INTRODUCTION
It is widely recognized that mental illness affects a significant proportion of the population; however, it is complicated to determine exact numbers. This problem can be attributed to such issues as the changing definitions of mental illness as well as difficulties in classifying, diagnosing, and reporting mental disorders. Limitations to adequate mental health services including social stigma, cultural incompatibility between patients and providers, language barriers, lack of insurance and logistical barriers. In addition, significant differences in socioeconomic status, lifestyle behaviors, and access to care have resulted in health disparities between rural and urban communities (Institute of Medicine, 2004). According to Sulzbacher et al., many families who live in rural areas do not have the financial, social or psychological resources, to travel to distant urban centers to obtain adequate care particularly for a chronic mental health problem. There is also evidence to suggest that mental illness in rural areas is as nearly as high as among people in metropolitan areas. However, the accessibility of mental health services and professionals in rural areas is extremely low compared to major cities and metropolitan areas. Such barriers can impede the diagnosing, treating and reporting of mental illnesses and have also been instrumental in developing and improving telepsychiatry and e-mental health models.
Telepsychiatry
Telepsychiatry has been used for many years and is highly regarded as an area where the use of telemedicine has been successful. It has been defined as “The delivery of healthcare and the exchange of healthcare information for purposes of providing psychiatric services across distances” (Woo...
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The Centers for Disease Control and Prevention (CDC) reports that 25% of people suffer from a mental illness and that 50% of people will develop one during their life ("Surveillance Report," 2011). Mental illness is also associated with “chronic diseases such as cardiovascular disease, arthritis, asthma, and diabetes” (Pederson et al., 2013, p. 695). Rural communities have higher rates of chronic illnesses, mental health issues and fewer providers thus making this population vulnerable to health disparities. The purpose of this paper is to explore mental illness in the rural community, ways to improve accessibility to care, and improve outcomes through the role of a rural nurse educator.
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Physician engagement - Physicians often resist acceptance of new technology and complain about lack of hands on interaction with patients with Telehealth. According to Gustke et al (2000), fear of malpractice suites is another consideration for physicians. Lack of staff with appropriate skills for telehealth also poses a
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One new way in which technology has been used to extend the services of the counseling field is through online counseling. According to Corey (2011), online counseling can be beneficial because some consumers want brief and anonymous therapy, some clients who are unwilling to participate in traditional therapy may be willing to accept help online, it’s easier for persons with physical disabilities, may be easier for clients who experience anxiety, allows for access to clients in rural places, enhances record keeping, expands pool of referrals, increases flexibility in scheduling, increases options for supervision, and enhances collection of research data. Despite that, Corey (2011), also discusses the disadvantages of online counseling which are as follows: high possibility of inaccurate diagnosis/treatment, confidentiality and privacy cannot be guaranteed, therapists’ duty to warn and protect others is hampered, suicidal clients cannot receive immediate help, enables minors to pretend to be adult to access treatment, and it can be difficult to build and maintain a therapeutic alliance.
A 2015 study (Brown, 2015) showed that the average American adult spends around 11+ hours on electronic devices per day. With an increasingly large amount of communication being done online, why not bring therapy into the electronic age? Online therapy has many benefits and has already proven to be effective. There are many trained professionals who are ready to provide different methods of counsel to many people. First I will discuss the benefits of e-therapy and how it’s already proven to be effective, next I will talk about the different methods of counsel available. Finally I will discuss some concerns surrounding e-therapy and possible solutions, and some problems that the movement still is faced with.
Telehealth allows a lower-level healthcare practitioner to communicate with a physician or specialist when necessary. Remote rural areas use a Physician Assistant or a Nurse Practitioner on location in remote areas. When procedures call for a physician, an internet or satellite link provides a teleconference with a physician who can prescribe appropriate treatment (Gangon, Duplantie, Fortin & Landry 2006). This could be implemented in lower income urban areas, allowing free clinics to lower costs, and require fewer physicians. Programs that increase the level of healthcare available to school children could be increased.
We live in the era of technology and telehealth is becoming a part of our lives. According to Guido (2014), telehealth Is a removal of time and distance barriers for the delivery of health care services and related health care activities. Internet and other communication technologies are the means for health care professionals to practice across state lines.
Telemedicine is a new comer to the field of medicine and it is the treatment of patients by means of telecommunications technology. Telemedicine is carried out in a variety of ways whether it is by smart phone, wireless tools or other forms of telecommunications. Examples of telemedicine include: 1) transmission of medical images 2) care services at the home of the patient 3) Diagnosis at distance 4) education and training of patients. The diversity of practices in what is known as telemedicine raises many questions and one of those questions, which is extremely important, relate to the safety of the practice and the risks involved.
The economic impact of telehealth is a critical factor to examine when looking at the feasibility of incorporating such technologies into practice. Exploration of economics is also essential as it has been posited that telehealth has the potential to deliver care to individuals that is cost saving in nature (Wade, Karnon, Elshaug, & Hiller, 2010). Furthermore, the estimated expenditure on telehealth services and technology is expected to reach into the billions of dollars (Berger, 2010). However, there are myriad individual elements that may be considered in the broad subject of economics, which complicates determining the economic impact in a parsimonious way (Bergmo, 2009; Wade, et al., 2010).
States obtain many services that fall under mental health care, and that treat the mentally ill population. These range from acute and long-term hospital treatment, to supportive housing. Other effective services utilized include crisis intervention teams, case management, Assertive Community Treatment programs, clinic services, and access to psychiatric medications (Honberg at al. 6). These services support the growing population of people living in the...
Sally and Rebecca, I appreciate your thoughtful discussion on PHRs. Sally, I was particularly interested in your questions regarding telehealth in psychiatry and how patient emails should be managed in the case of a potential suicidal crisis (Sally Rothacker-Peyton, personal communication, April 8, 2018). I struggled to find guidance in the literature on how to advise a clinician to manage emails which from potentially suicidal patients as you mentioned. I believe email is similar to voicemail in terms of its efficacy in managing emergent issues. However, unlike with a voicemail message, email does not allow you to provide instructions for an emergency or give a timeline for response up front. While it is possible, to have an automatic reply to
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The tone a person takes on the phone can either make or break a relationship. In some conditions telenursing is not always appropriate, for instance a patient who is suffering from a deadly condition. Telephone and computers cannot provide compassion like a real person. In the end telenursing is a valuable service to patients but it is not
It is important not to let technology interrupt what is important for mental health. Next time while at the dinner table put the phone down and communicate with family members. Try to limit time on the internet and simply do as many activities as possible without technology. Technology may help the world but is not beneficial when it comes to the people using it, technology is truly taking a turn for the