Some hospitals turn to telepsychiatry for patients in crisis

From the Times of Trenton in N.J.:

A patient arrives in an emergency room talking of suicide or exhibiting other symptoms of mental illness. In the past, that patient could have waited for hours before a staff psychiatrist would be available to perform an evaluation.

But increasingly, that patient is likely to be placed in front of a monitor, where he or she can receive a faster evaluation.

For the past year, Princeton House Behavioral Health (PHBH) has joined with the Emergency Department at University Medical Center at Princeton, providing them with telepsychiatry services.

Princeton House is using telepsychiatry for assessment in a crisis setting, which involves a one-time consultation with the patient, said Ken Tedesco, director of external orograms for PHBH, a unit of the Princeton HealthCare System (PHCS). They then assess if the patient should be released to outpatient care or be committed, Tedesco said. With telepsychiatry, a psychiatrist in a separate location is connected to a patient and a medical team through audio and video-conferencing equipment. The psychiatrist is not just seeing a patient's face and hearing the patient talk; the doctor can move his or her camera around the room and pick up on body language, Tedesco said.

The service at University Medical Center at Princeton is used on nights and weekends, when the need is greatest, and only with the patient's consent, Kevin Sopko, director of admissions for Princeton House, said in a press release. Using the services has reduced the time a psychiatric patient waits to within two or three hours, while they used to wait up to 10 hours, Tedesco said.

Now, PHCS is outsourcing its telepsychiatry services to regional facilities and medical centers so that they can provide timely -- and remote -- treatment to people with mental-health issues.

"These tele-health tools were initially used in rural or remote areas where there weren't enough physicians to provide care. They're now spreading to other uses, including specialty care, to expand patients' access to an array of health-care services," said Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association.

But the service has had its critics. Tedesco said he has heard the argument that it may not be best to place someone experiencing psychosis in front of a "talking television," but he replied that keeping a psychiatric patient in an emergency room for up to 10 hours is not ideal.

The cost of outsourcing this service also varies, depending on the set-up. Princeton House will provide the equipment and the staff psychiatrists to whomever they contract with, Tedesco told The Times.

"The experience we've gained in-house has created the opportunity for us to help other facilities maintain after-hours coverage or provide efficient alternatives to their current options," Tedesco said in a prepared statement. He said in a phone interview that Princeton House recently received a request for a proposal from a Georgia company looking for telepsychiatry services for nursing-home patients.

Telemedicine has been used by the U.S. military and in rural areas of the United States for many years, but with technology becoming more available and affordable, more places are starting to offer these services. Cumberland County freeholders have approved a contract with CFG Health Systems LLC, which provides "medical director and telemedicine services," according to the News of Cumberland County.