By Helen Buttery
Spring 2010, Volume 13, no 3
Kirsten* and her mother, Carol*, have an appointment with an adolescent psychiatrist – virtually, that is. They are seeking help because 12-year-old Kirsten struggles with anxiety, depression and night terrors that started after she was sexually abused four years ago. When Kirsten and her mother arrive at the hospital in their northern Ontario community, a nurse ushers them into a room, where they sit in front of a large television mounted with a video camera. The nurse leaves and Kirsten and Carol turn their attention to the television. They are met by the pleasant gaze of an adolescent psychiatrist, hundreds of kilometres away at the Ontario Shores Centre for Mental Health Sciences in Whitby. The psychiatrist smiles, introduces herself, and the session begins.
This scene is part of the Virtual Emergency Room (VER), which since its inception in 2008 in the Central East Local Health Integration Network has spread across Ontario. Stretching from Scarborough in Toronto’s east end to Algonquin Park in the province’s north, the program uses live, two-way video conferencing, supported by the Ontario Telemedicine Network (OTN). These telemedicine ERs link youth experiencing mental health crises with three psychiatrists from Ontario Shores, and take referrals from three other hospitals – Lakeridge Health, Peterborough Regional Health Centre and Ross Memorial Hospital. The hope is to expand the program province-wide.
It’s a realistic goal because OTN is the largest telemedicine network in the world. The network is linked with nearly 900 Ontario sites, including public health units, addiction treatment centres and rural nurse practitioners. The OTN is a valuable resource, since Ontario faces an uneven distribution of medical professionals, explains CEO Dr. Ed Brown. Through the VER, it aims to even the geographical playing field of expertise by linking and integrating resources. For instance, Peterborough may not have a child psychiatrist, but a referral can be made through the VER and a case assessed within 72 hours. In Kirsten’s case, her sexual abuse counsellor made a referral to the VER, and less than two weeks later, she had an appointment with a youth psychiatrist.
Ontario faces an uneven distribution of medical professionals. The Virtual Emergency Room aims to even the geographical playing field of expertise by linking and integrating resources.
Last year, OTN conducted 53,000 virtual consultations. Of these, nearly half, including Kirsten’s, involved mental health issues. Particularly successful in the mental health field, telemedicine uses the most straightforward application of this technology – to talk. “You don’t need fancy equipment,” says Brown. The technology is excellent, and you can be treated for mental illness just as you would if you were physically in the office with the doctor.”
Without this virtual lifeline, youth in crisis might have to wait months for a consultation – if they get help at all. Currently, only one in six youth under age 18 with a mental illness receive appropriate help in Ontario, says Brown. The VER is working to improve these odds, expediting a process often mired by distance and wait times. At Ontario Shores, for instance, the three youth psychiatrists participating in the VER provide on average seven consultations a week.
Dr. Gabrielle Ledger, one of those psychiatrists, explains the importance of getting immediate help: “Diagnostically, seeing the person when they are having the symptoms is very helpful,” she says. Imagine, for instance, having a gallstone attack and having to wait six months for a doctor and then being asked to recall how it felt and the specific details. It’s the same for mental health issues. “When we see kids early on in an illness, we can assess the situation when everything is fresh and get a good sense of what the story is and what the important issues are,” says Ledger.
Referrals often come to Ledger and the other psychiatrists through emergency room or family physicians. For instance, a teenager who starts having panic attacks at school is referred to the VER by her family doctor. Or, after a suicide attempt, a youth ends up in the local emergency room, where the social worker involved makes a VER referral. “It’s a way to bridge existing services and support the health care team,” says Ledger.
In Kirsten’s case, she hit what her mother describes as a “therapy roadblock.” Kirsten needed support beyond what was available in her small northern community. “Her counsellor couldn’t get Kirsten past her fear and depression,” says Carol. That’s what prompted their visit to the VER. During her session, Kirsten underwent full psychiatric and family function assessments and was screened for other mental health symptoms. “She divulged personal, private information that she hadn’t talked about before,” says Carol. The psychiatrist then gave Kirsten and her mother feedback on the most likely diagnosis, even prescribing psychotropic medication.
In fact, the psychiatrist’s options don’t stop at the prescription pad. Virtual psychiatrists can fill out a Form 1, which is used to keep a person in hospital for up to 72 hours for further psychiatric assessment when there is risk of harm to themselves or others, or when they are deemed incapable of consenting to treatment. For Ledger, this ability demonstrates that virtual consultations are considered as valuable and robust as face-to-face assessments.
The technology also reflects how young people communicate: “Children are already using these technologies in their daily living, through Skype (an Internet calling service) and webcasts,” says Ledger. “It only makes sense that we would use this technology to reach them. The doctor is, virtually, in.”
*not their real names