Paul McLaren

A Comparison of Communication Modes in Adult Psychiatry

The process and outcome of clinical tasks in an acute psychiatric unit were compared using four different communication modes: face to face, telephone, hands-free telephone, and a low-cost videoconferencing system. Six doctors and six patients took part in the study. Four assessment measures were used. The videoconferencing system was positively received by both patients and doctors. Both doctors and patients preferred communication modes with visual cues. However, there were few significant differences between communication modes when using single measures; only multiple levels of analysis can adequately assess the differences between such modes of communication.

The tele-assessment of cognitive state: a review

The telephone is used by all mental health professionals and many of their clients. Despite this, the telephone has been formally evaluated only occasionally. This paper reviews the literature on cognitive testing by telephone and by videoconferencing, and summarizes the different strategies employed to do this task. There remain weaknesses in the use of the telephone for cognitive testing but it could certainly be used more extensively in both clinical work and research, although the choice of test must be made with a clear view of what the assessment is designed to achieve and the limitations of the assessment instrument itself. Assessment by videoconferencing remains at an early stage of development, with much work to be done before it can be routinely employed as a clinical tool. However, videoconferencing shows promise for the future because it allows a much wider range of assessment than the telephone.

The use of telepsychiatry in the brief counselling of non-psychotic patients from an inner-London general practice.

Brief counselling of 13 non-psychotic patients was carried out using an interactive television link, in order to assess patient satisfaction with this technique. Informed consent was obtained from all patients before the videoconferencing sessions, which were conducted at 128 kbit/s. Over the four-month study period, 11 men and two women participated in a total of 29 sessions. A total of 28 questionnaires were completed. After the sessions, 93% of patients agreed that they would like to use this medium for communication again, 75% stated that they were able to see everything that they needed to see and 86% agreed that they were able to hear everything they needed to hear. Overall, these findings indicate that patients were happy with the standard of care they received.

Telepsychiatry in an inner-city community psychiatric service

In the UK psychiatric services have become community based. Staff resources, which have not increased to keep up with the change in service demand, are unevenly spread throughout the various service elements. Community nurses, mental health teams and psychiatrists spend time moving between hostels, teaching centres and small community inpatient units, general practice surgeries and patients’ homes. Outpatient clinics take place at sites closer to the patients and away from inpatient services. In inner-city sectorized services the geographical distances may be small, but travelling times may still be long. This is often compounded by traffic congestion, poor public transport and travel costs. Techniques such as videoconferencing have the potential to improve communications between service elements, to reduce travelling time for staff and patients, to increase the accessibility of services for patients and to improve supervision by staff1. We have investigated the use of a videolink betweena community mental health centre, the Speedwell centre in Deptford, south-east London, and the inpatient ward for the sector at Guy’s Hospital in central London, 5 miles (8 km) away. The centre is open from 09:00 to 17:00 on weekdays and is staffed by about 25 persons including nurses, social workers, occupational therapists, administrative and support staff. Many of the staff have sessions at the inpatient unit as well as at the mental health centre. Patients usually present to the Speedwell centre for emergency consultation or to make informal inquiries. At the start of the study the communication requirements identified between the inpatient service and the Speedwell centre were the handing over of information to members of the community mental health team for the follow-up of patients with severe mental illness who were discharged from the ward, and arranging for the admission of patients in the community who had become ill. Before the installation of the telemedicine link communication was by post, telephone and by staff travelling between sites. The videolink was installed as part of the European Commission’s Telemed project (RACE-1086). This was designed to evaluate broadband communications links in a variety of medical applications. The equipment was a prototype videoconferencing system known as the MCVC and was based on a 386 PC which produced a digitized video signal from a monochrome camera. The MCVC was connectedvia a multiplexer (Craycom2000) to a 2 Mbit/s private leased circuit (BT Megastream). The transmitted picture was displayed on a 12 inch (30 cm) monochrome monitor at a resolution of 128 ́ 128 pixels with 64 greyscales, at about 25 frames/s. Sound was transmitted via the public telephone network using hands-free telephones (GEC) modified by bypassing the integral microphone with a clip-on microphone. Three cases are reported from a trial clinic which the sector consultant held over the link to review certain long-term patients. The psychiatrist was at Guy’s Hospital and the patients were at the mental health centre. All interactions were recorded on video and audio tape, and patients were asked to report their responses on a self-completion questionnaire, the Focused Observation Schedule (FOS) II. Observations were recorded in a logbook.

An Evaluation of the Use of Interactive Television in an Acute Psychiatric Service

This study reports the results of the use of a low-cost videoconferencing system (LCVC) for communication in an acute psychiatric service. Qualitative research methodology was used to examine the use of the LCVC in interactions between psychiatrists, patients and nursing staff, including information on refusals. One hundred and five clinical interactions were studied over four months. The LCVC proved technically reliable and compatible with the performance of a wide range of clinical tasks. However, the results suggest the need for better understanding of the nature and origins of the attitudes that users bring to the use of such communications technology. A framework is presented for the classification of user responses in terms of preexisting attitudes of the users, technological limitations of the system and the mental state of the users. The study demonstrated the potential for interactive television to support many of the communication tasks necessary in a dispersed psychiatric service and for telepsychiatry to become a major method of service provision.

Integrating interactive television-based psychiatric consultation into an urban community mental health service

We conducted a pilot study of urban telepsychiatry employing interactive television (IATV) over ISDN links for psychiatric consultation to support a primary-care mental health team. During the six months of the pilot phase, 30 consultations were arranged by the general practitioners for 14 different patients. Of these, 24 were completed by IATV and one by telephone when the IATV link failed. The system was used to manage patients with complex problems, many of whom were difficult to engage in standard services. The results showed high levels of user acceptance. Various problems for the further implementation of such systems were also identified.

Interactive television for an urban adult mental health service: the Guy's Psychiatric Intensive Care Unit Telepsychiatry Project.

We carried out a feasibility study of an interactive television (IATV) system to enhance the provision of psychiatric intensive care services to a remote adult acute psychiatric ward in the same National Health Service mental health trust. The system used videoconferencing equipment connected by ISDN at 128 kbit/s. The system was used for patient referral, assessment and monitoring by staff at the remote site 8 km away.

The North Lewisham Telepsychiatry Project: Beyond the Pilot Phase

The integration of a telepsychiatry application into an inner-city community mental health service was evaluated over 10 months. ISDN videoconferencing at 128 kbit/s was employed for psychiatric consultation between a primary care centre and a community mental health centre. A convenience sample of patients and referrals seen by videoconferencing was compared with a sample seen face to face. During the study period 19 patients were managed by videoconferencing and 12 face to face. There were 162 consultations, comprising 81 prearranged teleconsultations and 81 prearranged face-to-face consultations. There was no significant difference in attendance between videoconferencing and face-to-face consultations. Nine of the videoconferencing new referrals had not completed their treatment at the end of the study period, compared with only three in the face-to-face group. This implies that it takes longer to complete treatment for new referrals managed by videoconferencing.

The use of videoconferencing to enhance tertiary mental health service provision to the island of Jersey.

A six-month trial of videoconferencing was undertaken between the States of Jersey Health and Social Services in the Channel Islands and the South London and Maudsley NHS Trust in England. The purpose of the project was to evaluate the effectiveness and benefits of obtaining specialist tertiary mental health services not normally available on the island of Jersey. During the six-month pilot project in 2001, five teleconsultations were conducted: two acute psychiatric assessments and three case reviews. In addition, six presentations using videoconferencing were held on forensic psychiatry (24 participants), affective disorders (12), psychosis (8), eating disorders (3), crisis disorders (12) and community specialist teams (12). Results using the Guy s Communication Questionnaire indicated high satisfaction levels from all participants. The project successfully raised the awareness of telemedicine and its potential in the delivery of mental health services in Jersey.

Interpersonal communications and telemedicine: hypotheses and methods

Demonstration interviews between a psychiatrist who has used videolinks for a range of clinical interactions and a simulated patient facilitate a better understanding of interpersonal communication, both face to face and mediated. This might allow users to be trained to maximize the use of the available communications technology and provide a source of more rational reassurance for the technophobic professional.