“I lie in bed, motionless. Fixating on the wooden propeller of the ceiling fan turning in circles, I lie in bed, emotionless. I can hear the fishermen yelling at the top of their lungs, trying to sell their latest catch, and the relentless lapping of the waves against the shores of Lake Tanganyika. I haven’t been to the market in three months… or more. I can’t tell. The flies are now roaming freely around the house; I couldn’t care less. The place is filthy, but it’s the best my husband could do while his worthless wife was lying in bed. Another healer is at the door. Many have come and gone, trying to find the cure, to extract the demons that have sentenced me, my three beautiful children, and a devoted husband to a life fallen in depths of an unfeeling abyss. No need. I am not worth it. The razor by the mirror is calling my name: Aude. Aude. Aude…”
Be it a movie scene, a novel, or the pages of a diary found at the Uvira region of the Democratic Republic of Congo, the above paragraph highlights a few important facts about the current reality of global mental health provision: Mental health problems are a major cause of disability, death and economic burden around the world1. In the case of depression alone, WHO estimates that the number of people affected worldwide has surpassed 350 million2. Despite the scale and the urgency of the current circumstances, the available treatment and care remains scarce. Especially in rural areas, such as in central Africa, the number of psychiatrist per capita requires one to fight with millions of other patients who are also in dire need of professional services. In most cases, the specialists are located in big cities, leaving this vulnerable patient population to either face a long trip with limited resources or seek help from the local healers, who with their best intentions are not always successful.
With this picture in mind, a local Congolese organisation called the Uvira Psycho-Social Rehabilitation Center (CRPU)wondered whether they could take advantage of recent advancements in technology in order to bridge the gap between the available psychiatric services and the patients in need of immediate care: the resulting solution was “telepsychiatry”. A common practice in the US, UK and many other countries in the developed world, telepsychiatry is defined as “a form of video conferencing that can provide psychiatric services to patients living in remote locations or otherwise underserved areas”3. Growing evidence supports the effectiveness and feasibility of this type of 21st century e-medicine. It gives doctors the opportunity to manage their time effectively, to reach out to underserved patient populations, and to train other medical professionals, all while providing the patients with the therapies and follow-up consultations they require in order for them to reintegrate themselves back into society4.
In the case of low resource settings, a systematic review conducted in 2012 concluded that telepsychiatry could significantly improve the mental health care provided in resource scarce areas such as South Africa. The results indicated that the videoconferencing based psychiatric consultations not only improved outcomes, but also were reliable, cost-effective, and acceptable by the local communities5. Nevertheless, despite the reasonable confidence from the scientific community regarding the effectiveness of telepsychiatry, more clinical trials comparing face-to-face consultations, and research studies based in developing countries, will be required to achieve conclusive results.
Furthermore, the growth and success of telepsychiatry depends on a number of technical barriers that need to be overcome. The lack of infrastructure leads to power-cuts, unreliable and poor quality Internet connection, and difficult access to computers. The scarcity of trained personnel creates a vicious cycle in which the current professionals do not have the time to train medical students in e-medicine. Finally, there are context-specific, ethical and legislative concerns6. Nevertheless, telepsychiatry might prove an effective approach to providing psychiatric assistance to the millions of patients in need of professional help. That is why centers like CRPU are actively looking for volunteers, both from the local and the international community, to join their team of psychiatrists, psychologists and counsellors and help make a difference in the delivery of mental health care globally. With the right amount of support from international organisations and local governments, telepsychiatry might just become the status quo of mental health care delivery around the world.
PhD Student in Clinical Neurosciences
University of Cambridge
Disclaimer: This article was originally published on Polygeia.
 World Health Organisation. 2013. Mental Health Action Plan 2013-2020 (page 7)http://www.who.int/mental_health/publications/action_plan/en/
 World Federation for Mental Health. 2012. Depression: A Global Crisis.http://www.who.int/mental_health/management/depression/
 American Psychiatric Association. 2014. Telepsychiatry. http://www.psychiatry.org/practice/professional-interests/underserved-communities/telepsychiatry
 Shore JH (2013): Telepsychiatry: Videoconferencing in the Delivery of Psychiatric Care, Am J Psychiatry; 170:256-262.
 Chipps J, Brysiewicz P & Mars M (2012): Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence, Afr J Psychiatry; 15:235-243.
 Mars M, 2013. Telepsychiatry in Commonwealth Africa http://www.commonwealthhealth.org/wp-content/uploads/2013/07/Telepsychiatry-in-Commonwealth-Africa_CHP13.pdf
Image Credit: Hey Paul Studios, Flickr