Improve Access Through Telepsychiatry

In their excellent analysis of lessons learned from the passage of the New Mexico law giving prescribing privileges to psychologists under certain conditions (Psychiatric News, April 5), Drs. Richard Harding and Steven Mirin and Jay Cutler discuss how psychologists made it appear that psychiatrists were unable to respond effectively to the perceived rural-access problem.

We should vigorously pursue ways of improving access to psychiatric care in rural and other underserved areas, such as some prisons, nursing homes, and primary care centers. Telepsychiatry is one such way.

Because of technological advances involving telephones, videoconferencing, and computers and reduction in the cost of equipment, it has now become feasible for psychiatrists to evaluate patients in rural or other underserved areas without actually being there. Primary care physicians, nurses, or other allied health professionals can staff centers equipped for two-way transmission of audiovisual information. They can conduct the examination under guidance from and observation by psychiatrists, and the psychiatrists can do assessment and propose treatment plans including medication. This would be a better and safer solution than authorizing inadequately trained nonmedical persons to practice medicine.

Telemedicine can also bring access to scarce subspecialists or experts, such as child psychiatrists. The telemedical facilities can be shared by more than one specialty, for example, psychiatry and dermatology.

APA has a good resource document prepared by the Committee on Telemedical Services and other useful information, such as listings of programs, organizations, publications, and vendors. Many people, however, including many psychiatrists and legislators, are ignorant about the feasibility and potential of telepsychiatry. APA and its district branches and state associations should vigorously promote telepsychiatry in situations where face-to-face psychiatric contact is not feasible.