Psychiatrists Offer “Face-to-Face” Sessions Via Technology in Washington State

by Candi Helseth

Ferry, San Juan Islands

A ferry provides the only transportation between the San Juan Islands and larger, inland towns.

Tourists view San Juan County’s lush, remote cluster of islands as a perfect place to get away from it all and relax, where they can enjoy whale watching and an abundance of wildlife. Yet, in this paradise, 78 miles northwest of Seattle and accessible only by air or sea, depression is ranked the second highest health issue, behind cardiac disease, among island residents. Psychiatrists are non-existent anywhere on the 173 islands.

For the last three years, the grant-funded San Juan County Telepsychiatry Project has linked patients on San Juan Island to a psychiatrist on the mainland, using state-of-the-art videoconferencing equipment. Primary care providers (PCPs) refer patients for free psychiatric evaluations and medication management with a psychiatrist at Compass Health, a nonprofit provider in Everett, Wash. “Telepresence” technology brings patient and psychiatrist together in a face-to-face setting where both can easily hear the other’s voice and see one another’s eyes, position and movements in lifelike size. The psychiatrist can also zoom in on the patient to do physical assessments.

“It’s as close as you can get to the real thing without having two people actually sitting in the same room,” said Carrie Unpingco, Inter Island Medical Center Telepsychiatry Project Coordinator. “Before we had these services, our residents had to take an entire day to travel to the mainland by ferry and drive to Seattle or Everett another two to two-and-a-half hours away just to see a psychiatrist. It’s expensive and meant they missed a day of work. What we found was that they just wouldn’t do it. Most were not going to leave the island for psychiatric care.”

Inter Island Medical Center, a designated rural health clinic on San Juan Island, partnered with San Juan County Public Health and Compass Health to form a consortium to improve psychiatric access on San Juan Island. They applied for and received a $375,000 three-year Rural Health Care Services Outreach grant from the Health Resources and Services Administration (HRSA).

By the time the grant concluded in April, nearly 100 people from 7 to 90 years old had completed 221 sessions. Thirty-four patients continued treatment and medication management under their PCP’s direction. Of 26 patients that completed a follow-up survey, 14 found no difference between telepsychiatry and face-to-face contact and five said telepsychiatry was better because they didn’t have to leave the island for care.

Dr. Robert Wilson, the only physician at Lopez Island Medical Clinic, referred patients who suffered from depression, anxiety, schizophrenia, bipolar disorder, obsessive-compulsive disorder, attention deficit disorder and attention deficit hyperactivity disorder. While his patients showed mixed enthusiasm about telepsychiatry, he said the service definitely improved care.

Telepsychiatry Project

John Manning (l), Joan Pedrick, Carrie Unpingco, Dan Rivera and Beth Williams Gieger, sit in front of the video conferencing equipment used by the San Juan Co. Telepsychiatry Project for patient sessions.

“I had a bipolar disorder patient who the psychiatrist was able to adjust medications to be managed more effectively,” he said. “The patient became stable to the point that I could manage his care.”

“Access to care was piecemeal (prior to the grant),” Dr. Wilson added. “Various psychiatrists have come and gone both on San Juan Island and Anacortes. So I was interested in the project although a bit skeptical. I am more accepting now. The fact that the care is provided on another island still is a barrier but it is better than the situation we had prior to that.”

The Consortium used remaining grant funds to purchase more mobile technology that Unpingco said will allow them to ship equipment to other islands. They are also looking to contract a psychiatrist who can commit more time to the islands’ needs. San Juan Island is the most populated island with about 7,000 residents and is among four main islands with 17,000 residents. HRSA approved usage of remaining funds by extending the grant to April 2011.

“During this extra year, we are working on continuing telepsychiatry and possibly adding teletherapy (telehealth services provided by other mental health professionals),” Unpingco said. “Medicare is currently reimbursing for telepsychiatry but it does not cover all the overhead costs of a session. We have heard that Medicaid is considering reimbursing for telepsychiatry. Overall, this Telepsychiatry Project has been a success for San Juan County residents.”

Carrie Unpingco
Inter Island Medical Center
550 Spring St. Friday Harbor, WA 98250
Phone: (360)378-2141 ext. 16

Back to: Fall 2010 Issue