Staying true to the mission: adapting telepsychiatry to a new environment.

A shortage of psychiatrists threatens significantly to worsen treatment for the mentally ill. The nation’s psychiatric workforce is in crisis. Currently, 77% of counties in the United States have a severe psychiatrist shortage, and, with 50% of psychiatrists over the age of 55, the situation is likely to worsen. Public mental health systems, which are losing traditional advantages such as generous pensions and stable employment, face a growing threat from psychiatrist shortages. Public psychiatric services are already scant in more remote areas, where recruitment threatens to become ever more difficult. Given that state revenues are anticipated to rise only slowly, if at all, in the coming years, state psychiatric systems are unlikely to have adequate funding to compete for psychiatrists. In this context, telepsychiatry provides a potential opportunity to relieve some of the immediate strains on the system. Though telepsychiatry was first introduced in the 1970s, its use has grown rapidly in the ensuing decades, as improvements in audio and video transmission, coupled with decreased costs, have made it more viable. A number of studies—conducted among populations of different ages and ethnicities, and with varying diagnoses—have pointed to its flexibility. These studies have examined telepsychiatry’s success largely from the standpoints of patient satisfaction, symptom improvement, accessibility of care, and cost. Based on these criteria, results indicate that telepsychiatry has provided a level of care comparable with care as usual. Telepsychiatry is no longer experimental or untested. Policy makers and professional organizations are writing telepsychiatry into standard practice. Medicare has added billing codes specific to telepsychiatry, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has added language to expedite the privileging of telepsychiatry. Public mental health systems are even now exploring the potential benefits of telepsychiatry, which include the following: