A Literature Review of Videophone Use in Mental Health

The delivery of mental health care via electronic devices—also called telemental health—has gradually become an established alternative to improve access to mental health services. Telemental health services routinely include psychotherapy, psychological testing, medication management, and forensic evaluations. Most of these services are provided through videoconferencing using a “hub and spoke” model. In this model, the care provider, or consultant, is at the medical center (or “hub”) while the patient is at a distant location, usually a satellite clinic (or tip of the “spoke”).

This model of care has effectively brought care closer to patients, but it still requires that patients travel to the “spoke” tip location, which may not be practical for those with chronic mental or physical illness. Videoconferencing equipment tends to be bulky (about the size of a living room television set) and requires dedicated space and information technology support staff. Both may limit technical deployment.

Telemental health alternatives with video capability that make the patient’s home the point of service are scarce. Videophones are a reasonable alternative that bring access to care directly into the patient’s home, provided the patient has a telephone line and a power source. Although limited by image size (6 to 8 inches wide) and bandwidth (25 to 50 kHz), videophones are easy to use and are readily accepted by patients and staff.¹ While these limitations may restrict videophones as first-line telemental health delivery devices, videophones could serve as an adjunctive means to mental health services for special populations, such as the severely mentally ill or those living in rural areas. We set out to systematically review the medical literature to determine the usefulness of this simple telemental health alternative tool.

We conducted a comprehensive search in electronic bibliographical databases using PubMed citations from 1960 to July 2010, Cumulative Index to Nursing and Allied Health Literature citations from 1981 to July 2010, and PsycINFO. The following keywords were used: videophones, videophony, video-phone, videotelephone, telephone, and telephony. The search was further refined with such terms as mental health, mental health services, psychotherapy, telepsychiatry, and psychology. The total results from all databases were 39 citations.

We included only those studies that described the use of videophones for mental health services, such as mental health disease prevention, psychotherapy, and testing. Twelve studies fulfilled these criteria and are included in the Table.

Palliative care

The 12 studies included a total of 97 patients. Of the 12 studies, 5 (41.7%) were applications of a videophone in palliative care with up to 34 patients (35%).^2-5 One study described 2 case reports of terminally ill patients where a videophone was used to provide each patient and his or her caregiver access to a hospital-based hospice care staff.² The goal was to decrease caregiver anxiety and maintain both the patient’s and caregiver’s quality of life while assessing the usefulness of the technology.

The patients lived in a remote rural location that would have made access to hospice care staff difficult. In both cases, the videophone was readily accepted and no technical problems were described. Anxiety levels measured by the S-Anxiety Inventory (a self-report instrument) remained low and quality of life was not diminished secondary to technical issues related to the videophone.

In another study, Oliver and Demiris³ compared how useful videophones were in delivering psychoeducational material with face-to-face sessions. One caregiver-patient dyad received the educational material face-to-face, the other received it via videophone. Both were equally satisfied. Curiously, the investigators noticed an increase in the number of verbal interactions between hospice staff and caregivers in the dyad when a videophone was used. Furthermore, the caregiver who used a videophone noted increased satisfaction because of not having to worry about leaving her business to meet face-to-face.