childhood mental disorders. Round trip airfares from remote communities may be as high as $1,000 per person, which is prohibitive for many families. For scarce specialties, like child psychiatrists and child psychologists, to travel to these remote communities of a regular basis is costly both in economic terms and in available specialist's time.
Telemedicine offers an opportunity to make the needed skills available to more children.
According to the October 1998 issue of Telemedicine Today, "Telepsychiatry is the "granddaddy" of interactive-video consultation applications. It has been used since the early 1960's and continues to be the single most popular type of clinical consultation, accounting for 20 percent of all video consultations. … There are several reasons that there has been so much telepsychiatry deployment relative to other specialties: it does not have the same resolution and motion-handling requirements of some other specialties (and thus requires less bandwidth and less sophisticated CODECs); it doesn't require peripheral devices; and it is an area that many rural practitioners feel especially eager to refer to someone else."
Apparently very little research has been done on the cost-effectiveness of telepsychiatry. However, according to another article in Telemedicine Today, in 1984 and 1985 a telepsychiatry project between London, Ontario and Woodstock, 30 miles away, found: "The sessions, though useful and generally well accepted by patients, were considered inferior to on-site interactions. Nevertheless, they allowed a 50 percent decrease in consultant's time, primarily by eliminating travel to the remote clinic."
In rural Alaska the specialist time and
economic savings would be higher. But more important, telepsychiatry
gives rural residents access to specialists not only within Alaska,
but at research hospitals in other states. Also, throughout Alaska,
children who are not responding to local treatment can have access to
specialists that may be able to help them.
While telemedicine
technology is used in Alaska to connect hospitals to radiology
consultants at the University Hospital in Seattle, telepsychiatry has
not been developed for diagnosing and treating mental disorders. It
is possible that some changes in state laws, in such areas as
licensing and insurance, will be required to make interstate
consultations possible.
We note that the
University Hospital System in Seattle is the federally designated
university research hospital for Alaska. Their community psychiatry
department has, in the past, said that they are there to help us, but
they need a request from some agency in Alaska. They could help
Alaska establish a demonstration program. We have been told, but have
not confirmed, that there is federal money available to develop the
infrastructure needed for telepsychiatry.
A demonstration program of telepsychiatry was recommended to the Alaska Mental Health Board planners in Shared Vision, about six years ago. However, no action was taken on that recommendation. Now we understand that there is a renewed interest in this technology by a psychiatrist at API. Hence, we need to find out how we may best encourage telepsychiatry.
Planned Action steps:
Contact the API psychiatrist for his comments and plans, and consider incorporating his plans into this issue paper.
Links to sites relative to this issue:
General Young Family Network | Introduction | Tips | Plans | Events | Forum | Chat Room | Publications | Membership Form Long-range Plan | Introduction | Mission, Goals & Assumptions | Service Principles | Issue Papers Links