Improving Telehealth in Psychiatry for Non-English Speakers

woman on phone at home

Telemedicine has become an increasingly important mode of care during the COVID-19 pandemic. Certain specialties lend themselves to telemedicine to a greater degree than others. One of these is psychiatry, thanks in large part to relevance of observation and conversation with patients and their families to obtain neuropsychiatric history.

However, certain populations of patients have a more difficult time accepting telemedicine than others — for instance, those who are over age 60 or don’t speak English. For those people who are in both of these categories, experts at Brigham and Women’s Hospital are conducting research to identify specific barriers to care and soliciting feedback on how the needs of these vulnerable patients can be better addressed.

“The language barrier alone is a big issue,” said Juan Carlos Urizar, MD, director of clinical services in the Brigham’s Division of Geriatric Psychiatry and a neuropsychiatrist specializing in treating patients who have psychiatric disorders related to neurological conditions. “But we also want to understand the other underlying factors that may make it difficult for us to reach these patients.”

Identifying Barriers to Telemedicine in Psychiatry

According to Dr. Urizar, a significant portion of patients seen within his division, both at the main hospital and at the Brigham’s satellite clinics, are Hispanic. Many of them don’t speak English, necessitating either health care providers who speak Spanish or interpreters.

“When the pandemic surged during the spring and summer of 2020, we were not able to connect as efficiently with our Hispanic patients,” he said. “We learned that in many cases, it was more than language barriers.”

One common problem was the lack of technology, such as computers, tablets and smartphones. But even people who have access to these technologies and use them to communicate with family members may feel uncomfortable with the specific software and platforms that are required for telemedicine due to privacy requirements, Dr. Urizar noted. Other concerns that have come up in this patient population are issues of racial discrimination as well as fears that sessions could be recorded and used against them in the context of deportation.

Reaching a Population That Can Benefit From Telehealth

Dr. Urizar and his colleagues, including geriatric psychiatrist Catherine Gonzalez, MD, and medical interpreter Margarita Avila-Urizar, MD, are now embarking on research to survey their patients and get to the heart of these dynamics.

“It’s important for us to understand these issues. We know that video calls are important in evaluating many of our patients, in large part because they most closely resemble face-to-face meetings,” Dr. Urizar explained. Because he often treats patients with neurological disorders such as Parkinson’s disease and Alzheimer’s disease, it is crucial for him to be able to see and hear his patients.

Dr. Urizar explained that even after the COVID-19 pandemic is over, telemedicine will continue to be an important part of medical care, especially in neuropsychiatry. “Many of my patients have problems getting to their appointments because of limitations with their mobility and other issues,” he said. “For these populations, telemedicine will continue to be a good way to reach out and connect.”

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