Military
For the most part, the base’s spousal support group had been helpful for “Debbie,”
a 34-year-old female whose husband’s unit had just been deployed for a third tour
in Iraq. But that was all about to change. As usually happens immediately after
a deployment, the spirits of the spouses became particularly low. But this time,
that was not the case for everybody. One woman insisted that the war in Iraq had
actually improved her marriage. “My husband has changed for the better since the
war began,” she told the group.
She then said her husband had apologized for taking her for granted over the last
several years of their marriage. He said he thinks of her for strength each day
while in Iraq and vouched to be a much better husband once he returns home for good.
“So I have to say, this war looks to be helping my marriage. I think everything
is going to be fine.”
Debbie got up, put her hand over her mouth and began to head toward the door. “Why
are you leaving?” asked the group facilitator. “Why don’t you stay and share your
feelings with the group?”
Debbie stopped, turned around and wiped her eyes. She spent about 30 seconds collecting
her thoughts. “What would like me to tell you about?” Debbie asked. “About while
this stupid war apparently is great for this woman’s marriage, it is destroying
mine because my husband is a zombie? Is that what you want to hear? Do you want
me to describe how he said about three words to me and our kids during the time
he came home before going back?”
Debbie had been dealing with undiagnosed depression and anxiety since her husband’s
first tour or duty. Caring alone for her three children, one of whom has ADHD and
a learning disability, had placed her under a considerable amount of stress. Services
on the base for mental healthcare had been limited, and she and her needy child
had not had psychiatric help for nearly a year.
She continued her rant to the group. “Should I tell you about the times when he
is gone and I sit on the floor all day long feeling paralyzed by worry? I am overwhelmed
trying to care for our kids alone. You want me to open up? I can talk all day about
how bad our lives have become since we invaded Iraq.”
Debbie sits down and begins to sob. Others in the group approach her but she is
inconsolable. She suddenly falls to the floor and faints. She is taken to the base
infirmary, where it is determined she had a nervous breakdown. The base had recently
been designated to be part of a telepsychiatry pilot program to help the family
members of U.S. military personnel serving overseas. The woman was given immediate
access to a psychiatrist. She was accurately diagnosed and prescribed appropriate
psychiatric medication. Her anxiety and stress have greatly diminished. She has
a positive outlook on the future and is able to concentrate on caring for her children
while waiting for her husband to return home for good.
Healthcare
None of the professionals who examined the 15-year-old boy could find a medical
reason for his abdominal pain, though the cause seemed obvious to them all: months
earlier he witnessed his older brother’s murder by a drive-by assassin outside their
Philadelphia home. He had never discussed it, not even with his mother. It was seven
in the evening and the onsite psychiatrist was not due to arrive until the following
morning; however it was obvious that the boy needed immediate assistance.
The social worker in the ER called Dr. James Varrell, the president and medical
director of InSight Telepsychiatry Services, to attempt a telepsychiatric consultation.
Within one hour, the consultation was arranged and the patient appeared on the screen
with his head covered by a blanket.
“It was clear he did not want to participate,” Varrell recalled.
The young man eventually revealed his face and looked at the monitor. “Where are
you right now?” he asked Varrell as he began to play with the camera that was pointed
at him. “And what is all this stuff?”
While explaining the technology, Varrell carefully steered the conversation toward
the young man’s pain. “Has anything stressful happened to you that might be causing
your pain?” Varrell asked.
The patient, for the first time, relayed his eyewitness account of the slaying.
He told how he watched as his brother was shot, then died before the ambulance arrived.
Yet, in the days that followed, he was somehow indifferent about his brother’s death.
However, the tragedy soon hit him hard, and he was deeply troubled that initially
he was not affected by the loss. Tears flowed as the teen described the feelings
of guilt that left him unable to function.
The use of telepsychiatry opened him up to talking where the traditional form of
communication had been ineffective. The patient was admitted to a mental health
facility, where he opened up further. The abdominal pain was gone when he was discharged
after a two-week stay.
“As much I would like to say it was due to my skills that he opened up, the fact
is that it was his interest in the technology that allowed for the breakthrough,”
Varrell said. “Patients are curious about the process and talk more than they expect
to. The conversation continues and eventually touches on the problem that placed
them in front of the camera. This case provides a tremendous example of the benefits
of this technology.”
Corrections
The woman in the jail cell clearly thought she was cradling a baby in her arms,
though she was holding nothing more than air. Jane Doe had been arrested a few hours
earlier and charged with killing her 4-year-old and 18-month-old children. She seemed
oblivious to her surroundings, and well on her way to a psychotic episode. She ignored
anyone who tried to communicate with her – no verbal response and no eye contact.
She repeated the same phrase over and over, indicating that she would soon “be her
with babies” – the ones she had been accused of killing.
Jail staff, rightly so, took that as an indication of her determination to commit
suicide. The jail utilized its telepsychiatry service and had her in front of a
psychiatric advanced practice nurse in a matter of minutes. In front of the monitor,
she became somewhat coherent and spoke to the APN.
“I thought another baby would fix our problems,” she said. “I was wrong. He didn’t
want me anymore.”
She then said her husband had been having an affair for nearly two years. He recently
told her he didn’t love her anymore and planned to leave her for the other woman.
He accused her of being unstable since the second child was born, and indicated
he planned to seek full custody of both of their children. She had no family in
the area, and felt nobody could help her sort through her options. She couldn’t
bear the thought of having her kids taken from her. Due to her state of mind, she
determined the only way to prevent this was to send them “to live with God,” she
said.
The psychiatric advanced practice nurse diagnosed her with severe post-partum depression
(PPD), which had gone untreated since the birth of her second child 18 months ago.
The psychiatric advanced practice nurse deemed Jane to be unstable and instructed
the jail staff to have her admitted into a psychiatric facility immediately. The
jail’s round-the-clock access to a specialist made it possible to make the evaluation
without delay and have her directly admitted to a psychiatric forensic facility.
There was no extended period of supervision during a lengthy Emergency Department
wait. Jane Doe remained at the forensic psychiatric facility for several weeks,
until she was cleared and returned to the jail to stand trial for her crimes.
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