Deputies test telepsych ser­vice

Pilot pro­gram al­lows them to of­fer ur­gent video chats in the field

The Dallas Morning News - - State - Keri Blakinger, Hous­ton Chron­i­cle

HOUS­TON — The nice old man near Old Town Spring calls 911 ev­ery month or so to com­plain about peo­ple hid­ing in the at­tic of his home.

There’s noth­ing there, ex­cept the in­ven­tions of his de­men­tia and schizoaf­fec­tive dis­or­der. But he’s now on a first-name ba­sis with mem­bers of the Sher­iff’s Of­fice Cri­sis In­ter­ven­tion Re­sponse Team.

They don’t arrest him, not even when they find 55 gal­lons of gaso­line stashed in the at­tic to keep out the imag­i­nary peo­ple.

Now the Har­ris County Sher­iff’s Of­fice may have a bet­ter so­lu­tion. A new telepsy­chi­a­try pilot pro­gram will arm deputies with tablets equipped to dial in to psy­chi­a­trists for ur­gent video chats, of­fer­ing pro­fes­sional help out in the field to peo­ple who don’t nec­es­sar­ily need to go to jail or an emer­gency room.

The pro­gram, which started last week, is be­lieved to be the first of its kind in the coun­try, of­fi­cials said.

“It will help bet­ter as­sess things and find a bet­ter out­come,” said Sher­iff Ed Gon­za­lez. “We can bet­ter pin­point the best way to deal with each in­di­vid­ual.”

Telepsy­chi­a­try pro­grams are al­ready in use in some county jails and ju­ve­nile lock­ups, but the pos­si­bil­ity of us­ing them in the field is the brain­child of Dr. Avrim Fishkind, a psy­chi­a­trist who is CEO of Hous­ton-based JSA Health Corp.

“If you think about it, the rub with psy­chi­a­trists is that there aren’t any — it takes months to see them,” he said. “I kind of got tired of hear­ing peo­ple com­plain we were never there to help any­body.”

Now, they’ll be on call 24/7. But aside from mak­ing psy­chi­a­trists more ac­ces­si­ble to those in the throes of a men­tal health cri­sis, the pro­gram could end up sav­ing the county money.

“These are mul­ti­mil­lion­dol­lar sav­ings, po­ten­tially,” Fishkind said. “Typ­i­cal men­tal health and jail stays are thou­sands of dollars.”

Fishkind’s com­pany, founded in 2007, al­ready makes use of a fleet of 70 psy­chi­a­trists to of­fer telemedicine ser­vices from Cal­i­for­nia to Louisiana. But those ser­vices weren’t por­ta­ble; most of the clients were hos­pi­tals and community clin­ics.

So to bring the con­cept to the streets, he ap­proached Cloud 9, an Austin-based startup that had al­ready de­vel­oped an app to let psy­chi­a­trists se­curely video chat with clients in their homes.

With a few tweaks to the soft­ware, devel­op­ers were able to make the pro­gram work for first re­spon­ders in the field. Ver­i­zon pitched in to of­fer free use of tablets and the cel­lu­lar net­work, and the pilot was born.

The pro­gram will run for eight weeks or un­til it’s used in 25 to 30 calls, whichever comes first, ac­cord­ing to Frank Webb, a Sher­iff’s Of­fice project man­ager.

For starters, only a hand­ful of deputies and su­per­vi­sors will carry around the telepsych-equipped tablets.

The lo­gis­tics are straight­for­ward. When a deputy or the Cri­sis In­ter­ven­tion Re­sponse Team is dis­patched to a call in­volv­ing a men­tal health cri­sis, they can dial in to alert JSA. Then, ac­cord­ing to JSA clin­i­cal op­er­a­tions man­ager Ter­rie May­field, the call goes into a queue for help, and by the time au­thor­i­ties ar­rive, a psy­chi­a­trist can be on standby.

Af­ter a video chat ses­sion, the psy­chi­a­trist will be able to help frame a so­lu­tion.

So the next time the el­derly man in Spring di­als 911, a deputy could rush to the scene with help in hand. And the cri­sis re­sponse team could di­rect its re­sources to higher-level crises.

It will work bet­ter for some sce­nar­ios than for oth­ers.

“If we are called for some­one be­ing sui­ci­dal and then we get there and say they’re not — that would be per­fect for this pro­gram,” sher­iff’s Deputy Don Hess said dur­ing a train­ing ses­sion at JSA this month.

“But a guy naked with un­der­wear on his head in the mid­dle of the road­way? Meh, we’ll prob­a­bly leave this in the car,” he said, ges­tur­ing to a tablet on the ta­ble.

In some cases, the telepsych con­sult will lead to a re­fer­ral to the Neu­ropsy­chi­atric Cen­ter — or, if that’s full, the emer­gency room or hospi­tal. But in other cases, the psy­chi­a­trist might de­ter­mine there’s no threat, call in a pre­scrip­tion, or rec­om­mend other coun­sel­ing.

“The goals are to re­duce the trans­porta­tion of pa­tients to the hospi­tal, and see if we can re­solve some of these sit­u­a­tions in the field and utilize other re­sources,” Webb said.

In the­ory, hav­ing a clin­i­cian on call at all times could achieve that goal. But that’s a pricey propo­si­tion, and guess­ing where to de­ploy a pro­fes­sional could be a chal­lenge in an area the size of Har­ris County.

Greg Han­sch, pub­lic pol­icy di­rec­tor with Na­tional Al­liance on Men­tal Ill­ness Texas, of­fered glow­ing sup­port for the pro­gram.

“It has a lot of po­ten­tial,” he said. “It can help peo­ple ac­cess men­tal health treat­ment and keep peo­ple out of set­tings that they don’t need to be in.”

But de­spite the op­ti­mism, ev­ery­one in­volved ad­mit­ted it’s not clear that the project will work. Will peo­ple in cri­sis on the street want to get help through an app? Will deputies feel com­fort­able us­ing it? How soon should they make the call for help?

“A lot of the pilot is just to test the vi­a­bil­ity and the tech­nol­ogy of do­ing this,” Fishkind said.

But if it does work, Fishkind has am­bi­tious dreams for the fu­ture.

“In my fan­tasy world, we work with Ama­zon to use drones to de­liver drugs to the site,” he said. “I’ve got to get Uber to pro­vide free trans­porta­tion and Ama­zon for the de­liv­ery ser­vice. You’ve got to think out­side of the box.”

“It can help peo­ple ac­cess men­tal health treat­ment and keep peo­ple out of set­tings that they don’t need to be in.”

Greg Han­sch, pub­lic pol­icy di­rec­tor with Na­tional Al­liance on Men­tal Ill­ness Texas

Pho­tos by Steve Gon­za­les/hous­ton Chron­i­cle

J.C. Adams of Cloud 9 con­ducted a train­ing ses­sion this month for Har­ris County sher­iff’s deputies on how to use a telepsy­chi­a­try pro­gram. The pilot pro­gram will arm deputies with tablets equipped to dial in to psy­chi­a­trists for ur­gent video chats,...

Deputies Jose Gomez (front) and Fred Lerma were among those in the train­ing ses­sion who took part in a call with Dr. El­iz­a­beth Truong.

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