[Show abstract][Hide abstract] ABSTRACT: The Department of Veterans Affairs (VA) encompasses one of the largest telemental health networks in the world, with over 45,000 videoconferencing and over 5,000 home telemental health encounters annually. Recently, the VA designated suicide prevention as a major priority, with telehealth modalities providing opportunities for remote interventions. Suicide risk assessments, using videoconferencing, are now documented in the literature, as are current studies that find telemental health to be equivalent to face-to-face treatment.
Remote assessment of suicidality, however, involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability. Published in 2008 by John Wiley & Sons, Ltd.
Behavioral Sciences & the Law 05/2008; 26(3):271-86. DOI:10.1002/bsl.811 · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to review relevant research issues in the provision of culturally appropriate e-mental healthcare and make recommendations for expanding and prioritizing research efforts in this area. A workshop was convened by the Office of Rural Mental Health Research (ORMHR) at the National Institute of Mental Health (NIMH), the Center for Reducing Health Disparities at the University of California, Davis, the California Telemedicine and e-Health Center, and the California Endowment in December 2005, during which papers were presented concerning culture and e-mental health. Relevant literature was reviewed and research questions were developed. Major issues in the provision of culturally appropriate e-mental healthcare were defined, as were the barriers to the provision of such care in rural areas and interventions to overcome these barriers. Rural areas have increased barriers to culturally appropriate mental healthcare because of increased rates of poverty, increasingly large ethnic minority populations, and various degrees of geographical isolation and cultural factors specific to rural communities. Although culture and language are major barriers to receiving appropriate mental healthcare, including e-mental healthcare, they cannot be separated from other related influential variables, such as poverty and geography. Each of these critical issues must be taken into account when planning technologically enabled rural mental health services. This review describes one in a series of ORMHR/NIMH efforts aimed at stimulating research using culturally appropriate e-mental health strategies that address unique characteristics of various racial/ethnic groups, as well as rural and frontier populations.
Telemedicine and e-Health 07/2008; 14(5):486-92. DOI:10.1089/tmj.2007.0070 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An international telepsychiatry service was established between Denmark and Sweden for cross-cultural patient groups, such as asylum seekers, refugees and migrants. Over an 18-month period starting in mid 2006, 30 patients were treated by telepsychiatry (21 men and 9 women). The patients received mental health care by videoconferencing from providers who spoke the patients' own language, i.e. without the assistance of interpreters. The total number of telepsychiatry sessions was 203 (range 1-22; average 6.8 sessions per patient). Patients completed a satisfaction questionnaire at the end of treatment. Seven patients (23%) were not able to complete a questionnaire, due to illiteracy and/or a psychotic condition. The rest of the patients (n=23) reported a high level of acceptance and satisfaction with telepsychiatry, as well as a willingness to use it again or recommend it to others. Any disadvantages of telemedicine were compensated by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references. Mentally ill asylum seekers, refugees and migrants are under-served in their mother tongue and telepsychiatry can improve access to scarce health-care resources.
Journal of Telemedicine and Telecare 07/2008; 14(5):241-3. DOI:10.1258/jtt.2008.080301 · 1.54 Impact Factor
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