The future is upon us!
Substance misuse is a major problem in the UK. Addiction statistics in the UK remain one of the highest in Europe and we are right up there with the heaviest alcohol consuming countries. However our addiction patterns are changing. In fact, addiction to traditional drugs, such as heroin, is on the decline and nowadays more of us are being treated for medicinal opiate analgesic dependency. The abuse of novel substances, often unknown to professionals are also increasing. The specialists are now steps behind mostly young ‘psychonauts’ who are experimenting and sharing their experiences online in the blogosphere! Even though little is known about them, some of these new drugs seem to be highly addictive and potentially very dangerous.
Meanwhile the burden of alcohol and tobacco remains ever present. One in four of us drink too much and still the single most important advice any doctor can give a patient is to stop smoking. One in five of us still smoke despite the ongoing measures to reduce this.
We had a successful telepsychiatry symposium at the Royal College Psychiatrists Congress, Edinburgh, on 28 June 2017. We explored the role of telepsychiatry in managing diverse mental health issues; including addictions, ADHD and in an A&E department. We spoke on the feasibility of the usage of telepsychiatry, both within the UK and from the UK to any other country, including otherwise inaccessible areas such as war zones. Telepsychiatry is now recognised as a feasible, cost effective and reliable method of assessing and treating patients. The message was that the problem is not so much the technology or the effectiveness of telepsychiatry, but the fear of innovation and change. Attitudes of those without experience of telepsychiatry is usually sceptical, and these attitudes after trying it became much more positive.
A number of psychiatrists approached us after the event to talk about the possibilities, feasibility studies and the potentials they saw, mainly outside NHS settings. I must admit to being frustrated by the tendency of many NHS managers and commissioners who fail to embrace change. The time for feasibility studies has passed! The technology is already here – and moving forward at a pace. Mental health is ideally suited to online work, so we should just do it!
Addictive disorders can be safely and effectively treated on-line
Working with addiction patients can be taxing, with one major issue being trust. Addictive disorders by nature can lead to patients breaking laws and cheating – lying to themselves as well as those who are trying to help them. The urge not to cooperate may be outside their control. As with all psychiatric conditions we take a full history online, arrange for any required investigations locally from GPs and set up prescriptions for delivery or collection at a local pharmacy. One problem with addictions is ensuring compliance. For example, to treat opioid addictions we often use substitutions, such as buprenophine. We can send patients saliva drugs assessment kits. They then produces a sample that is analysed on screen, while being visually monitored by a specialist. New oro-dispersible formulation of buprenorphine (Espranor) makes monitoring compliance online even easier.
We will be taking the Psychiatry UK ‘roadshow’ to Berlin for the forthcoming World Psychiatric Association (WPA) congress in October 2017, where we are scheduled to give another symposium on Telepsychiatry. Furthermore, we are already planning for the American Psychiatric Association (APA) annual congress in 2018.
Dr Cyrus Abbasian is a Partner and Consultant Psychiatrist with Psychiatry UK. You can view his complete profile here.