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Early effects of upgrading to a high bandwidth digital network for telepsychiatry assessments in rural South Australia

There is some evidence that telehealth can increase access to specialist mental health services, thus resulting in better outcomes for patients. However, the wide scale use of telehealth in the provision of mental health services is often inhibited by reimbursement models, privacy, security and patient safety concerns along with interoperability and reliability problems. Despite the availability of reimbursement for telepsychiatry in Australia since 2002, only 0.06% of the psychiatric consultations provided between 2002 and 2011 were through telehealth. Telehealth was first used in mental health services in the country regions of South Australia in the mid 1990s. Increased recognition of the importance of access to high resolution videoconferencing led to plans for establishing a Digital Telehealth Network (DTN) in South Australia (SA). The SA Mental Health Act of 2010 permitted increased reliance on the use of videoconferencing, enabling clinical assessments to be undertaken for the purpose of confirming Mental Health Act orders. In SA, a psychiatrist must review an Involuntary Treatment Order (ITO) within 24 hours of a general practitioner (GP) making the ITO. This review may confirm or revoke the ITO. If the ITO is confirmed, the patient is admitted to one of the psychiatric units, all of which are situated in the state capital. Prior to the introduction of the DTN, rural patients who had been involuntarily detained by a GP would need to travel to the state capital for this review. However, a city-based psychiatrist can review the patients while they are still located in the country via videoconference over the DTN. Where the ITO is revoked, this avoids an unnecessary transfer of the patient to the city. The new SA Mental Health Act was the principal reason for upgrading the telehealth infrastructure, as high quality audio and video was thought to reduce the medico-legal risk to psychiatrists reviewing ITOs. It was also intended that the upgraded network would provide country mental health patients with faster access to consultant psychiatrists for general reviews and assessments. The DTN was established in rural SA starting in 2012. There are now over 160 videoconferencing units operating in over 80 health service sites, predominantly for telepsychiatry. We have examined whether the introduction of the DTN was associated with an increase in number of specialist assessments and whether this led to changes in mental health service provision for rural and remote patients. Emergency Department (ED) mental health presentations prior and post upgrading were obtained from hospital databases. Data relating to the number of conference calls and individual call records were extracted from the clinical information system used to record mental health encounters. Statistical analyses were performed using a standard package (SPSS version 17). Most sites on the DTN experienced an increase in bandwidth for videoconferencing from 128 to 512 kbit/s. The early indications are that this increased activity in rural mental health services. During the 12 months following the introduction of the DTN there was a 17% increase in the number of mental health assessments made by specialists through videoconferencing (from 2047 to 2318). There was a 46% increase, in the number of ITOs for rurally-based mental health patients reviewed by metropolitan based psychiatrists using videoconferencing (from 71 to 104) in the same period. During the first 12 months of the DTN operation, 9% of the ITOs for rurally-based mental health patients were revoked, thus avoiding unnecessary transportation of the patients to the capital city. During the 12 months following the introduction of the DTN there was a 26% reduction in mental health presentations to metropolitan EDs (from 249 to 186). However, this occurred in country hospital catchment areas where there had also been other local mental health changes, for example community based intermediate care and visiting psychiatrists, as well as telepsychiatry. The national Department of Health and Aging commissioned a review of the status of telehealth services in Australia in 2011. The report 6 documented telehealth services, both internationally and in Australia. It noted that: ‘‘even though telehealth has been utilized for decades, the take up of telehealth as a mainstream service is yet to be realized’’. Our findings suggest that the provision of better videoconferencing technology may lead to more widespread use of telepsychiatry. This may be particularly Journal of Telemedicine and Telecare 2015, Vol. 21(3) 174–175 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1357633X15569955 jtt.sagepub.com