By Toni Baker
The Georgia Health Sciences University Telemedicine Center is taking aim at Georgia's inadequate and maldistributed mental health services by making psychiatric care and continuing education more readily available.
Telemedicine is a network of computers, high-resolution cameras and a special grouping of telephone lines that makes patient examination possible regardless of distance between patient and doctor.
State psychiatric hospitals and community mental health centers will be embraced in this latest telemedicine initiative for Georgia where more than half the 159 counties have no psychiatrist and only 19 counties have at least one child psychiatrist, said Dr. R. Kevin Grigsby, director of research for the GHSU Telemedicine Center. Georgia has 73 child psychiatrists; more than half those are in the Atlanta area.
"In terms of ratio of patient-to-physician, we are much more like Alaska or Hawaii than we are like, say Connecticut," Dr. Grigsby said. Affordability is another issue affecting access to psychiatric care in Georgia where at least 20 percent of the population lives below poverty level.
This initiative, funded by a $1.5 million National Patterns of Academic Excellence grant from the University System of Georgia Board of Regents, parallels Georgia's reorganization of its mental health system that creates 19 different regions with boards in each empowered to contract for services. "These regions are going to have a tough time getting a child psychiatrist in rural Georgia," Dr. Grigsby said. "They either have to contract with somebody that rides the circuit or use telemedicine."
In fact, the vast majority of mental health services in Georgia today are provided by nurses and social workers; a 1994 study by the National Association of Social Workers found that, by far, social workers were the number-one mental health-care provider in the rural South, said Dr. Grigsby, who has a doctorate in social work.
This newest initiative is possible because of the Georgia Statewide Telemedicine Program, which eventually will link 54 hospitals, clinics and correctional facilities in the largest long-distance patient-examination system in the country, Dr. Grigsby said. Georgia's eight psychiatric hospitals are located in cities that are part of that system. Additionally, Georgia has over 400 distance-learning sites.
Both telemedicine and distance-learning networks will be accessed to make psychiatric consultations accessible and less expensive for patients and to make continuing education readily available for the social workers, nurses and psychiatrists providing care. Included in that education process is establishment of a learning center on the GHSU campus where mental health professionals can get hands-on training on how to use telemedicine.
A full-time telepsychiatrist, who specializes in consultation liaison psychiatry instead of long-term psychotherapy, will be hired to direct the initiative in psychiatry and telemedicine, Dr. Grigsby said. However, patients being seen by telemedicine will continue to have access to GHSU psychiatrists and psychologists who specialize in a particular area such as depression, Alzheimer's disease or schizophrenia.
Georgia's telemedicine program -- which at 30 frames per second produces essentially broadcast-quality images -- easily lends itself to psychiatric care, Dr. Grigsby said. The distance learning system won't be adequate for actual patient examination because less-sophisticated communication lines cause more of a delay so that a patient's facial expression and movements aren't as sharp, he said.
"Observational techniques used in psychiatry may use the instrument of the clinician rather than a blood pressure cuff or stethoscope," he said. "The Georgia Statewide Telemedicine Program is ideal as it uses both the clinician as an instrument and medical telemetry."
Georgia Health Sciences University Telemedicine Center