When Mental Health Professionals Are Scarce, Telepsychiatry Is a Godsend


A shortage of mental health workers has put telepsychiatry among the fastest-growing sector of telemedicine.

“Telepsychiatry will rapidly become the fastest-expanding segment within psychiatry as a whole.” So said Avrim Fishkind, president and CMO, JSA Health in a September 10, 2008 Houston Chronicle article. “Psychiatrists cannot possibly cover the 4,700 medical emergency rooms, inpatient units and intensive care units in the United States.”

A shortage of mental health workers and increased availability of computer and video technology that allows a psychiatrist to see nearly everything necessary for an optimal evaluation has put telepsychiatry among the two fastest-growing sectors of telemedicine, according to Jon Linkous, chief executive of the American Telemedicine Association. He added that the growth of telemedicine is apparent in the numbers: at 200 US hubs, physicians and other specialist treat patients at 3,000 clinics, schools, and prisons across the nation.

The phenomenon is best seen in Texas, where 184 of the state’s 254 counties have an inadequate number of counselors, according to the Texas Department of State Health Services. Further, even though it is one of the five most populous states, Texas has the fewest psychiatrists, psychologists, and social workers per 100,000 people, a shortage that’s more pronounced in rural and border areas.

Fred Ramirez, a psychiatric nurse at JSA Health, is able to examine a patient 400 mile away from his Houston office, in the West Texas town of Big Spring. JSA’s telepsychiatry services have allowed Fishkind to see patients in four different Texas clinics in one day; he would have to drive more than 600 miles to see those patients in person.

Another telepsychiatry adopter in Texas, Christopher Thomas, child psychiatry professor at the University of Texas Medical Branch, Galveston, said that with the right equipment, a psychiatrist can see nearly everything needed for optimal evaluations, with cameras enabling him to zoom in a child’s hand to see if it is trembling or view how a mom reacts to a child’s remarks, without the child or mom noticing any movement by Thomas; the same interactions in a typical office visit wouldn’t be possible, as looking at a parent while a child speaks or staring at a patient’s hand would be obvious to all parties in the exam room. "It's not really different from seeing patients face-to-face. And it helps reduce barriers and improves access to care," Thomas said.

Telepsychiatry can also keep costs down, from travel expenses for the patient or provider to decreases in unnecessary hospitalization. The West Texas Centers for Mental Health and Mental Retardation—which provide services to a relatively small number of people spread out in 23 counties covering 25,000 square miles—has used the telepsychiatry services of JSA Health to conduct emergency evaluations at any time, thus keeping people in mental health crises out of emergency rooms and the hospital’s mental health units. “Maybe we really didn't need to put some of these people in the hospital,” said Janet Payne, West Texas Centers director of mental health services. "JSA has been a godsend in treating these people.”

Learn more about telepsychiatry from the American Psychiatric Association.

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