Telepsychiatry — making the connection

At UND SMHS, new technology helps psychiatry residents expand services to western North Dakota

Andrew McLean, Telemed

Andrew McLean, clinical professor and chair of psychiatry and behavioral science at the UND School of Medicine & Health Sciences, practices telepsychiatry to help reach patients in underserved areas of North Dakota. Photo courtesy of SMHS.

Robert Olson is connected to western North Dakota.

“We are determined to reach rural areas,” said Olson, a Williston native and geriatric psychiatrist who directs the residency training program in psychiatry at the UND School of Medicine & Health Sciences (SMHS). “The ability to access psychiatrists is in short supply in many areas, quadruply so in rural areas.”

That’s one of the reasons the Williston native and fellow North Dakotan Andrew McLean are using technology to expand psychiatric services in the western part of the state.

Psychiatrists are desperately needed to help combat addiction and psychiatric problems, especially in the oil patch and western North Dakota, they said.

After the North Dakota legislature recently expanded the number of residency slots at the School of Medicine and Health Sciences through the Healthcare Workforce Initiative, the psychiatry residency program, which Olson directs, rose from four to six residents per year. At the same time, the SMHS began training those residents—who are stationed primarily in Fargo—to use telemedicine to reach rural areas and better serve the state.

The initiative is part of the OneUND Strategic Plan Goal 4 Grand Challenges, help rural communities solve their unique health and social problems.

Telepsychiatry 2018

Robert Olson, a geriatric psychiatrist who directs the UND SMHS residency training program in psychiatry, and Andrew McLean help psychiatry residents become comfortable practicing telemedicine. Photo courtesy of SMHS.

Wave of the future

“This is about serving the state,” said McLean, who serves as clinical professor and chair of the Department of Psychiatry and Behavioral Science at the SMHS and is a psychiatrist who practices telemedicine. “Telepsychiatry training allows us to educate residents in this type of practice and to serve patients who have limited access to psychiatric services.”

“Telepsychiatry is clearly the wave of the future,” said Olson.

Many towns in rural North Dakota have no psychiatric services on site, Olson added. “We are training residents to be comfortable with technology and to reach out to rural areas easily.”

That’s important, said both physicians, because all of North Dakota benefits from better access to mental health treatment.

Telepsychiatry also exposes psychiatry residents to other parts of the state and may increase their interest in practicing there after finishing residency, McLean said.

By combining rural outreach with telemedicine, the psychiatry residents also visit the communities and work with patients and medical providers once a month in person, then continue caring for patients using telemedicine every week. Patients travel less, and providers can still provide care, even in bad weather.

Over the past two years, third- and fourth-year psychiatry residents have served Dickinson, Williston, Minot, Devils Lake, Jamestown and Bismarck, mostly at human service centers as well as with telemedicine, where their patients often have serious mental illness and addiction.

“Our patients often are people who struggle with access to care, and may have lower income or less insurance,” said McLean. “We are focused on helping them.”

Almost like being there

“Telemedicine is as effective as face-to-face,” said Olson. “It’s almost like you’re there, especially in psychiatry. You can make eye contact and see movement and facial expressions. Studies have shown its effectiveness.”

“For most scenarios, telemedicine is almost as good as being there,” said McLean. “With high definition video, we’re able to zoom in and out, see tremors and check side effects. Most patients enjoy telemedicine.”

And, McLean said, at one of the human service centers they have been able to prescribe medicine that’s underused but effective, and needs to be monitored closely

“We were able to start the meds in person and provide follow-up with telemedicine,” McLean said. He added that the technology can help psychiatrists use time more effectively while improving the lives of patients.

Olson said they receive good feedback from clinics and human service centers, along with patients and residents.

“The residents love it,” said Olson. “We had some apprehension that residents would not want to travel to the human service centers, but they have very much enjoyed it. One has taken his kids with and stays in a hotel. They start out with no idea of what Minot and Dickinson are like and come back with great stories about the towns.”