July 01, 2009
Internet Filtering Can Hinder A Psychiatric Assessment
An interesting letter to the editor in the May-June Psychosomatics describes a case where a hospital’s Internet filtering system impeded a thorough assessment of a case that presented to the Emergency Department.
An 18 year old was brought to the ER by police for psychiatric evaluation after it was discovered that he had posted threats on a popular Internet social networking site. It included threats to kill the assistant principal of his school, other students, and himself. As the staff tried to view the threats, they were thwarted by the hospital’s Internet filtering system, which denied access to "Social Networking and Personal Sites." Hospital Information Technology personnel were unable to remove this filter, despite the clinical importance of doing so.
After several hours, a hospital computer far from clinical areas was identified that had an unrestricted access to the Internet; and it allowed access to the website. In addition to the threats, it revealed clear references to drug use. The patient was admitted to the psychiatry service.
In the discussion of the case, the authors describe how important social networking websites have become in peer to peer communication and the openness with which highly personalized information is presented. They point out that "as use of social networking sites becomes more common, the gathering of additional information during a psychiatric assessment may include viewing such online content produced by the patient." In this case, access to online content was crucial to the overall evaluation of the safety of this patient and the safety of others. The Internet with its expanding scope of accessible personal information, is rapidly becoming an important collateral source of information in a psychiatric assessment.
Use of Internet filters in hospitals can also become a restriction of educational content. "As professional organizations have begun posting various materials online, including videos of educational presentations, patient examinations, and self-assessment tests. If these are posted to sites that are flagged as inappropriate (e.g., a video posted on YouTube.com) they will be blocked, limiting access to an important educational resource."
The authors conclude that "Internet filtering systems, while intending to restrict recreational or inappropriate use of the Internet, may unintentionally serve as barriers to effective clinical information-gathering and educational material. Hospitals and organizations must carefully weigh the risks and benefits of instituting such measures. Mechanisms by which Internet filters can be overridden (perhaps with a recorded rationale) in cases of clinical or education import may be a useful compromise that should be further explored."
Psychosomatics 50:301-302, May-June
Posted by rsk at July 1, 2009 11:03 AM