New Jersey is currently suffering from a shortage of psychiatrists, particularly child psychiatrists; merely 10 child psychiatrists exist for every 100,000 people. Consequently, some patients who experience a mental health emergency, including suicidal thoughts, must wait up to 10 hours in a hospital emergency room before receiving a psychiatric evaluation to determine whether hospital admission is necessary. This evaluation centers on whether the patient is an imminent danger to his or herself or others and whether the individual can function independently. At some hospitals, the patient must even be transferred to another facility to receive such an evaluation. Recently, to address the problem, nearly half of the state’s designated mental health screening centers have received waivers from the New Jersey Mental Health Screening Law’s face-to-face evaluation requirement and have substituted telepsychiatry.
Telepsychiatry allows the patient and the psychiatrist to be in different locations while the patient sits in front of a screen, connected to audio and video-conferencing equipment. In addition to listening to the patient speak and seeing his or her facial expressions, the psychiatrist has the ability to observe the patient’s body language by moving a camera around.
In the past, telemedicine was most commonly used to evaluate rural patients and members of the military, who had the least access to medical care. Advances in technology have driven down costs, resulting in a wider availability of such services. Now, emergency mental health services are being provided remotely in schools, prisons, community mental health centers, and substance abuse treatment centers, in addition to in hospitals. Within the Princeton Health Care System, the use of telepsychiatry on nights and weekends, when there is the greatest demand, has reduced the average wait for a crisis screening to two to three hours.
Despite the advantages demonstrated by telepsychiatry, it still has its criticisms. Some contend that placing the patient in front of a screen cannot replace the more personal face-to-face encounter where the doctor can make eye contact with the patient. There is always the risk of technology failures interrupting sessions and potential problems that could arise by having a psychotic patient talk to a “talking television.” One practitioner recalled instances where visual effects created by the technology contributed to the delusions of severely ill patients who thought he was both God and the devil.
However, studies have shown that telepsychiatry patients are satisfied with their care on an equal level with those who receive face-to-face care. According to Carolyn Beauchamp, president and CEO of the Mental Health Association in New Jersey, telepsychiatry is a useful stopgap measure until more people decide to enter the psychiatry field and Medicaid reimbursement for psychiatry services increases.