Telepsychiatry

To the Editor: Telepsychiatry, or, as some of us prefer to call it, "telemental health," is the use of interactive telecommunications technology to provide care to a distant consumer. While Dr. Brown's overview (1) of rural telepsychiatry in the July 1998 issue is a basic introduction for the unfamiliar reader, it does not do justice to the increasing range and frequency of applications now under way worldwide. Like the personal computer and the Internet, interactive teleconferencing will be a common tool in every effective mental health program, both rural and urban, within a few years. A great deal of activity is occurring, with full-time telepsychiatrists working with patients whom they will never see in person and who otherwise would go without treatment.

In a database compiled by the Association of Telemedicine Service Providers, some 50 active telemedicine programs with a mental health or psychiatric component were identified. Telemedicine Today surveyed 19 programs in the United States and found that since their inception, they have carried out almost 10,000 clinical interactions, averaging almost 50 consultations a month (2). We are well beyond the demonstration and experimental phase of this technology.

In our project, the Appal-Link Network of Virginia, we have carried out 2,700 clinical contacts with more than 400 seriously mentally ill patients in three and a half years. This network has had a tremendous impact on the public mental health system in our region by enhancing continuity of care. The same inpatient psychiatrist provides long-term community follow-up after the patient is discharged. Community staff and family members readily participate in treatment and discharge planning conferences. Our entire mental health system is more fully integrated.

Several studies will soon be published on the impact of this technology on patients' access to psychiatric care and providers' ability to conduct clinical assessments. The federal Office of Rural Health Policy will conduct a comprehensive nationwide assessment of telemedicine systems, with a special emphasis on telemental health. In the area of reimbursement, several programs already receive Medicaid and private insurance payments. The cost of this technology and its related transmission expense continues to decline. Any interested mental health care organization can now afford to purchase equipment and participate in a service delivery network.

During the past year, seven of the most active projects in the U.S. produced a report on the history, uses, and effects of interactive telecommunications technology on mental health care. Funded by a grant from the Center for Mental Health Services, the National Telemental Health Report should be available later this year. Telemental health is on the verge of radically improving mental health care, with an impact second only to that of new atypical antipsychotic medications. The ultimate impact is clear. One day anyone, anywhere, needing treatment will have equal access to a high level of clinical care.

Mr. Smith is director of mental health services at Cumberland Mountain Community Services in Cedar Bluff, Virginia, and project director of the National Telemental Health Report Project.