Low-Cost Telepsychiatry for the Deaf in South Carolina

Background. In 1989 the South Carolina Department of Mental Health (SCDMH) established the Deaf Services program to supplement the care provided to its deaf clientele by local mental health center psychiatrists with a staff of case managers and other personnel specially trained in serving the needs of this population. Although each client's Deaf Services case manager is fluent in American Sign Language, encounters with (non-signing) psychiatrists required the presence of third-party interpreters for therapeutic reasons. It was felt that quality of care could be improved by using a psychiatrist who specializes in care for the deaf mentally ill and who interacts directly with clients by signing. For these reasons, in 1991 Deaf Services retained one ofthe authors (JNA, the only such psychiatrist in the state') and charged her with providing psychiatric service to all the Program's clientele throughout the state. Dr. Afrin travelled extensively (up to eight hours per day) to provide this service and had to carefully ration her time amongst the various Mental Health Centers where she saw patients.