AIM

This pilot study aims to examine the effects of Tele-consultation Liaison Psychiatry in the management of rural psychiatric inpatients in country general hospitals, studying both the outcomes for these psychiatric inpatients and the levels of satisfaction experienced by them, their families and the service providers in the rural areas who use this form of management. The Tele-consultation Liaison Psychiatry was administered and assessed by the author through videoconferencing which is a part of the service for rural and remote South Australians initiated by the Rural and Remote Mental Health Division of the South Australian Health Commission.

METHOD

The author developed special questionnaires to assess the satisfaction for the consumer, the community mental health worker (CMHW), the general hospital nurse and the general practitioner (GP). Additionally the GP’s and CMHW’s questionnaires sought an evaluation of the usefulness of the telepsychiatry interview in terms of the assessment and the bio-psychosocial management. At the initial interview all patients were rated on the Brief Psychiatric Rating Scale (BPRS-24) expanded version by the author. At the same time, patients were given the Behaviour and Symptom Identification Scale-32 which is a self rating outcome instrument.

Patients were seen via videoconferencing, initially everyday, reviewing both the patient’s progress and management issues. As the patients improved, the frequency of the reviews was reduced. All recommendations and plans were communicated immediately to the general practitioner and the primary nurse who were usually present during the sessions.

At the time of discharge. The developed questionnaires were given to all the service providers (ie. the general hospital nurse, the community mental health worker and the general practitioner). The patients were reviewed routinely, again via videoconferencing, four weeks after discharge. At this point the Behaviour and Symptom Identification Scale (BASIS 32) self rater instrument was given to the patient. The BPRS 24 was completed by the author and by another rater from a group of raters who did not know the patient.

The patient was also given the developed consumer satisfaction questionnaire.

RESULTS

In all there were 28 subjects (N=28) who were managed in 17 country hospitals in rural and remote South Australia. The patient population was characterised by high rates of Depression and Schizoaffective Disorder and eight patients fulfilling the criteria for an AXIS II diagnosis of Personality Disorder.

There was a significant improvement in the Mean Total Scores of both the clinician rated BPRS and the patients’ self rated BASIS outcome score. There was a high rate of satisfaction from all the service providers and the consumers. The highest rate of satisfaction was from the community mental health worker, followed by the general practitioner and the consumer with the general hospital nurse rating the lowest satisfaction. It was further noted from the questionnaire that the general hospital nurses rated their experience of nursing patients with psychiatric problems as poor. This low score improved significantly when they were asked to again rate their confidence and competence after their experience of specialist psychiatric support via telepsychiatry.

CONCLUSION

This study demonstrates that many patients with psychiatric problems can be effectively managed in their local country hospitals with good outcomes. The trauma of having to move them away from their families and familiar surroundings can be avoided and their recovery can take place in an environment in which they feel safe.

This study demonstrates that telepsychiatry can have strong support from the consumer and all the rural service providers - the general practitioner, the CMHW and the general hospital nurse.

The study further demonstrates that although there was initial resistance from the general hospital nurses, their satisfaction significantly improved after being exposed to the experience of telepsychiatry. There was also significant improvement in the competence and confidence expressed in managing psychiatric inpatients following the exercise.