Treatment from a distance

When Jessica Beattie was looking for a dissertation subject for her doctorate in nursing, she didn’t have far to search.

A nurse practitioner at Chico State’s Student Health Center, she’d long been aware that many of the center’s patients had mental-health problems. But the health center had no psychiatrists on staff. With this in mind, she focused her dissertation on telepsychiatry as a way to increase students’ access to mental-health care.

Telepsychiatry is the use of modern audiovisual technologies as alternatives to in-person sessions with a psychiatrist.

College students, especially those at a residential campus like Chico State, comprise an especially vulnerable group, Beattie said during a recent interview in her book- and plant-filled office at the health center. They’re young and unformed, away from home and familiar support structures for the first time, and experimenting in ways that can be dangerous. Too often they make bad choices. And some arrive at Chico State with diagnosed illnesses—bipolarity, for example—that can be exacerbated by the use of alcohol or other drugs.

“We tried for years to hire a psychiatrist [at the Student Health Center],” she noted, but it didn’t work out. And the wait time for a private psychiatrist in town is as much as six weeks, which is often too long, she said.

Then she heard of Community Psychiatry Associates, a private partnership that has offices throughout much of Northern California. The group is experienced with telepsychiatry and also has worked extensively with young people. Its administrators had been thinking of opening an office in Chico, and when Beattie suggested they could draw patients from the student population, they leased a suite on Governor’s Lane, off the north Esplanade. Dr. Welby Nielsen became the staff psychiatrist.

But the office didn’t draw much student business, for several reasons, Beattie said. Many students didn’t want to go that far, especially on bicycle. The health-center doctors weren’t referring patients to it as much as expected, and neither was the university’s Counseling and Wellness Center.

It took a series of campus shootings, like those at Virginia Tech in 2007, to create the kind of safety issue and legal liability that would convince university officials to provide psychiatric care on campuses. Last spring, Beattie said, Chancellor Charles B. Reed sent a memo to all 23 campuses in the California State University system requiring them to “facilitate psychiatric care” for students.

Within two months, the health center had signed a memorandum of understanding with Community Psychiatry, which then paid to install the audiovisual equipment in an upstairs office. It’s been available all this school year, but so far hasn’t been used.

Part of the reason for that, Beattie said, is that students don’t know psychiatric care is available to them. But it’s also because other medical experts—doctors and therapists—aren’t fully familiar with it, don’t think it works as well as in-person treatment, and aren’t making referrals.

Another problem is that Community Psychiatry accepts only privately insured patients, and about 30 percent of Chico State’s students don’t have insurance. Many others are insured by Kaiser, which doesn’t pay for out-of-system care. Community Psychiatry does provide some pro bono care, however, so students without insurance who need treatment should talk with Beattie.

I wanted to see how the technology worked, so Beattie arranged an interview with Nielsen using the telepsychiatry equipment. I sat looking into a large flat-screen monitor, where I saw him sitting in his comfortable office two miles away looking at me. It was a lot like Skype, but with higher definition and a screen large enough to enable me to see most of the room behind him. It wasn’t exactly like being there, but close enough.

Nielsen said he’s worked extensively with telemedicine tools. He acknowledges that it can seem awkward at first. “The first time I did it I felt funny,” he said, “but it gets easier and easier” with every session. Young people are especially comfortable with it and often less guarded than with a live therapist, he added.

He’s working to set up similar arrangements in some of the rural communities in the North State that are too small to support a psychiatrist. He once worked in Utah, he said, where he treated patients who lived in towns hundreds of miles away without ever being in the same room with them.

Chico State’s Student Health Center is the first campus clinic in the CSU system to use telepsychiatry, Beattie said, but it isn’t the only local agency doing so. Ampla Health (the former Chico Family Health Center) uses it extensively, and so does, interestingly, the Butte County Jail.

Jail inmates have a wide variety of mental-health issues, Undersheriff Kory Honea said in a phone interview. Obviously, they can’t get out, so the Sheriff’s Office has contracted with a local psychiatrist to provide treatment one day a week, when he sees about 20 patients via telemedical equipment.

Once every three months the psychiatrist meets with the inmate patients in person, to establish a more personal connection. The doctor is also able to coordinate with other doctors in the community and provide information to the courts, Honea said.

Overall, Honea continued, the program has been very effective.

In fact, most studies of telepsychiatry show it works well. It’s certainly a good alternative to no treatment at all, which is the lot of those living too far from a doctor or those locked up in jail. But it also seems to work satisfactorily in comparison to in-person sessions, especially for young people.

As part of her dissertation, Beattie pored over the literature on the subject, and she found a high level of satisfaction. “Subjects felt it was more convenient than traveling for appointments, with an overall measure of satisfaction at 92.8 percent,” she writes.

She wants students to know that the Student Health Center is meeting the mandate to provide psychiatric services, and that they have a couple of options for obtaining it, including telepsychiatry.