Interview with Davor Mucic, MD
Telepsychiatry is a growing discipline and the current pandemic has intensified its use. Yet one needs proper training to use the various equipments successfully.
Why did you become interested in telepsychiatry?
I came to Denmark together with many others from the former Yugoslavia in the 1990s. I soon realized that providing proper psychiatric care to the many refugees was a major task for mental health services, finding sufficient number of qualified interpreters was a logistic problem, and that providing care for this population in their own language would be an achievement.
You have been one of the pioneers in the field.
Yes, I was the first one to offer telepsychiatric services in the late 1990s. ”I collaborated with a technical engineer who helped me set up the video equipment. Initially, I provided psychiatric help to traumatized refugees in their own language. In fact, when interviewed whether they preferred talking to a therapist in their own language via video or with a therapist plus interpreter face-to-face, about 95% preferred video connection. From the very beginning I had an interest to carry out simultaneous research. An interesting outcome of the first years was that patients with very few exceptions were very positive - even people suffering from paranoid delusions. They explained that the video- equipment I used was visible and I had in details explained the procedure, so they were not afraid in contrast to the video-cameras they believe are “hidden under the ceiling”. Research has now shown that telepsychiatry is as reliable as face-to-face contact regarding diagnostic assessment and treatment outcome.
Did you receive any financial support for this innovative approach?
In 2004 I was lucky to receive about 2.3 million DKR from different foundations and the Ministry of Health to continue and develop this work. I have had a continuous collaboration with the mental health services on Bornholm where I still once a week meet patients via video.
So what are your experiences after almost 2 decades?
Telepsychiatry has come to stay, but it is important to emphasize that it is not “just” talking to a patient via video. Indeed, it needs proper training to use the equipment optimally but also knowledge on how to inform the patients adequately both verbally and in written form. It is also essential to ensure that the patient is not “left in a vacuum”. The therapist has to know what to do if e.g. the patient becomes suicidal – how to contact local psychiatric services, emergency care, relatives, police, etc. All this needs training and specific competencies that I think should be part of the medical curriculum.
A “hybrid model” is generally preferable. It means that you have sessions with the patient located at their own home, but that you also have a possibility to meet the patient face-to-face when required. I do not think that telepsychiary is an either-or situation, but a combination of both.
Furthermore, there have been several regulatory constraints related to the use of telepsychiatry. If you have a patient in therapy and he or she works or studies abroad, you cannot continue “remote therapy” across the borders. In the US each state has specific licensing regulations so you cannot be located in one state and treat a patient via video in another unless you are certified in the state where the patient is located. However, the completely new aspect is “the meeting in the cloud” where the location of the patient and the doctor depends of the location of the server. It imposes new challenges for the policy makers related to the licensing regulations related to the use of telepsychiatry even across the borders. It is one of the many new things that we have to deal with within WPA Telepsychiatry Global Guidelines in comparison to all other existing guidelines.
Innovation comes from limitation. Widely adopted and free available video-platforms do not fulfill basic data and patient safety requirements. However, they have been used during the pandemic as the governments worldwide have waived previous restrictions. In the future we will certainly not continue to use non-safe platforms. But we shall neither go back to the pre-COVID19 era with regard to using videoconferencing in teaching, treatment etc.
Where do you see the role of international professional organisations?
They are very important, and both WPA and EPA have expressed a vivid interest in the field. Back in April 2020, I launched a small expert group in WPA aimed to advise national member societies in use of telepsychiatry during the pandemic; to organize competency training courses and create Telepsychiatry Global Guidelines which have been published last week. It is my hope that we shall create an international network of bilingual psychiatrists who may offer their expertise, carry out second opinions etc.
The current pandemic is a turning point for telepsychiatry . Opportunities are many and the present situation has reduced the resistance to use of videoconferencing for a multitude of purposes. I believe that we shall see a growing interest for this constantly changing and developing tool that requires so little while it in return gives us so much.
To download WPA Telepsychiatry Global Guidelines, click here. □
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