title: Telepsychiatry integration of mental health services into rural primary care settings.
abstract: From a population health perspective, the mental health care system in the USA faces two fundamental challenges: (1) a lack of capacity and (2) an inequitable geographic distribution of services. Telepsychiatry can help address the equity problem, and if applied thoughtfully, can also help address the capacity problem. In this paper we describe how telepsychiatry can be used to address the capacity and equity challenges related to the delivery of mental health services in rural areas. Five models of telepsychiatry are described, including (1) the traditional telepsychiatry referral model, (2) The telepsychiatry collaborative care model, (3) the telepsychiatry behavioural health consultant model, (4) the telepsychiatry consultation-liaison model, and (5) the telepsychiatry curbside consultation model. The strong empirical evidence for the telepsychiatry collaborative care model is presented along with two case studies of telepsychiatry consultation in the context of the telepsychiatry collaborative care model. By placing telepsychiatrists and tele-therapists in consultation roles, telepsychiatry collaborative care has the potential to leverage scarce specialist mental health resources to reach more patients, thereby allowing these providers to have a greater population level impact compared to traditional referral models of care. Comparative effectiveness trials are needed to identify which models of telepsychiatry are the most appropriate for patients with complex psychiatric disorders.
authors.affiliation: a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington.|b Department of Veterans Affairs, Health Services Research and Development , Center of Innovation for Veteran-Centered and Value-Driven Care , Seattle , Washington.
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.affiliation: c Department of Psychiatry, College of Medicine , University of Arkansas for Medical Sciences , Little Rock Arkansas.|d Department of Veterans Affairs, Health Services Research and Development , Center for Mental Healthcare and Outcomes Research , Little Rock Arkansas.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.affiliation: a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington.|e Seattle Children's Research Institute , Seattle , Washington.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Turner
authors.affiliation: f Lee Country Cooperative Clinic , Marianna Arkansas.
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Farris
authors.affiliation: g Valley View Health Center , Chehalis Washington.
authors.forename: Tre M
authors.initials: TM
authors.lastname: Normoyle
authors.affiliation: a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Avery
authors.affiliation: h Department of Psychiatry and Behavioral Sciences, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Hilty
authors.affiliation: a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D008605:Mental Health Services; D011320:Primary Health Care / Q000458:organization & administration*; D011570:Psychiatry / Q000458:organization & administration*; D012017:Referral and Consultation; D019035:Rural Health Services / Q000458:organization & administration; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*; D049269:Videoconferencing / Q000458:organization & administration
keywords: Collaborative care, integrated care, rural, telepsychiatry, virtual care