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Psychiatry in the future: Information technology can pull mental health care into the 21st century

  • Isaac Marks (a1)
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A hundred and fifty years ago, physical disease was known to be widespread but was usually untreated. Anxiety and depression is now like that. Up to a fifth of the entire population are affected, of whom 84% were untreated in a UK community survey (Bebbington et al, 2000). ‘Developed’ countries are underdeveloped when it comes to treating anxiety and depressive disorders, even though effective treatment is available in the form of brief cognitive–behavioural therapy. In the UK, waiting times for such therapy can be as long as 2 years. Routine therapy outcomes are rarely reported. The delivery and monitoring and also teaching of therapy still largely conform to a 19th century model, and could be advanced by greater use of information technology. Such technology could catalyse a model of community care delivered mainly in the home, by enhancing access to effective self-help, audit of outcome and professional training.

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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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Bebbington, P. E., Brugha, T. S., Meltzer, H., et al (2000) Neurotic disorders and the receipt of psychiatric treatment. Psychological Medicine, 30, 13691376.
Greist, J. H., Marks, I. M., Baer, L., et al (2002) Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry, 63, 138145.
Marks, I. M., Mataix-Cols, D., Kenwright, M., et al (2003) Pragmatic evaluation of computer-aided self-help for anxiety and depression. British Journal of Psychiatry, 183, 5765.
Marks, I. M., Kenwright, M., Mcdonough, M., et al (2004) Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomised controlled trial in phobia/panic disorder. Psychological Medicine, 34, 110.
Mcdonough, M. & Marks, I. M. (2002) Teaching medical students exposure therapy – randomised comparison of face-to-face versus computer instruction. Medical Education, 6, 16.
Osgood-Hynes, D., Greist, J. H., Marks, I. M., et al (1998) Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open US–UK study. Journal of Clinical Psychiatry, 58, 358365.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Psychiatry in the future: Information technology can pull mental health care into the 21st century

  • Isaac Marks (a1)
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eLetters

Psychiatry and Information Technology

Suraj Gogoi, Psychiatric Trainee
15 October 2004

I was very interested to read Isaac Marks' Psychiatry in the future. The author is right in highlighting the problems of poor access to services for patients with mental health problems. Information technologyindeed has the potential of addressing this serious deficit and enhance community care at home. The recent trials of computer-aided therapy in the UK have set the ball rolling and further research in this field will most certainly improve our understanding of how information technology could effect both patients and providers of care.

The role of telepsychiatry was not given its due mention in the article, although this has been extensively researched in the past few decades. Many say that psychiatry is ideal for videoconferencing because of the primacy of face-to-face, question-and-answer interaction. This wasshown to improve access to services, improve education and training and also reduce travel time. Advances in telecommunications and digital technology allow organizations to extend their boundaries beyond physical and geographic barriers (1). In general telepsychiatry has proved satisfactory for both patients and providers. A pilot study of telemedicine used for patients with obsessive-compulsive disorder showed that telemedicine resulted in near-perfect inter-rater agreement on scoreson semi-structured rating scales for obsessive-compulsive, depressive, andanxiety disorders (Baer, Jenike, Leahy, O'Laughlen, & Coyle, 1995).

It has been argued that patients and carers may find it easier to approach internet-based services than seek out help through a mental health centre initially. This could be both because of ease of access as well as the still prevailing stigma of mental illness. The development ofhigher bandwidth internet in the UK is a promising step for the future of the digital revolution in psychiatry. The internet has hugely influenced the way patients and their carers are informed about mental health disorders nowadays. It imperative that we, as service providers master our understanding of the 'virtual environment' and use this as a further medium for service delivery and follow-up. Various asynchronous modes of therapy eg. discussion groups, internet communities and electronic mail should also be reviewed and encouraged. Psychiatry, in comparison with other disciplines, is quite well poised to stake its claim in this digital revolution and responsive organisations and stakeholders should ensure that we don't 'miss the boat' this time.

References:

1. Turner, Jeanine Warisse. [WWW] Telepsychiatry as a Case Study of Presence: Do You Know What You Are Missing? JCMC. 2001 July; 6(4). http://www.ascusc.org/jcmc/vol6/issue4/turner.html (25the September 2003).

2. Hilty, D. M.; et al. Telepsychiatry: an overview for psychiatrists. CNS Drugs. 2002; 16(8):527-48

Competing interests: None declared
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Conflict of interest: None Declared

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