Telepsychiatry Fulfills Promise in Rural Mississippi

The Mississippi Delta—in northwest Mississippi—has its claims to fame. The Delta is the birthplace of playwright Tennessee Williams, actor Morgan Freeman, and a spate of blues musicians, but it also is home to some of the poorest and least visible people in America. Along with that poverty has been minimal access to psychiatric services—that is, until a year ago, when telepsychiatry arrived in the Delta.

The program was spearheaded by Grayson Norquist, M.D., chair of the Department of Psychiatry at the University of Mississippi Medical College (UMMC) in Jackson.

Two years ago, Norquist approached the Delta Health Alliance about setting up a telepsychiatry service in the Delta. The alliance, which was founded in 2001 to support community-based health care initiatives, liked the idea and gave him a grant to do it.

Norquist and his colleagues at UMMC decided to set up their telepsychiatry service between their psychiatry department in Jackson and community mental health centers in two small Delta towns—Clarksdale and Greenwood—which are more than 100 miles from Jackson. “But then we had to figure out how to do it,” Norquist said in an interview.

The “major hassle,” he said, was getting the phone company to put the requisite cables into place. But it was finally completed, and they got their telepsychiatry service up and running a year ago.

At first adult patients were not especially comfortable with two-way live communication via a television screen, Norquist said. However, “the kids adapted to it immediately,” he reported. “They love it! They call us the TV docs.”

And now a year later, adult patients indicate that they are happy with the system as well. In fact, it is so popular that Norquist and his team are having difficulty meeting the needs of their patients in Clarksdale and Greenwood, along with all of their other responsibilities at the University of Mississippi, but nonetheless they are working on an expansion.

“We hope to install telepsychiatry communication between community mental health centers in Clarksdale and Greenwood and the state hospital to improve the continuity of care of mentally ill patients from those regions. We hope to expand telepsychiatry communication to some other community mental health centers in the Delta as well. And if equipment could be set up for broadband wireless telepsychiatry communication, it would expand our capabilities even more. For instance, we might be able to use it to reach elderly persons at home.”

In five years, in fact, he visualizes having a “seamless telepsychiatry system in place in the Delta.” Also, he is making progress in working with the state on reimbursing psychiatrists for telepsychiatry services.

Another facet of their program, Norquist reported, is using telepsychiatry to train staff in the community mental health centers in Clarksdale and Greenwood to practice evidence-based medicine. “A psychologist is helping us conduct training in motivational interviewing,” he said.“ We are also using the telepsychiatry system to provide ongoing case supervision after the training to ensure fidelity to the practice.”

Although there are a number of other telepsychiatry programs throughout the United States that deliver patient care and training, he said, this continued training through case supervision appears to be unusual among telepsychiatry programs. ▪