Few are more aware of the current problems in healthcare than NHS consultant psychiatrists. Historically, the Cinderella discipline has been badly neglected. Though recently there has been some welcome increase in awareness and understanding around mental health, reducing prejudice, this makes little difference on the ground.
Mental health remains underfunded. Mental health institutions are generally understaffed and under-resourced and the future looks grim. Demographic challenges, social tensions, reduced social care budgets, and what feels like a loss of respect from those in charge for our opinions and medical standards is not making the job any easier for us psychiatrists.
I could produce a list of what is wrong in my own domain. I might dream of making positive changes – but psychiatrists, perhaps all doctors, now feel that there would be little point in trying as we would have little expectation of significant support for local solutions. Rather than having authority or receiving resources to use our initiative, we are bombarded with edicts and regulation, restricting our abilities to act independently.
Increasingly we spend our time filling in computerised forms based around the current set of centralised targets. It sometimes feels as if the only way that digital technology is being used in the NHS is to regulate and control.
Despite this I remain confident for the future of medicine and especially for psychiatry. Digital technology, and, in particular, its use to provide remote services, is the future. Psychiatry is uniquely well suited to remote provision because, firstly, there is a much reduced need for physical examinations when dealing with mental health issues and, secondly, because discreet access from a private location greatly reduces fear of stigma and is therefore particularly attractive to many of our patients.
Having now had considerable experience of online consultations, my initial fear about not being able to pick up nuances has greatly diminished. Any minor loss in this area is more than made up by the increase in our patient’s comfort. There is huge potential in tailoring access to the particular needs of patients, not least in terms of cultural and linguistic compatibility. We can now deliver rapid, cost effective, bespoke, patient-centred mental health care, directly into people’s homes; wherever that is and from wherever the psychiatrist is located.
For other areas of medicine telemedicine technology isn’t quite there yet. However, in the close future, through internet based platforms, virtual reality and smartphone applications, consultations with the best specialists will become readily available, even at very short notice, without the need to attend clinics. Medical information, including their genetic profiles, will be carried by patients. Remote technology will monitor patients at home, around the clock, making hospitalisation unnecessary for the majority. Medications will be delivered automatically, by drones, and robotics will replace day to day patient care, reducing human error. Virtual reality technology will make distant examinations and treatments possible for most branches of medicine and medical investigations will become far more accessible.
The opportunities to improve the delivery of medical care are huge, across the whole spectrum of medical disciplines, but, for once, psychiatry is at the forefront of medical development. For us, the fairy godmother of technology has already waved its magic wand – and, for the first time ever, the Cinderella service is actually driving the coach to the ball.
Dr Cyrus Abbasian is an NHS Consultant Psychiatrist and a partner in Psychiatry-UK LLP. You can view his profile here