Strengthening telepsychiatry's role in clinical care and education.

Telepsychiatry provides psychiatric care and support for individuals separated by distance from providers, through the engagement of electronic and other communication and information technology [1–3]. Also referred to as “telemental health” [3], telepsychiatry has been used for decades and continues to evolve. Actually, in 1973, Thomas Dwyer [4] described the use of “interactive television”—possible at that time because of the introduction of “cable TV” systems—as an “enormous leap forward in carrying psychiatric help to the population.” Telepsychiatry has indeed become increasingly popular in the USA and other countries, such as Australia, Canada, Finland, Israel, New Zealand, and the UK [1, 3]. The first comprehensive curriculum for teaching telepsychiatry to psychiatry residents was proposed on the pages of this journal 15 years ago [5]. Telepsychiatry has been promoted as a more practical and less expensive way to diagnose and manage mental and substance use disorders in remote communities that may not have a local psychiatrist [6]. Telepsychiatry has been used in the identification and treatment of diverse disorders, for example, psychosocial support and medication management in the care of patients with schizophrenia, group therapy sessions for veterans with posttraumatic stress disorder, and evaluation and consultation neuropsychology services [1]. Provision of care across distance is a patient-centered clinical strategy, we suggest, in which it can bring treatment into a patient’s own living space. This approach reduces the burden and costs experienced by those who must travel, for example, to urban centers, in order to receive appropriate specialty and subspecialty care. For these reasons, telepsychiatry has the important potential to make psychiatric services accessible to those individuals and special populations who might otherwise miss out, including many patients who are economically disadvantaged or otherwise marginalized. Indeed, current discussions in integrated behavioral health suggest that telepsychiatry makes more accessible new communityand evidence-based approaches for treating major mental disorders [7] and co-occurring disorders, often through integration with primary care services at Federally Qualified Health Centers, for example. Consultation and follow-up delivered by telepsychiatry was found to produce outcomes equivalent to services provided face-to-face in one Canadian study [6], with telepsychiatry services being at least 10 % less expensive per patient than services provided in person. Beyond direct clinical care, telepsychiatry facilitates innovative clinical training. Through engagement of the telepsychiatry platform, it is possible to offer an ancillary educational function for clinicians managing complex cases who may not have the in-house faculty to support ongoing professional development and quality improvement. The combined effect of clinical training and clinical care in psychiatry represents an exciting next evolutionary step in telepsychiatry. Efforts to deliver and amplify muchneeded expertise across populations and to strengthen the skills and knowledge of current and future independent practitioners are needed, given the prevalence of mental conditions and the insufficiency of current systems of care. Telepsychiatry can thus enable mental health of individuals and populations directly and indirectly through clinical care and clinical training approaches. R. Balon (*) Wayne State University, Detroit, MI, USA e-mail: rbalon@wayne.edu