Scope of Problem Using Evidentiary Information

Every day-to-day effort to provide mental health service to psychiatric patients at the community mental health sites has proven to be a struggle. Several patients would be scheduled with Psychiatrists and registered nurses (RNs) for medication management and treatment, yet, less than fifty percent (50%) would show up. Evidently, within short period of time, clinicians would receive unfavorable events reports, such as, emergency psychiatric/medical hospitalization, incarceration, suicidal episode, and so on.

Having psychiatric patients to stay compliant with treatments has been a big challenge for decades. Rao, George, Sudarshan, & Begum, (2017) defined treatment compliance as “the extent to which a person’s behavior coincides with medical or health advice” (p. 69). Then, further defined non- compliance as, “opposite of compliance” (Rao, et al, 2017, p. 69). Compliance is a major part of determinant of patients’ health outcome. Most Mental health patients have minimal or no insight of their illnesses due to cognitive impairment. As a result, they end up making poor health decisions, engaged in risky behaviors, and, consequently resulting to poor health outcomes. However, if psychiatric patients could stay compliant, there would be symptom control; decreased relapse and hospitalization; and overall improvement in their physical, mental, emotional, and social functioning

Identification, Definition and Explanation of Problem

It has been identified that, majority of the reasons for non-compliance among psychiatric patients are, but not limited to, forgetfulness, treatment complexity and fear of medication adverse reaction (Mukattash, et al, 2016); lack of family support to bring patients for appointments as a result of frustration in dealing with mentally ill; patients’ dislike to visit mental health facilities due to associated stigma by the society (Taghva, et al 2017);  poor patients’ motivation to go for appointments as part of negative psychotic symptoms; lack of funds for transportation; indifferent attitude of patients to treatment, and poor choice due to poor insight. Meanwhile, clinicians and mental health providers continue to implement different strategies and approach to address the challenges of non-compliance among psychiatric patients. Some of which are listed below.

Existing Efforts and Approach to Support Treatment Compliance

• ·         Prior appointment reminder calls by providers
• ·         Community support staff home visits
• ·         Written appointment cards
• ·         Patients’ personal calendar
• ·         Family members’ notification  

In spite of the above listed efforts, psychiatric patients still struggle to maintain treatment compliance. Therefore, based on the identified challenges of treatment compliance among mentally ill,  in the presence of existing clinicians’ efforts and approach in place, and as telehealth is a newly adopted way of using electronic technology to provide healthcare service to patients at a distance (Sewell, 2016),  considering full adoption of telehealth to manage mentally ill patients at their comfort zones, the world of psychiatric patients would definitely change, and increase their overall health outcome. 

Description of Proposed Interventions/Solutions

First, Providers should be granted licensure to provide telehealth across the nation irrespective of their patients’ location, so as to provide increased patients’ opportunity to different providers of choice, encourage patient-provider relationship, and consequently increase compliance. Secondly, because psychiatric patients are mostly paranoid, and experience fear to make change, which inadvertently create constrains in their treatments, therefore, providing adequate patients’ information, and maintaining patients’ privacy and confidentiality would increase confidence, and reduce paranoia. Thirdly, to support patients’ and providers’ awareness of telehealth, psychiatric providers and nurses must be well trained on how to efficiently provide telehealth care to mental health population; at the same time, educate patients and family members, on benefits of telehealth and its functionalities to aid acceptance of technology. Lastly, all individuals diagnosed with mental illness should be provided free personal encrypted smart phones via a government certified information technology vendor, to ensure patients’ privacy and confidentiality. And, in addition, the providers’ access portal should allow patients to leave messages at any given time for easy access and quick providers’ response to crisis. 

How will Telehealth Benefit Nursing Practice and Improve Psychiatric Patients’ Outcomes

 As non-compliance to treatment among psychiatric patients is devastating to patients’ health outcome, so it is to providers. That is, as the patients suffer, the providers as well feel overwhelmed from repeated patients’ relapse; increased complexity in achieving medication therapeutic levels and treatment goals; and poor revenue in spite available staff resources. Therefore, if full adoption of telehealth via patients’ personal smart phones occur, achieving treatment compliance would be less challenging, as the specific following benefits would aide compliance:

·         Easy access to care: Providers can reach patients without having to travel to facilities

·         Easy crisis management: Patients and providers can be reached at any time, at their comfort zone and on timely manner, irrespective of distance or location, in event of any psychiatric crisis, reducing psychiatric relapse, as opposed to restricted eight to five (8 :00 am -5:00 pm) schedule

·         Patients’ privacy and confidentiality: Patients would have their privacy with their providers due to use of personal smart phones, instead of a facility location where others are present

·         Increased patients’ autonomy: Patients would be more involved in decision making of their care, as they directly deal and communicate with providers without intermediary, or interruption of sessions

·         Decreased adverse events: Due to easy access to care, there would be decreased unusual events, like suicide episode, and serious treatment/medication adverse reaction

·         Decreased hospitalization cost: Easy patients’ access to psychiatric care would result in increase treatment compliance, reduce psychiatric relapse, and decrease hospital visits.

·         Increased providers’ revenue stream: As long as consumers are accessible through their respective smart phones, there would be decreased no-show billing, and increased revenue stream for providers.

Moving Forward

As telehealth is making its ways to improve patients’ health outcome in other areas of healthcare, fully adopting telehealth in psychiatry would be a better option to make mental health populations live a more meaningful life, through a technology that supports treatment compliance. And by the year 2025, I expect to see all individuals diagnosed with mental illness to have access to psychiatric healthcare through telehealth. 

References

Mukattash, T. L., Alzoubi, K. H., Abu El-Rub, E., Jarab, A. S., Al-Azzam, S. I., Khdour, M., & ... Al Hamarneh, Y. N. (2016). Prevalence of non-adherence among psychiatric patients in Jordan, a cross sectional study. International Journal of Pharmacy Practice, 24(3), 217-221. doi:10.1111/ijpp.12239

Rao, K. N., George, J., Sudarshan, C. Y., & Begum, S. (2017). Treatment compliance and noncompliance in psychoses. Indian Journal of Psychiatry, 59(1), 69-76. doi:10.4103/psychiatry.IndianJPsychiatry_24_17

Sewell, J. (2016). Informatics and Nursing: Opportunities and Challenges (5th Ed.). Philadelphia, PA: Wolters Kluwer Health, Lippincott Williams & Wilkins.

Taghva, Arsia, Zahra Farsi, Yavar Javanmard, Afsaneh Atashi, Ahmad Hajebi, and Mojgan Khademi. 2017. "Stigma Barriers of Mental Health in Iran: A Qualitative Study by Stakeholders of Mental Health." Iranian Journal of Psychiatry 12, no. 3: 163-171. CINAHL Complete, EBSCOhost (accessed August 27, 2017).