Telepsychiatry with rural American Indians: issues in civil commitments

Abstract

The use of live interactive videoconferencing to provide psychiatric care, telepsychiatry, has particular relevance for improving mental health treatment to rural American Indian reservations. There is little literature on civil commitments in telepsychiatry and none specifically addressing this topic among American Indians. This article reviews telepsychiatry in the mental health care of American Indians, civil commitments and telepsychiatry in general, and the current state of civil commitments in American Indian communities. We conclude by considering commitment through telepsychiatry in rural reservations and offering guidelines to assist practitioners in navigating this challenging landscape. Civil commitments of American Indian patients residing in rural reservations can be successfully accomplished through videoconferencing by thoughtful and informed clinicians. However, much more work is needed in this area, including research into the cultural attitudes and perspectives towards commitments and further inquiry regarding potential legal precedents, as well as case reports and examples of this work.

Review of key telepsychiatry outcomes

“…Until a resolution is reached, telepsychiatry providers must have separate licenses for each state in which they provide services and are advised to be familiar with statespecific regulations. For example, Shore et al [115] suggests that a priori arrangements should be made with local law enforcement and social services that are responsible for initiating involuntary commitments.…”

Institutionally based videoconferencing

“…In addition to IHS, the VA has developed programmes for the subpopulation of Native American veterans who would otherwise lack access to high quality psychiatric care (Shore & Manson, 2004) (Shore, Brooks et al, 2008). Such programmes have provided infrastructure for exploration of creative applications including the use of telepsychiatry in civil commitments within rural American Indian reservations (Shore, Bloom et al, 2008).…”

Aboriginal Mental Healthcare in Canada: The role of alternative service delivery in transforming the provision of mental health services

“…In the United States, eHealth services, particularly interactive videoconferencing (also called telepsychiatry), are being used to provide treatment to rural American Indians and to American Indian veterans (Shore, Bloom, Manson, & Whitener, 2008;Shore et al, 2012). Close to 2.5 million Americans identify as American Indian or Alaska Native, belonging to one of over 560 federally recognized tribes (Shore et al, 2008). The use of telepsychiatry can improve "both the access and quality of care available to rural American Indian reservations" (Shore et al, 2008, p. 289).…”

“…To address the needs of the veterans, the University of Colorado partnered with Veterans Affairs and the Indian Health Service. Many of the needs were tackled through the American Indian and Alaska Native Programs (AIANP), run by the medical school at the University of Colorado (Shore et al, 2008). American Indian veterans were treated in their home communities, by professionals in Denver, via teleconferencing (Shore et al, 2012).…”

“…A major challenge identified by Shore et al (2008) is the issue of jurisdiction -do all States have the same laws or require the same credentials? Are reserves self-governing?…”