John Drescher

April 11, 2014

Drescher: More NC residents seeing psychiatrists through real-time video

Mentally ill people are crowding emergency rooms. It's there that North Carolina's best innovation in mental-health care in years is emerging: Psychiatrists and psychologists use real-time video and audio meetings with patients and health care providers to treat people with mental health and drug and alcohol problems.

You can’t find a psychiatrist in much of North Carolina. There isn’t one in 28 of our 100 counties. In 18, there’s one for the entire county.

At the same time, our adult-care centers, jails and prisons are jammed with mentally ill people. The state has cut the number of beds in its three psychiatric hospitals by half (from 1,750) in the past decade. That has left thousands of people without psychiatric treatment.

Mentally ill people also are crowding emergency rooms. It’s there that North Carolina’s best innovation in mental-health care in years is emerging. Telepsychiatry offers a way for mentally ill people in ERs to get treatment. Psychiatrists and psychologists use real-time video and audio meetings with patients and health care providers to treat people with mental health and drug and alcohol problems.

Of the counties without a psychiatrist, 10 are in northeastern North Carolina. In 2010, the Albemarle Hospital Foundation in Elizabeth City borrowed an idea from South Carolina, which had used a grant from the Duke Endowment to establish telepsychiatric care.

Albemarle Hospital forged a partnership with psychiatrists in Jacksonville to develop a hospital-based system of telepsychiatry for northeastern North Carolina. The effort succeeded, according to the N.C. Center for Public Policy Research, a Raleigh-based nonpartisan research center, and was expanded to serve 14 hospitals in 29 counties. Four more hospitals were added in 2013.

The center, in a report released this month, found:

• The length of stay in emergency rooms for patients awaiting inpatient treatment declined from 48 hours to 22.5 hours.
• Eight percent of patients had to return to Albermarle Hospital within 30 days, compared with 20 percent before.
• The number of involuntary commitments decreased by 33 percent.

State Rep. Susan Martin, a Wilson Republican, thought the program should be expanded. Of North Carolina’s 108 hospitals, 49 provide telepsychiatry. Wilson got $2 million included in the current state budget and $2 million in next year’s budget (which starts July 1) so that all hospitals in North Carolina could participate. The program will be similar to the Albemarle Hospital program and will be run by East Carolina University.

Of the $2 million this year, more than $1 million will be spent on equipment and Web portal development. At the end of March, 23 hospitals had been added; two more contracts had been signed; and 40 more hospitals were in contract negotiations.

“I love this because it’s real health care reform, and it changes the way health care is delivered,” Martin told me. “This is an innovative way to provide care.” Martin says everyone wins – patients, health care providers, law enforcement (which often deals with mentally ill people) and all of us who pay for emergency room visits of uninsured people with mental illness. The program has been embraced by Gov. Pat McCrory and his health and human services secretary, Aldona Wos, a physician.

There are challenges to telepsychiatry. The technology must protect patients’ privacy. Psychiatrists, in not sitting across from a patient, might have difficulty in developing patients’ trust (although the center reported that some children find it easier to be open when communicating through video).

Those issues are worth working through. The last decade has not been a good one in North Carolina for mental-health treatment. Telepsychiatry promises a step forward.

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