Friday, July 20, 2007

I guess if it's possible to have "phone sex" then you can have "telepsychiatry"

I've never heard the phrase "telepsychiatry," but apparently it's been used in rural Texas jails for 20 years for mentally ill offenders, and according to the Amarillo Globe News ("Jail telepsychiatry to expand," July 20) will expand now to the jail in Dalhart and to Amarillo-area probation departments. The paper touts this as a significant improvement.

OTOH, the scope of the program doesn't give me much confidence. Reports the Globe News: "Those who are bipolar, schizophrenic or suffer from major depression are seen by MHMR at least once every 90 days through the telepsychiatry program."

Uh ... once every 90 days?! For schizophrenia, bipolar disorder and fer Godssake major depression! That's setting the bar pretty low given the severity of those mental ailments and their impact on society and the criminal justice system, another example where underinvestment on the front end leads to greater costs to taxpayers down the line.


Anonymous said...

As a mental health provider I can't believe this type of treatment is ethical.

Anonymous said...

Telemedicine is being used not only for psychiatry but regular medicine by UTMB for inmates at TDCJ. UTMB wants to provide the same services to TYC.

Anonymous said...

With this quality of service, it is no wonder Court Ordered counceling is ineffective and usually ignored by participants.

Add to the bad medicine the fact that the providers share everything they hear with the probation/parole officers and you end up with a big waste of money.

The State, the individual and society all get nothing but a big tax bill. The only benefit goes to incompetent health care providers and educators.


Anonymous said...

There is no relationship between the absurdity of this and court ordered counseling.I really doubt the health care providers (i.e. psychiatrists) are incompetent and what do educators have to do with this? Also the psychiatrists undoubtedly do no sort of counseling and the only information for everyone to here is what types of meds are being taken.

I will say that this is an absolutely unacceptable practice and Texas should beware. California is currently being sued for neglecting mental health care in prisons with ridiculously high numbers of psychiatry vacancies at their facilities. Man I should have been a forensic psychiatrist. They can basically name their price at these facilities.

I will also note that psychiatry in TYC is being moved to UTMB and they are talking about telepsychiatry for youth. Absolutely ridiculous.

Anonymous said...

what a joke...a bad joke on the taxpayers

Anonymous said...

Sorry, but telepsychiatry isn't as bad as many of you might think it may be. I know at TYC all of the kids have a psychological assessment at Marlin which includes a review of records and I would imagine the same to be true at TDCJ.

Most Psychiatrist don't spend more than 15 minutes talking with a patient reviewing records and recommending treatment. Few Psychiatrists check pulse, blood pressure etc... usually as in most Doctor's offices an LVN takes the vitals for a patient and passes the information to the doctor.

As long as the psychiatrist can talk with the patient and gather the same info as he would if he/she were in the room (along with a review records, many record systems are becoming electronic) I really am not seeing the problem.

As far as seeing patients once every three months that is standard routine case management for MHMR. Most patients who are on medication and are stable whether they have a diagnosis of Bipolar, Schizophrenia, Schizoaffective, or Major Depression, Recurrent, Mod. to Severe (must have GAF 50 or below to get services to begin with) only see the psychiatrist on average every 3 months or so.

For severe cases (ACT) then the client may have contact with a case manger about 3 times a week and a psychiatrist about once a week.

Fact is, there are many clients who refuse treatment, regardless of a court order that says a client must attend treatment or be screened at MHMR a client can not be given medication unless he poses a risk to him/her self or others.

Unfortunately, there are many barely functioning/stable persons who may be psychotic and delusional but still rational enough to say no to medication.

As far as counseling goes, you can lead a horse to water but can't make him drink. No amount of therapy is going to provide change if the client does not on some level want to change.

Ultimately, it is the providers responsibility (be they TYC, TDCJ, MHMR, etc..) to provide the opportunity and support if the client "chooses" to change but it is up to the client to make the choice and follow through.

Given the costs (transport) and limited availability of services due to lack of adequate funding the if done right then telepsychiatry may provide coverage and treatment to those who might not get much needed services otherwise.