Telepsychiatry in an inner-city community psychiatric service

In the UK psychiatric services have become community based. Staff resources, which have not increased to keep up with the change in service demand, are unevenly spread throughout the various service elements. Community nurses, mental health teams and psychiatrists spend time moving between hostels, teaching centres and small community inpatient units, general practice surgeries and patients’ homes. Outpatient clinics take place at sites closer to the patients and away from inpatient services. In inner-city sectorized services the geographical distances may be small, but travelling times may still be long. This is often compounded by traffic congestion, poor public transport and travel costs. Techniques such as videoconferencing have the potential to improve communications between service elements, to reduce travelling time for staff and patients, to increase the accessibility of services for patients and to improve supervision by staff1. We have investigated the use of a videolink betweena community mental health centre, the Speedwell centre in Deptford, south-east London, and the inpatient ward for the sector at Guy’s Hospital in central London, 5 miles (8 km) away. The centre is open from 09:00 to 17:00 on weekdays and is staffed by about 25 persons including nurses, social workers, occupational therapists, administrative and support staff. Many of the staff have sessions at the inpatient unit as well as at the mental health centre. Patients usually present to the Speedwell centre for emergency consultation or to make informal inquiries. At the start of the study the communication requirements identified between the inpatient service and the Speedwell centre were the handing over of information to members of the community mental health team for the follow-up of patients with severe mental illness who were discharged from the ward, and arranging for the admission of patients in the community who had become ill. Before the installation of the telemedicine link communication was by post, telephone and by staff travelling between sites. The videolink was installed as part of the European Commission’s Telemed project (RACE-1086). This was designed to evaluate broadband communications links in a variety of medical applications. The equipment was a prototype videoconferencing system known as the MCVC and was based on a 386 PC which produced a digitized video signal from a monochrome camera. The MCVC was connectedvia a multiplexer (Craycom2000) to a 2 Mbit/s private leased circuit (BT Megastream). The transmitted picture was displayed on a 12 inch (30 cm) monochrome monitor at a resolution of 128 ́ 128 pixels with 64 greyscales, at about 25 frames/s. Sound was transmitted via the public telephone network using hands-free telephones (GEC) modified by bypassing the integral microphone with a clip-on microphone. Three cases are reported from a trial clinic which the sector consultant held over the link to review certain long-term patients. The psychiatrist was at Guy’s Hospital and the patients were at the mental health centre. All interactions were recorded on video and audio tape, and patients were asked to report their responses on a self-completion questionnaire, the Focused Observation Schedule (FOS) II. Observations were recorded in a logbook.