An Interview with Murat Soncul
Conducted by Contributing Editor: Bob Pyke Jr., RN, CPNP
Pyke, B. (February 2004). An Interview with Murat Soncul. Online Journal of Nursing Informatics (OJNI). Vol. 8, No. 1. [Online]. Available at http://ojni.org/8_1/pykeiv.htm
Murat Soncul, BDS, PhD, is a dentist and a health sciences researcher. His interests include health technology, service delivery, and international development. He is currently working in Telepsychiatry, as Telemedicine Co-ordinator for South London and Maudsley NHS Trust in London , United Kingdom .
An interview with Dr Murat Soncul Telemedicine Co-coordinator, South London and Maudsley NHS Trust
Murat, Can you tell me how you became involved with Telemedicine and how you came about your current position?
It was a bit of a coincidence, I must admit. I had completed my doctorate, and was eager to do further research. Then I found myself in Telemedicine. The team who has done so much work here over the last decade has been a driving factor. Dr Paul McLaren has led so much high quality work in Telemedicine and he has achieved so much with Telepsychiatry, I was happy to be part of this team. Telemedicine and South London and Maudsley NHS Trust (SLaM) sounded like a good combination too. A geographically dispersed, busy, inner-city health service provider with renowned psychiatric expertise; lot's to gain, lot's to offer.
Can you tell me the history of SLAM Telepsychiatry Programme?
Our Telepsychiatry work dates back to early 90's, before South London and Maudsley was formed as a NHS Trust as it is today. Dr Paul McLaren started Telepsychiatry using existing technologies like telephone and piloting low-cost videoconferencing systems at Guy's Hospital in south London . The first pilot studies used videoconferencing as a teaching tool in clinical psychiatric training in the United Medical and Dental Schools (UMDS), and the responses from both students and tutors were very positive. The success of the trials motivated the clinical use of videoconferencing systems to link community teams to psychiatric wards. Since then SLaM Telepsychiatry Programme developed with the new advances in the technology and lots have been learned from other pilot studies.
Tell me about the training you offer at SLAM Telepsychiatry Programme, for medical students , physicians and nurses and therapists?
Dr Paul McLaren teaches medical students at the Medical School of Guy's Kings and St. Thomas 's Hospitals (GKT) of University of London . These lectures include Telepsychiatry and e-Mental Health. The students also actively take part in videoconferencing sessions. SLaM also offers training to other health service Trusts. There have been presentations on forensic psychiatry, affective disorders, psychosis, eating disorders, crisis disorders and community mental health. These presentations are aimed at all health professionals, as we believe one important objective of Telepsychiatry is to bring all disciplines in health services together and encourage multidisciplinary understanding.
Tell me what is going on with your program these days besides training and providing daily consultations to the areas you serve?
There are some plans for major development of SLAM's network, which will make very exciting changes the way we conduct our videoconferences. Unfortunately our work has been suffering limitations of ISDN lines, videoconferencing will be supported fully by the new network. When we achieve high quality picture and sound, we will be able to expand our services more confidently.
What are the busiest clinical programs aimed at right now?
The busiest one at the moment is the Care Programme Approach programme. The framework for communication in community mental health care in the UK is the Care Programme Approach (CPA). Service users, carers, members of the community mental health team (CMHT) are expected to attend CPA meetings, but attendance rates are variable, especially because of the geographically dispersed nature of SLaM in a busy inner-city setting. With the introduction of videoconferencing into this process, more frequent contacts between GPs, CMHT staff and service in hospital and increasing participation from primary care teams in CPA meetings have facilitated clinical communication. The responses from professionals and service users have been very positive, so this service is expanding to include more primary care providers, community teams and the in-patient wards.
How many patients do you serve and how many locations do you cover?
South London and Maudsley NHS Trust covers four boroughs in London for mental healthcare. The Trust has over 180 different sites. I think these are two reasons big enough to accept the impact videoconferencing can make. Currently our Telepsychiatry network covers one of these boroughs, where 250,000 people live. We cover community mental health teams, three local primary care centres and the psychiatric inpatient wards. We also provide tertiary mental health services from Bethlem Royal Hospital to the Island of Jersey , which is the largest of the Channel Islands and has a population around 87,000.
What projects are you involved in ?
The telepsychiatry projects we are conducting are:
What excites you the most about these projects? Do you have a favorite?
They are all very interesting, very exciting projects. We commissioned a feasibility study to improve access to mental health services for Mentally Disordered Offenders, and the results indicate that this project will be very interesting, and equally challenging. We are hoping to expand our network to Prisons, the Police and secure units that care for MDOs. This is going to be a major development.
What about research?
Research is the foundations of SLAM's Telepsychiatry programme. Several pilot projects were carried out to measure user satisfaction with different services.
What do you want to do, and in what direction would you like to see your program go in the future?
We would like the programme to follow a service development plan. Everything needs to be well planned, co-ordinated. Otherwise in a setting like SLaM, you could easily get lost, or get distracted. This is also very important in order to avoid mistakes in investments. Once you know your route, you are more confident. On your route, you can walk with others, show others the way, ask others when you think you are getting lost. I would like to see professional and organisational boundaries to come down with further developments in Telemedicine.
I am convinced that one of the most exciting areas in Telemedicine is the potential role it may have in international health care and disaster responses.
Certainly. With professional and organisational boundaries, international borders will come down too. In disaster responses, it can change so many things. I have one example in mind. There was a major earthquake in north-west Turkey in 1999. It was utter devastation. There was aid coming from all over the world. I believe Telemedicine would have been so useful to co-ordinate the aid in the vast area affected by the quake. And the survivors of this big trauma needed counselling, but the resources were not sufficient. Telemedicine would fit and benefit so many people in a similar disaster.
Looking ahead 1, 5, and 10 years from now, where and what do you see in telemedicine and in mental health?
I believe most communication will be over videophones by then anyway, so probably it will be like us nowadays using the telephone, or e-mail for so many things but not acknowledging their importance in our achievements, almost taking communication for granted. I would like to see the technology to get cheaper and Telemedicine to go more mainstream in the next few years, and be available in parts of the world where healthcare services are stretched due to lack of resources. The developments in Telemedicine in India are very exciting. Imagine the potential for Telemedicine in a country as vast as India , and the co-operation local healthcare providers can show as well as international co-operation.
What can be done to continue to promote Telemedicine in the UK and the EU?
I think Telemedicine is one way national health services across the EU can work together efficiently. However we have to remember Norway here. Although it is not a member of the EU, Norway has the expertise EU needs in Telemedicine. And Telemedicine develops when there is demand for it. The EU enlargement next year is a great opportunity, which will increase demand. Telemedicine can be used as a tool to standardise healthcare in the new member States and to encourage co-operation.
David Balch from Eastern Carolina said that Telemedicine, as we know it will disappear, meaning it would be commonplace and web based. What do you see happening?
It will definitely be more commonplace. As I said earlier, videophones will probably be used more widely, as well as web based systems. I think variety of videoconferencing tools will be more like the telephones available at the moment; some people using cordless and some hands-free, etc. But just because both the patient and the healthcare provider has a phone doesn't mean they can communicate all the time, so the more available Telemedicine becomes, the more protocols will be introduced, otherwise the communication traffic would be unmanageable.
What do you want to say or add to your colleagues out there? And what words of advice can you offer?
Let's work together!