Using the digital tools of telepsychiatry to forge emotional bonds

Tung Tran (left), Director of the CIUSSS’s Mental Health and Addiction Program, and Dr. Marc Miresco, JGH Director of Adult Psychiatric External Services
Tung Tran (left), Director of the CIUSSS’s Mental Health and Addiction Program, and Dr. Marc Miresco, JGH Director of Adult Psychiatric External Services

Comfort of home helps clients open up to their therapists

Compared to many other branches of medicine, psychiatry might appear to be a dubious candidate for telehealth, where bonds are forged with screens and keyboards, rather than in the privacy and intimacy of the doctor’s office.

And yet, long-distance counselling has taken root and flourished throughout CIUSSS West-Central Montreal since the lockdown came into effect in March for the coronavirus (COVID‑19) pandemic.

“I’ve noticed that the quality of the sessions and, in some ways, the nature of the therapeutic relationship improves when it happens virtually,” says Dr. Marc Miresco, a psychiatrist and Director of Adult Psychiatric External Services in the Institute of Community and Family Psychiatry at the JGH.

“Many patients initially feel somewhat shy or reserved about opening up to a mental health professional. For these patients, there’s something about using their own computer at home that makes it easier and more comfortable for them to say what’s really on their mind.”

“Many patients—especially if they’re new to therapy—may also feel nervous about possibly being stigmatized,” adds Tung Tran, Director of the CIUSSS’s Mental Health and Addiction Program.

“If they feel secure at home, they’re more inclined to express their thoughts and emotions, and more open to talking about what’s happening in their lives.”

“Psychiatry and mental health are actually the most obvious candidates for telehealth,” adds Dr. Miresco. “We’re one of the only—if not the only—medical specialties where we don’t need to place our hands on our patients to examine them.”

Before COVID-19 struck, says Mr. Tran, the Ministry of Health rarely remunerated doctors for work that was done remotely with a digital connection. However, as the threat of a pandemic loomed in February, the government changed its policy and allowed payment to be made to physicians who practice with telehealth.

By that point, Mr. Tran had already begun preparing his entire CIUSSS team for the impending digital transformation. For staff working from home, this included access to electronic medical records and ensuring that everyone was comfortable with Zoom and other types of software.

What was encouraging to staff, says Dr. Miresco, was evidence-based research from elsewhere in the world, which “showed that assessments by telepsychiatry are equally as safe and effective as those done in person.

“In ideal circumstances, you would take many months or a year to change the work habits of 30-odd psychiatrists and nearly 100 other mental health professionals. We had to do all of that in two weeks or less.”

In the process, four noteworthy projects were developed:

  • Therapeutic webinars, moderated by professionals, have been “broadcast” four times a week since April to an audience of about 60 people.
  • With support from Bell Canada and the JGH Foundation, iPads have been lent to vulnerable clients who are at home and don’t have a computer, tablet or cell phone. The iPads allow them to connect remotely to their treating teams.
  • Special measures were needed to protect the health of psychiatrists in their 70s and 80s, who wanted to maintain contact with their patients, despite the vulnerability of these doctors to COVID-19. This has been accomplished by giving tablets to certain patients when they are admitted or are in the Emergency Department.
  • The Youth Drop-In Clinic has switched from in-person sessions to Zoom. The informal discussions are chaired by professionals, who can refer a participant to a treatment team, if necessary.

On a related note, the Telehealth Intervention Program for Isolated Older Adults has also been introduced to provide support via telehealth to vulnerable older individuals, for whom the isolation of the pandemic meant a potential increase in stress and depression.

“We know that older adults are disproportionately affected by this crisis, because they are at the highest risk of mortality from COVID-19,” says Dr. Blanca Vacaflor, a resident in geriatric psychiatry at the JGH. “For this reason, we initiated a unique clinical trial to help alleviate their stress.”

The program is directed by Dr. Syeda Bukhari, a Postdoctoral Fellow, and by Dr. Soham Rej, a Geriatric Psychiatrist at the JGH and researcher at the Lady Davis Institute.

But will telepsychiatry be able to maintain its high degree of usefulness once the immediate threat of the pandemic subsides? Mr. Tran says he’s sure it will.

“If the service is available wherever the patient or client happens to be, there’s a better chance of having more people show up for their appointment.”

Dr. Miresco agrees. “I think the classic style of face-to-face psychiatry will always be there, and many patients and clinicians will prefer it.

“But telehealth and telepsychiatry are finally being accepted as mainstream options that are becoming part of the permanent landscape.”