Using HIPAA compliant email to close gaps in schizophrenic spectrum care

Schizophrenia is a chronic condition marked by symptoms such as hallucinations, delusions, disorganized thinking, and cognitive impairments that can affect communication abilities.

This makes it a terrifying disorder for patients to face, a fact that is especially true when statistics like the fact that, as reported by Psychiatry Online only 26% of patients with the condition receive minimally effective treatment. The prominent gaps in care can result in isolation during treatment, which negatively impacts the efficacy of treatment with patients adopting a demotivated attitude towards care. 

Understanding the gaps in schizophrenic spectrum care

The gaps in care for schizophrenia spectrum disorders range from access to medication management. Many patients with schizophrenia face serious comorbid conditions like depression and substance use disorders. These disorders are exacerbated by the feeling of isolation previously mentioned. 

A recent news article from the American Psychiatric Association provides commentary from Natalie Bareis, Ph.D, on the matter, “...persistent high rates of poverty, unemployment, and poor functioning suggest that existing treatment and social welfare approaches are not meeting the needs of many people with schizophrenia spectrum disorders. Policies to improve access to and use of existing evidence-based interventions are essential.”

When including prevalent and ever present social factors like poverty and unemployment that affect many, the issue goes beyond purely medical. Through fragmented systems, patients often slip through the cracks and become part of negative statistics. 

How communication impacts schizophrenic care models

How, when, and by whom a diagnosis of schizophrenia is communicated can shape a patient’s entire care journey. A 2017 Cochrane Library study on delivering the diagnosis of a serious mental illness notes that it is “an important skill in most fields of medicine, including mental health,” and research shows that communication skills can affect “a person’s recall and understanding of the diagnosis, treatment options and prognosis”.

Historically, providers have sometimes hesitated to share the diagnosis openly due to fears of stigma or concerns about patient reactions. Yet, withholding or diluting this information can delay patients' acceptance of their condition and their engagement with treatment, which is vital early on. Good initial delivery of information can “aid informed decision‐making about treatment and empower people and their families,” helping to reduce anxiety, fear, and stigma.

Adopting structured communication strategies, like the SPIKES protocol originally developed for oncology, has shown promise in helping clinicians disclose difficult diagnoses with empathy and clarity. Schizophrenia’s cognitive and social impairments mean that the way clinicians convey complex information about symptoms and treatments must be carefully tailored. Cochrane reviews show that communication skills training (CST) programs improve how healthcare providers engage patients. CST equips clinicians to navigate the difficult conversations inherent in psychiatric care. 

How communication affects treatment adherence

Communication creates a shared understanding, which is a predictor of adherence. A Elsevier study examining psychiatrist-patient interactions found that patients who frequently sought clarification during consultations and received clear responses had better medication adherence six months later. 

This repair process in dialogue, where misunderstandings are actively addressed, facilitates mutual comprehension and trust, enabling patients to engage more confidently with treatment plans. Encouraging patient questions and ensuring clinicians respond with clarity are practical communication targets to boost long-term adherence. There is, however, the matter of consultation times. HIPAA compliant email in this regard allows for patients to communicate concerns in a way that is secure and accessible.

Interventions focusing on motivational interviewing (MI) further confirm the central role of communication. MI is a patient-centered approach that uses open-ended questions, reflective listening, and empathetic dialogue to improve motivation and resolve ambivalence about treatment. A Patient Preference and Adherence study noted how this is used in conjunction with alternative solutions: “Various strategies have been used to improve medication adherence in people with schizophrenia, including patient and family education, motivational interviewing, cognitive and behavioral approaches, and other combinations of strategies.”

The inclusion of patients in care coordination

Healthcare teams often face challenges like inconsistent response times and unclear roles in managing patient emails, which can stall progress and frustrate patients. A study published in BJ Psych Open by the North London Mental Health Trust tackled this issue by co-creating email management protocols with patients, clinicians, and administrative staff. 

The study notes “delayed responses to clinical communications can compromise patient safety, lead to treatment delays, and increase stress among professionals.” An email response protocol with input from clients, carers, mental health professionals, managers, and administrative staff, aiming to ensure “timely and consistent communication regarding patient care.”

Organizations and their providers should take an approach of defined expectations, such as how quickly patients could expect replies, distinguishing urgent queries, and crafting professional yet compassionate language templates. The result was smoother, more dependable communication that reassured patients they were being heard and cared for. 

While email is an all-encompassing solution, many psychiatric patients struggle with technology due to cognitive difficulties, lower health literacy, or limited internet access. There is a need to assess each patient’s comfort level with digital communication before fully integrating email into their care. For some, extra guidance is helpful, initial training sessions, simple step-by-step email templates, and combining emails with phone calls or in-person support to reinforce messages. This approach, combined with the use of HIPAA compliant email solutions like Paubox, allows for a comprehensive approach to filling gaps in psychiatric care. 

Related: Top 12 HIPAA compliant email services

FAQs

What is a comorbid disorder? 

A medical condition that occurs alongside a primary condition. 

What are the requirements for a patient's family to be informed about their condition? 

The patient has to give consent for patients to receive any information related to their health unless the patient is a minor or in a situation where the law allows disclosure like a power of attorney. 

What is telemedicine and how can it benefit mental healthcare?

Telemedicine is the use of technology to provide healthcare remotely. When used in mental healthcare, there is an increase in access to treatment especially in underserved areas and those with mobility issues.