Computer Applications in Mental Health

Education and Evaluation

Marvin Miller

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317756910
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This practical book describes computer programs designed specifically for mental health clinicians and their work. It examines a variety of computer resources and some of the latest developments in the field. Computer Applications in Mental Health provides examples of computer programs that have proved helpful in private practice and institutional treatment settings. Among the programs discussed in the book are those that have succeeded or failed within the large Veterans Administration computer system; a system designed to help choose the best reinforcers to use with patients in a behavioral program; a computerized self-administered screening battery in use in community health center settings; patient education programs useful in caring for the chronic mentally ill; and a reminder system for helping the hospital-based clinician meet paperwork deadlines. Encouraging mental health professionals to investigate the types of computer technology available to them, this book also stimulates further development and sharing of computer software.To enable readers to seek out more information on certain systems and programs, this book lists many computer resources. Several of the software packages evaluated are available on computerized bulletin board systems at no cost beyond that of a long distance phone call. Although Computer Applications in Mental Health is primarily for mental health clinicians, administrators and computer programmers within mental health settings can also find useful information in this book.

Obtaining Mental Health Software by Telephone from a Computerized Bulletin Board System

Marvin J. Miller

Marvin J. Miller, MD, is Assistant Professor of Psychiatry at Indiana University School of Medicine and a staff psychiatrist at Larue Carter Hospital, 1315 W. Tenth Street, Indianapolis, IN 46202.

KEYWORDS. Mental health software, telecommunications, computer bulletin boards, computerized patient testing

INTRODUCTION

One important aspect of the computer revolution has been the ability to send messages and computer files by telephone to another computer. This chapter will be a discussion of free standing computer Bulletin Board Systems (BBSs) but will also discuss other telecommunications services of interest to the mental health professional.

The telecommunications opportunities in today’s market are wonderfully diverse and useful in a variety of different ways. Electronic mail can be sent to the opposite side of the globe at little or no cost. A chapter for a book can be transmitted in compact form across the country in one minute, edited and returned with comments within the hour. A discussion of the latest side-effects from a new psychotropic medication can be held on-line (simultaneously or over a period of hours) and the entire discussion be available in written format for all of the participants. A patient can be tested at a local doctor’s office via phone line and the results printed out at the local office within minutes after the end of testing. A search of the relevant literature published over the last 20 years can be performed in several minutes with a print out of professional articles which might be relevant. A local physician’s office can generate the day’s billings and transmit them to local insurance companies over the phone line for more rapid payment. All the above are examples of a mental health professional using a computer and a phone line to get work done more quickly. One clinician can dial into the computer of a colleague across town or across the state and view the exact same information on his computer screen as that being viewed by a colleague. This can form the basis of a consultation or collaboration very nicely.

A computer bulletin board serves a more narrow subset of the above functions (Schwartz, 1985). It mainly exists for message exchange and for file transfer. Over 400 medical bulletin boards existed in the United States in 1991 and about 10 of these (Appendix I) focus primarily on the mental health field. In addition there are about 30 additional BBSs devoted to the lay audience wherein they exchange questions and ideas about various illnesses or treatment approaches.

LARGE COMMUNICATIONS NETWORKS

The free-standing BBS is only one component of a large network of communications systems which have served the computer community for over 20 years (Rickard, 1990). One of the oldest of these was funded by the military initially and served as a backbone of a national communications systems for a considerable time. The Defense Department system was called ARPANET and served as a way to link and convey messages between many different computer systems in industry and academia throughout the country. The philosophy and the software behind this effort were translated for the larger civilian community in a network called INTERNET/BITNET.¹ This system currently handles tens of thousands of E-Mail (electronic mail) messages each day. The messages are currently collected on a local system throughout the day and then transmitted at night at high speed under lower telephone rates to the intended destination. These messages may be routed through several systems before reaching their final address point. The system is so efficient that the messages cost only pennies to transmit and the costs are typically borne by universities and industries tied into the network. ARPANET will possibly be phased out over the next several years but the INTERNET/BITNET Communications System will likely continue to exist. There are periodic squabbles about the rather loose system of funding the network but this has proved adequate to this point.

Two large communications networks (Appendix II) devoted to the general public but containing some items of information relevant to the medical field are currently offered. CompuServe is available by subscription with an additional fee for connect time. It offers a wide variety of services (Green, 1985) but includes one particular discussion section/file section called Medsig. This is a forum for discussion among medical professionals regarding current issues. There are also hundreds of files available for downloading which have some applicability to the practice of medicine in general and to the mental health field in particular.

A newer communications service is offered jointly by IBM and Sears. This service is called Prodigy and offers an unlimited connect time for a fixed monthly fee. A limited number of messages can be exchanged as a part of the base fee with additional charges for extra messages which are exchanged.

The American Medical Association offered a communications network with a variety of services specifically for the physician community (AMANET). It included the ability to obtain continuing medical education credit over the phone, do literature searches and obtain full text copies of the articles, do a differential diagnosis of a difficult clinical situation, and exchange messages. This service however discontinued operations during 1990 because of low usage patterns. Interestingly the only replacement for this large multimillion dollar network was a small free standing bulletin board system called FedNet which is available to AMA members and to subscribing specialty organizations.

THE FREE STANDING BBS

The minimum equipment required to set up a free standing BBS is a computer, modem, and bulletin board system software. The configurations listed in Figure 1 demonstrate the variety of costs for an initial BBS. The minimal system would have to be dedicated to the single task of running the BBS. The recommended system would cost more but could run the BBS in background while being available as a regular computer for other tasks all the time. Monthly operating costs consist of less than $1.00 per day for the telephone line and whatever costs are necessary to maintain the computer equipment.

Hard Disk Size

An introductory system focused on the need to a very small select group of users might be able to get by with 20 megabytes of hard disk storage. This would be sufficient for up to 500 or so different computer files or up to several thousand messages. The larger BBSs today have 3–5 gigabytes of storage available. This could mean over 100,000 different computer programs available for downloading. The need for large capacity storage devices has made it increasingly popular to use optical disk storage systems for this purpose.

Modems

The modem translates the computer signals for transmission over the phone line. The current most popular speed for modem transmission is 2400 baud. Many BBSs however permit speeds as slow as 1200 baud or as fast as 9600 baud. The newest standards of compatibility for modems require the V.32 protocol for high speed data transmission and usually include the MNP as well as the V.42 protocols for error correction and data compression. By sending the data in more compact form the effective speed of data transmission over the phone line can be increased by 3–5 fold. Error correction insures that each character or command sent over the phone line is received error free or retransmitted until it can be received properly. There have been numerous software provisions for error free transmission of computer files (i.e., XMODEM) but the last several years have witnessed hardware methods for insuring data transmission over noisy phone lines. The older protocol which must be included in any modem compatibility list is the Hayes protocol. This standardizes a series of commands used in software addressing of the modem. C...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Mental Health Clinical Computer Applications That Succeed: The VA Experience
• Obtaining Mental Health Software by Telephone from a Computerized Bulletin Board System
• The Development of the Missouri Automated Reinforcer Assessment (MARA): An Update
• An Automated Screening Schedule for Mental Health Centers
• Psychiatric Paperwork Enhancement Through Quasi Automated Office Systems Development
• Tickler: An Automated System to Monitor Assessment Dates for Psychiatric Care
• Speech Timing of Mood Disorders
• A Knowledge Based System for Assisting in Differential Diagnosis of Chemically Dependent/Mentally Ill Patients
• TRANS: A PC-Pilot Preprocessor for Behavioral Health Education
• Microcomputers for Behavioral Health Education: Developing and Evaluating Patient Education for the Chronically Ill