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Forensic telepsychiatry

  • Paul Stankard (a1) and Saleem Younus (a2)
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Abstract
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Saleem, Y. & Stankard, P. (2006) I'm only at the end of a videolink. BMJ Career Focus, 333, 223.
Zaylor, C., Whitten, P. & Kingsley, C. (2000) Telemedicine services to a county jail. Journal of Telemedicine and Telecare, 6, 9395.
Zollo, S., Kienzle, M., Loeffelholz, P., et al (1999) Telemedicine to IOWA's correctional facilities: initial clinical experience and assessment of program costs. Telemedicine Journal, 5, 291301.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Forensic telepsychiatry

  • Paul Stankard (a1) and Saleem Younus (a2)
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eLetters

Hazards of forensic telepsychiatry

Laurence M Tuddenham, SpR in Forensic Psychiatry
02 May 2007

Dr Saleem's positive experience of assessing prisoners via a video link raises some interesting questions. Clearly if travelling time is prohibitive, this method frees up time for other work. However my experience of "remote" assessments, while not identical, suggests that their quality is poorer than traditional face-to-face interviewing. I provide psychiatric cover for forensic CPNs who perform assessments at thebusy local Sheriff court. Recently, for safety reasons, the interviews must be carried out in a room divided in two by a transparent partition, in the design beloved by Hollywood prison movies. I interviewed a prisonerwho had been assessed by the CPNs earlier in the week but was thought to be "at it". At interview there was little overtly unusual but he made somefleetingly odd comments and given his lengthy psychiatric history I felt he needed further assessment. His charges were of a serious nature so I suggested that a psychiatrist from the high security hospital should see him. He was duly interviewed in the local prison under traditional interview conditions, and he showed features of textbook hypomania - he was overfamiliar, intrusive of the interviewer's personal space, picked upher purse etc.

In the above case, the partition had inhibited the patient so that the signs of his mental illness were attenuated to the point that the diagnosis could be missed. The chances of this occurring are greater in a high turnover setting such as a Sheriff Court forensic liaison service, where the CPNs have deadlines set by the court sittings. I would guess that the effects of a video link on a mentally ill patient's behaviour might be even greater than a partitioned room - and might feed into any delusions about being watched! I also think that the possibility of doing some therapeutic work during an interview are reduced. The opportunity to reassure a frightened patient or prisoner in the relative intimacy of a standard interview room is lost by these artificial barriers. I'm not surethat the gain in efficiency from cutting out travel time makes up for this. However I suspect that most forensic psychiatrists rarely have to travel for several hours to their local prison so this innovation is unlikely to gain favour elsewhere.
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Conflict of interest: None Declared

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