This can not only help with understanding cultural norms, but it can also allow for an understanding of any important historical contexts that could influence symptom presentation, treatment adherence, or ability to actively engage in specific treatments. Case Study: Telepsychiatry in India One telepsychiatry service established in India provided mental health services across the country under the auspices of an Indian NGO (Naskar et al., 2017). Using local cultural artifices, the staff in this program created outreach and awareness campaigns in the forms of street theater, folk songs, and film screenings. The goal of these outreach activities was to raise awareness about mental illness and a new telemental service, including teleconsultations. Providers in this program coordinated telemental health treatment with access to free medication at local access points. Based on the response of the community to the telemental health services, the team created a mobile telepsychiatry unit in one area of the country. The mobile telemental health unit was contained in a bus-type vehicle and included a teleconsultation room with a flat-screen television, a camera, and a pharmacy consultation room. The mobile unit had an onboard pharmacy so that medications could be dispensed immediately following psychiatrists’ orders through teleconsultation. Both the telemental health consultation and the medication were provided free of cost. Providers also provided emergency services via telemental health. The mobile unit also provided psychoeducation to caregivers to help remove the stigma of mental illness of their family members. They provided information about job opportunities. The prerecorded street performances and films with mental health workers were broadcasted on a television screen mounted on the back of the mobile bus. In addition, health workers distributed posters and pamphlets about mental illness and the telemental health services provided. Because of the scarcity of mental health professionals in India, nonpsychiatric professionals were also recruited to help (Naskar et al., 2017). General practitioners and paraprofessionals participated in the provision of service. The telepsychiatry program also provided services in tribal and rural areas in central India. In many areas, especially among industrialized countries around the world, telemental health programs are moving from the pilot phase of implementation to a more permanent infrastructure. In a 2015 survey of 53 European countries conducted by the WHO (2016), 84% of the respondents (38 member states) reported that their national universal health coverage policy includes language that supports technology-based health and communication.
eHealth is a broad term that refers to the use of electronic technologies to deliver health-related information and can include telemental health. Most respondents (70%) had a national eHealth policy that included specific policies for eHealth. The majority of those that had a national eHealth policy (69%) reported having financial support available for the implementation of a national eHealth policy. The majority of member states (89%) offered education and training programs for the use of information and communication technologies, including eHealth. Although the growth of eHealth in Europe seems promising, there are no standards, policies, or legislation with oversight for this system of care. In many countries with large immigrant populations and in countries that are home to a variety of languages or dialects, local providers may experience linguistic barriers with individuals who need services (WHO, 2016). UniversalDoctor, UniversalNurses, and UniversalWoman are Internet-based programs that offer services from providers who have multilingual backgrounds. These services can be accessed through computers and applications on smartphones and tablets. The programs connect service providers who can speak the language of the individual needing care to improve access to services. In addition, there are large-text and audio functions that can help people who are blind or deaf/hard of hearing. Some of the mobile applications can be downloaded in advance so that they can operate in areas that do not have an Internet connection. The fast development of technologies and ever-expanding applications have the potential to improve the well-being of individuals worldwide. Studies of the efficacy of telemental health services point to improvement in clinical outcomes, particularly for those who had not previously had access to mental health services (Lerman & Quashie, 2016). In the U.S. and other industrialized countries, professional organizations across a spectrum of disciplines have developed or are developing telemental health practice guidelines. In an international context, telemedicine, telemental health, and other types of telehealth technologies have been applied to many different situations, including natural disasters; war- conflicted countries; and industrial, chemical, and biological catastrophes (Doarn & Merrell, 2014). In many situations, telehealth technologies have been used in disaster responses for preplanning, such as an impending tsunami, or postdisaster, such as chemical explosions. Although teleservices cannot prevent catastrophic events from occurring, they can be used to provide support and relief to individuals who may not otherwise have access.
CONCLUSION
Telemental health services can be called different names but essentially are behavioral healthcare services that are provided using telecommunications or video conferencing technology. A range of technologies are used to provide healthcare, such as live video, remote patient monitoring, and mobile health. Clinicians can provide telemental health services in a wide array of settings, thus making the modality versatile and flexible. Providers can use telemental health to provide individual, couple, family, and group therapy. Telemental health services help to fill gaps in service to individuals who live in areas where there are limited behavioral health professionals, such as rural areas, or where barriers to accessibility exist, such as stigma and the financial burdens associated with the cost of traveling to locations. Telemental health can be used for assessment
and diagnosis as well as the provision of direct treatment. Clinicians may need to adapt current practices to better fit with telemental health, such as establishing a visual telepresence, ensuring that equipment or software meets security and privacy requirements, and meeting licensure requirements. Telemental health providers must continually meet ethical guidelines and manage emergencies and crises effectively. Although there are challenges to telemental health practice, the potential benefits to individuals who do not otherwise have access to behavioral health care make efforts to overcome those barriers worthwhile.
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Book Code: SWFL1825
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