IM and Mental Health – Reflections of a Medical Director -- June 13, 2006
I was intrigued with the potential use of instant messaging (IM) in the highly public-phobic and sensitive area of mental health. In particular, I wanted to learn directly from a senior medical director and psychiatrist of a large mental health facility on the potential limitations, benefits, and general reaction to using IM as a channel for those seeking professional help in our chaotic world. As a noted philosopher once said, to find answers and truth, one must understand what questions to ask – I learned I have a long way to go in this area.
My brief dialogue with “Dr. A” is contained below but due to privacy issues and other legal limitations I cannot give him or his facility formal attribution.
- (MD) What is your professional opinion and reaction on the adoption of instant and anonymous messaging dialogues to assist patients or potential patients? After a pause and a sigh, (Dr. A) “The use of any technology solution in our mental health profession should be viewed as a positive as long as it materially contributes to assisting patients deal with their unique situations. These situations are not as you or I would expect as their challenges or perceived realities are not necessarily logical. In particular, the needs and perceptions of a patient suffering from anxiety disorders differs greatly when compared to the complex impulses of a schizophrenic or even a bi-polar. If the patient is relatively stable and has a history with me or members of my staff, then an active, non-visual dialogue can be potentially useful. However, if it is truly an anonymous interaction with no history in front of the person providing advice, the dialogue and recommended actions could be catastrophic.”
- (MD) Tell me why you believe that without having a history with the patient, the use of IM could be disastrous? Don’t we already have this type of situation today with online medical portals and sites like WebMD? (Dr. A) “Don’t confuse the known nature of medical conditions and prescription interactions with the still embryonic and rapidly growing mental health field. In the last 15 years, our understanding of how to treat and diagnosis conditions has gained well over 2000%. (It was only 30 to 50 years ago that anyone with a mental health condition usually found themselves locked up for life.) However, it still requires visualization of the patient to truly understand the symptoms being described. For instance, if a patient is suffering tremors and memory loss as a result of taking a drug (often times they are on several with each controlling a portion of their total problem) I cannot determine without watching their movements (i.e., are they also having compulsive issues such as rearranging items on my desk, pacing, or paranoia) that would not be apparent nor communicated via a text based chat. Therefore, while the patient tells me about a symptom the real problem may be medication efficacy, dosage levels or these events (symptoms) could be a precursor to a ‘full-blown’ event.”
- (MD) So are you saying the use of IM has no value in mental healthcare? (Dr. A) “No, what I think you should understand is that a business person looks at a solution with a vastly different lens than a mental healthcare professional. Mental healthcare is still a practicing art as much as it is a science. With the expansion of the human genome efforts we are now using technology to change discrete sequences or strands of DNA within controlled test to determine the type of patient that reacts to given medications. In the future, if we know a patient suffers from an illness or genetic disorder, we may potentially use their DNA map to determine the drugs or treatment that will be precisely appropriate for them and at what dosage levels. When this occurs, the need for visualization and face-to-face interaction will lessen. If the solutions are provided at the direction of and integrated with practicing medical professionals, then there is potential for patient value. If it is used as a substitute or as a profit vehicle, then harm could be done to the patient, their families and the efforts we are discussing.”
Bottom line, IM has a place within the rapidly expanding mental health profession, but only as part of a comprehensive care-giver program.
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