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August 2013, Volume 63, Issue 8

Student's Corner

Telepsychiatry: the way to reconceptualise access to psychiatric care in Pakistan

Hira Ghazal  ( 5th Year MBBS Student, Dow Medical College, Dow University of Health Sciences, Karachi. )

Madam, mental health disorders are extremely common worldwide. According to the World Health Organization (WHO) report 2001, around 450 million people suffer from mental health disorders globally.1 Just as prevalent in developing countries as developed ones, as much as 34% of population in Pakistan is affected by anxiety and depression.2 More disturbing is the fact that over 70% of the population worldwide does not acquire healthcare treatment for mental disorders.3
Many studies have highlighted factors that cause delay in access to psychiatric facilities: stigma and prejudice by community being the foremost; lack of confidentiality and trust; lack of knowledge about symptoms of mental illness; and lack of awareness regarding access to appropriate sources.3 This is an alarming situation, as delay in seeking the treatment leads to heightening of the disease burden, poor quality of life, declining performance at school and work and, the most gruesome of all, increased suicidal tendencies.1
Stated facts clearly manifest an urgent need of looking into other methods of treatment. In the West, desperate struggle and concurrently fast growth of the telecommunication industry gave birth to a magnificent mode - \\\'telepsychiatry\\\'.
\\\'Telepsychiatry\\\', or \\\'E-Mental health\\\', is the practice of psychiatry over distance via communication technology, i.e. telephone, videoconferencing, email, etc., and has become an effective and accessible tool. It is one of the most successful forms of telemedicine, as most of the interaction in psychiatry relies on verbal and visual communication. Though primarily developed to serve difficult-to-access populations such as rural areas and prison etc., it is gaining wide approval as an alternative to in-person psychiatric treatment. Benefits reported include: reduction of stigma associated with mental disorders; decreased absence from work; quicker access to a psychiatrist; enhanced confidentiality and comfort; and reduced hospitalisation.4 Intriguingly, some studies have shown that a majority of patients preferred videoconferencing to in-person setting during post-interview evaluations.5
Telepsychiatry is the solution to the distressing situation of mental health in Pakistan; this proposal has already been put to test by a pilot study. A health clinic employing \\\'store and forward\\\' technique of telepsychiatry was established at the Institute of Psychiatry, Rawalpindi, Pakistan, in collaboration with the University of Manchester, Department of Child and Adolescent Psychiatry, to train existing staff in the management of children and adolescents. In the feedback taken after 3 months, members reported marked improvement in their diagnostic and treatment skills. Patients also showed an enthusiastic response as they valued expert opinion from abroad.6
The undeniable success and patient acceptability in the West and at home shows promising results for e-psychiatry in Pakistan. It is high time Pakistan gets an introduction to telemedicine, and what better way than telepsychiatry!

References

1. World Health Organization. The World Health Report 2001: Mental health: new understanding, new hope. Geneva: WHO Press; 2001. (Online) (Cited 2011 December 7). Available from URL: http://www.who.int/whr/2001/en/whr01_en.pdf.
2. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ 2004; 328: 794.
3. Thornicroft G. Stigma and discrimination limit access to mental health care. Epidemiol Psichiatr Soc 2008; 17: 14-9.
4. Saeed SA, Diamond J, Bloch RM. Use of telepsychiatry to improve care for people with mental illness in rural North Carolina. N C Med J 2011; 72: 219-22.
5. Sharp IR, Kobak KA, Osman DA. The use of video conferencing with patients with psychosis: a review of the literature. Ann Gen Psychiatry 2011; 10: 14.
6. Rahman A, Nizami A, Minhas A, Niazi R, Slatch M, Minhas F. E-Mental health in Pakistan: a pilot study of training and supervision in child psychiatry using the internet. The Psychiatrist 2006; 30: 149-52.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: