Telemedicine is the delivery of medicine  using the telecommunication devices. The term telemedicine is composed of the Greek word tele meaning ‘far’, and medicine.

Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. It can also involve the use of an unmanned robot.

Telepsychiatry is the application of Telemedicine to the field of Psychiatry. It has been the most successful of all the telemedicine applications so far, because of its need for only a good videoconferencing facility between the patient and the psychiatrist, especially for follow-up.

Care at a distance (also called in absentia care), is an old practice which was often conducted via post; there has been a long and successful history of in absentia health care, which – thanks to modern communication technology – has metamorphosed into what we know as modern telemedicine. In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease. In the early 1900s, people living in remote areas in Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia.

SCARF Telepsychiatry

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Schizophrenia Research Foundation (SCARF) began experimenting with tele-psychiatry in 2005 using Integrated Services Digital Network (ISDN) lines as part of its psychosocial intervention program for tsunami victims and has since developed it into a full fledged component of its community outreach program.

In 2010 the program was considerably expanded with support from the Tata Education Trust to cover the district of Pudukottai in Tamil Nadu. During the first phase of the program, four taluks (administrative divisions) in the district are being covered. A unique component that has been the pioneering use of mobile telepsychiatry .

The mobile unit covering the two taluks encompasses 156 villages with a population of about 300,000. At present the service focuses only on those with serious mental disorders and currently about 1500 people have availed of the services offered under the SCARF Telepsychiaty in Pudukottai (STEP) Program.

Mobile telepsychiatry

SCARF’s mobile telepsychiatry service is provided on a bus that has been custom-built to contain a consultation room and a pharmacy. In the consultation room, communication takes place between the psychiatrist based at SCARF, Chennai (some 450 kms from Pudukottai) and patient through flat screen TVs and state of the art high resolution cameras using a wireless internet connection.

After a tele-consultation and with a diagnosis being reached, a prescription is dictated by the psychiatrist to the telepsychiatry clinic facilitator in the bus and fulfilled by the on-board pharmacy. A follow-up appointment date is given where medication is reviewed and further treatment provided

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The medication is provided free of cost, this is an essential component of the program considering the patients’ financial limitations and also the fact that psychiatric drugs are rarely stocked in rural pharmacies.

Each patient receives a patient-held record designed to facilitate continuity of care and information sharing between healthcare professionals. It details their diagnosis, prescription, and any relevant investigations that the patient must get done independently, such as an EEG or blood-sugar level check.

Other components of the STEP program

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Apart from tele-consultations the other interventions include running psychosocial rehabilitation programmes in conjecture with the local NGOs. The self help groups that are thus formed focus on economic activities rather than emotional support. This structure in our experience has been more successful because the financial benefit encouraged continued participation. The family of the patient is also strongly encouraged to participate since this helps to prevent collapse should someone fall ill and also provides them with support.

Structured educational programs are also conducted for family members to help them better understand their relatives illness and to enable them to manage it. Linking up with complementary service providers and organizing them to seek and gain benefits due to them is also forms an important aspect of the program.

The other main thrust of the program is awareness creation about mental illness. Poor understanding of the illness delays early identification and treatment and thereby adds to the stigma experienced. Key individuals such as local social workers, police officers and NGOs are also sensitised about the illness and informed of SCARF’s tele-psychiatry program and are encouraged to refer people to the service.

The villagers themselves are targeted by awareness campaigns, which include street plays, the distribution of posters and pamphlets, and the screening of films. These are broadcast on a TV screen fitted to the rear of bus, and were created specifically to educate people about the signs and symptoms of psychotic disorders. The film also explains the process of telepsychiatry and the objective of the program.