Beyond the Screen: Telehealth and Care in New Mexico's Behavioural Health System

Abstract

This thesis explores the use of telehealth in the behavioural health system of New Mexico (US), a state in which large portions of the population are rural and where residents live hours away from healthcare resources that tend to be concentrated in urban cities. In the effort to address gaps in the access to care, the state turned to telehealth technologies to provide secure, virtual, face-to-face doctor-patient encounters to rural residents. Drawing from ethnographic material collected across 2018 and 2019 at both sites that provide and receive such services, this thesis argues that telehealth shifts the nature of care by reconfiguring the mobilities, spaces and materials involved in the antecedent practices. These shifts afford changes in health worker roles and patient trust in the health system, as well as both the reduction and reproduction of inequities in healthcare. This thesis explores how the transformation of the doctor-patient encounter via telehealth produces new forms of distance, relations and entanglements that extend far beyond the basic technologies that so often characterise this type of care. These implications are felt throughout the communities and state-run health system and become part of the social geography of this sparsely populated state. Ultimately, in taking seriously the ambiguous realities of telehealth, this thesis contends that these technologies not only shape the way care is provided, but the functioning of health systems and the sociality of our daily lives.