Telepsychiatry aims to help

About two years ago, Ector County Independent School District and Texas Tech University Health Sciences Center agreed to offer mental health treatment through telepsychiatry.

Director of Nursing Services Laura Mathew said about 30 students were served during 2016-17 and now about two to four students are seen weekly by Dr. Bobby Jain. Jain and the students talk through a connection that is compliant with federal Health Insurance Portability and Accountability Act, or HIPAA, over a computer or laptop.

The service cannot be provided without parental consent, Mathew said. Parental involvement is necessary not only to obtain prescriptions, if needed, but to provide background information on their child to Jain, such as how long the child has been feeling the way they do and what they’ve tried previously, Mathew said.

“He’s good at sorting the family dynamics. Lots of times kids are difficult. The parents can give them a better idea of what’s really going on. …,” Mathew said.

She added that some conditions run in families like ADHD or depression, although it’s not always that way.

Patients Jain sees are age 5 and up, Mathew said.

She said that the district is happy to have this agreement with Texas Tech because there are so few child psychiatrists in West Texas and the ones that are here have long waiting lists. She added that it is not a substitute for in-person counseling.

Executive Director of Guidance and Counseling Nancy Vanley said the school nurse or counselor sets up the student’s paperwork and after that they are connected with Texas Tech for payment.

Vanley noted that the students don’t have to leave campus to talk to Jain, which simplifies the process. They just Skype in, she said.

Although there haven’t been large numbers of students participating in the service, Vanley said this is its first year.

Students are seen every Wednesday in a two-hour block. If there is an emergency, Jain can make a referral, Mathew said.

“The children in elementary school are going to be more ADHD or conduct disorder. … Disorders in teenagers tend to be more depression and anxiety,” Mathew said.

Conduct disorder is when a child is difficult to manage because of constant temper tantrums, inability to get along with others, inability to take direction from parents, constantly defying parents, arguing and just being unable to get along, Mathew said.

She said conduct disorders are more common in younger children, like age 5 to 8. Sometimes children have conduct disorder and ADHD, so the condition can be helped with ADHD medication as well as other medication for conduct disorder.

Youngsters can grow out of conduct disorder and some can grow out of ADHD. Some adults don’t grow out of ADHD, but they find ways to cope with it by relying on wives or administrative assistants or using calendars and lists, Mathew said.

Younger children may find it easier to take medication, but if you spend enough time with a child, they can learn coping techniques, Mathew said.

Adults may find the amphetamines used for ADHD speed them up and make them jittery, she said. It has the opposite effect on youngsters, relaxing them and making them more focused.

There are also slow-release medications that don’t pose much of a risk of addiction, Mathew said.

Depression is one of the biggest targets for ECISD.

“We’ve had suicides in the district, so we know that even children can get depressed,” Mathew said. “It takes a long time sometimes for them to actually get help because we don’t consider that children can actually get depressed.”

That is why Mathew and other district officials wanted to introduce telepsychiatry. She said some students were having trouble focusing or were distant and wouldn’t interact with others.

“It was hard for some of them to be in crowds because of their anxiety. They have social anxiety, so they couldn’t really mix. We do so many crowds in ECISD. I mean OHS (Odessa High School) has close to 4,000 kids, so just getting to class could create a panic attack,” Mathew said.

She added that there are a lot of medicines that don’t produce addiction and let students get back into the swing of things.

However, there is reluctance on the parents’ part to have their children see a psychiatrist because they think their child will be drugged, or the drugs will make their child a zombie. Mathew said there are some parents who think there’s nothing wrong with their child and that they don’t need counseling or medication.

“Some parents expect kids to be perfect and it’s hard for parents to reconcile. I try to tell parents they can be better off if they get treated. Treating them for a mental illness with medication is actually the same as treating someone with diabetes with insulin, or treating somebody with hypertension giving them their medicines. If your child gets diagnosed with something that medications will help with, I think we need to go on and do that. But they have to see a physician first,” Mathew added.

Jain said the telepsychiatry program also is available to ECISD employees. He hopes to expand the service to Midland ISD.

For ECISD, Jain said he is seeing three to four patients a week, but he uses telepsychiatry to see patients at Springboard, an alcohol and drug treatment center in Midland, and to conduct consultations at Medical Center Hospital and Midland Memorial Hospital. He said Texas Tech also is covering some patients in the emergency room at Midland Memorial.

He also hopes to add child psychiatry fellows. Accreditation was obtained, but Jain said Medical Center Hospital declined to fund it. Instead, Jain said he is going for private funding.

Jain said adding the fellows will help expand psychiatric services in the region.

Initial sessions last about an hour and follow-up visits are 20 minutes to a half hour. Depression, stress and suicidal thoughts are what he finds most in youngsters.

Mathew said she thinks mental health problems in students have always been around, but they have become more apparent in the last five to 10 years.

“This isn’t very different from the rest of the country,” Mathew said. “We’re just seeing more problems with students and adolescents throughout the country. It could be that social media is allowing kids to talk to each other and encourage each other to commit suicide, or bully other kids.”