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Prisons resort to video for psychiatric care

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A telepsychiatrist talks to her patient through a monitor.
Telepsychiatrist Tanuja Reddy talks through a monitor in the prison in Rush City, Minn., from her office near Nashville, Tenn. The screen has a piece of plexiglass over it and is enclosed in a metal filing cabinet. A patient sits on the chair in front of the screen so the telepsychiatrist can see the patient while they're talking.
Alisa Roth | MPR News

The psychiatrist is sitting at her desk, facing the spot where the patient would normally sit across from her. Behind her there is a bookshelf with books and little knickknacks.

It looks like an ordinary scene in a doctor’s office. Except that the doctor sees the patient on a screen and talks on a speaker phone.

“Seeing patients, it’s really not that different,” said the psychiatrist, Dr. Tanuja Reddy. “I feel like it’s the same patients, same type of patients, same type of concerns that we’re addressing. The only difference is I’m not there inside the prison.”

Reddy’s not only outside the prison, she’s far outside of Minnesota. She’s sitting in her home office in the suburbs of Nashville, Tenn. Her patients sit in the men’s prison in Rush City, Minn., about an hour north of the Twin Cities.

As more and more people in prison need mental health care, more and more prison systems are turning to telepsychiatry. It’s basically a video psychiatry appointment, a doctor’s visit via Skype or FaceTime.

Michelle Saari directs psychological services at Rush City's men's prison
Michelle Saari directs psychological services at the men's prison in Rush City.
Alisa Roth | MPR News

“We are a little bit of a rural facility so with traffic it could be an hour to two hours outside of a major metro area. So, to recruit providers for psychiatry here can sometimes be challenging,” said Michelle Saari, who directs psychological services at Rush City.

It’s tough to find doctors who will work in rural areas. And it’s hard to recruit doctors to work in prison because the working conditions are usually pretty unpleasant. So, it’s doubly hard for prisons that are trying to recruit doctors to work in them.

Psychiatrist Edward Kaftarian oversaw mental health care in a number of institutions in California: the jail in San Diego, the San Quentin prison, the state prison system. Now he runs a telepsychiatry company that serves five different jails in that state.

“With telepsychiatry it opens up that recruitment pool to anyone,” he said. “It can be anyone across the nation as long as they have a license for that state.”

Since much of a psychiatrist’s work these days is medication management, not therapy, having the doctor and patient sitting in the same room is less important than it might be otherwise, Kaftarian said.

Back at Rush City, the psychiatrist Tanuja Reddy is looking out from a screen enclosed in black metal cabinet. A piece of plexiglass covers the screen. In front of it is a no-nonsense chair for the patient to sit in. But other than that, the room is bare.

The room at Rush City isn’t warm or welcoming, but it’s better than some prisons provide, which have to double up with storage rooms or other offices.

As anybody who’s had a video conference or even talked to somebody on Skype has experienced, video chats aren’t the same as talking to somebody in-person. But Reddy said that’s OK.

“I actually feel like we can assess and gauge emotions and feelings even though there’s this screen between us,” she said. “There is something to be said about a person’s demeanor, their actions, their movements that gives us an idea what they’re going through.”

For that to work, though, depends on the positioning of the camera. And, more importantly, for telepsychiatry to work, there needs to be a reliable internet connection. A frozen or choppy connection makes it impossible for the doctor to do the job properly.

There are other challenges, too. A telepsychiatrist may be able to provide effective treatment remotely. But she still needs a full picture of the patient, some of which you can’t get remotely. If someone hasn’t been bathing regularly, for example, the odor obviously wouldn’t transmit.

That means the telepsychiatrist needs a strong connection to people who are working on site — nurses, psychologists and correctional officers — who can fill in the gaps. And having access to the patient’s records is critical, something that being off-site can complicate.

Head of the American Civil Liberties Union’s National Prison Project, David Fathi, said correctional systems often don’t have electronic medical records, which means somebody has to scan or fax the records to the psychiatrist.

“For whatever reason,” he said, “it’s a common problem in correctional use of telepsychiatry that the remote psychiatrist does not have access — sometimes to any part of the record — but quite frequently does not have access to the entire record before treating the patient.”

But Edward Kaftarian, the psychiatrist who runs a telepsychiatry company, said the question is not whether seeing a doctor in person is better than seeing one remotely. The real question, he said, is whether seeing a psychiatrist remotely is better than not seeing one at all.

If you have experience with telepsychiatry in or outside of the correctional system, we want to hear from you: aroth@mpr.org or 651-290-1061.

This reporting is part of Call to Mind, our MPR initiative to foster new conversations about mental health.