Undercurrents: Government Explores Telemedicine for Mental Health Patients

A regular Source column, Undercurrents explores issues, ideas and events developing beneath the surface in the Virgin Islands community.

With mental health care resources seriously lacking in the territory, the Health Department has launched an effort to fill the gap through telemedicine.

The practice of having health care providers consult with patients remotely via telecommunications has grown in popularity in the past 10 to 20 years, although it still has its detractors.

Critics say it can be impersonal and claim doctors can miss cues from patients.  Supporters say it increases access to treatment, especially specialized care that may not be available in a patient’s vicinity; it keeps patients out of waiting rooms where they are exposed to infection from other patients, helps contain costs, and saves time both for the patient and for the provider.

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Health Commissioner Michelle Davis had suggested telemedicine as a way to supplement services, particularly mental health care, early last year, soon after she took over as head of the department.

The Source requested an interview with Davis or with Berlina Wallace-Berube, director of the division of Mental Health, Alcoholism and Drug Dependence Services, about the progress of the initiative, but after submitting a list of questions, as requested, Nykole Tyson, Health’s director of public relations, said officials had decided they aren’t ready to talk publically yet.

In response to a request for the feasibility study the department had conducted, Tyson shared a single page report that said, as of late October, the Mental Health Outpatient Clinics in Christiansted, in Frederiksted and at Barbel Plaza on St. Thomas were all judged in a “moderate to high degree of readiness, with a low likelihood of implementation issues” for telemedicine services.

And according to an informed source, the department already has conducted training of in-house personnel, has approached several health care organizations outside the territory to discuss partnering on the initiative, has received some funding for equipment from a nonprofit group to start the service, and is seeking federal funding for ongoing support.

Current thinking, according to that same source, is that health care providers working with the Health Department would liaison with psychiatrists from other jurisdictions.  The physicians working outside of the territory would be limited in their ability to take on V.I. patients; they could only work through the department.

Issues that will need to be addressed include how insurers (including Medicare and Medicaid) cover telemedicine services, laws that require a doctor be licensed in the territory to practice medicine in it and to write prescriptions, ensuring confidentiality, how to select patients for telemedicine services, and pairing doctors in the territory with colleagues outside of it.  The department may also want to get the backing of private physicians.

The groundwork so far has involved mental health specifically, but it may be expanded to other areas of health care.

Dr. George Rosenberg, head of V.I. Equicare, a professional organization of Virgin Islands health care providers, said he was unaware of the current move by Health regarding telemedicine.

“We had tried it I guess when (Roy) Schneider was governor” in the 1990s, he said.  The hospital on St. Thomas was furnished with the necessary equipment, but it was “rarely” used.

Likewise, there was equipment installed at Myra Keating Smith clinic on St. John to hook it up with the Cleveland Clinic, but that was not used much either, he said.

Those hook-ups were not specific to mental health.

“What is the need for it is the question,” Rosenberg said, adding that it might be helpful in addressing some specialized medicine needs. 

Told the focus in now on mental health, he said, “Well, there is a paucity of psychiatrists in the Virgin Islands … So perhaps that would be helpful … Anything that helps the underserved population, I can’t imagine anybody would be opposed to that.”

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