In Reply: I agree with Dr. Alessi's proposition that telepsychiatry should be explored as a means of providing care to a difficult-to-treat patient population in an underserved rural area that lacks psychiatric specialists. I also sense that he agrees with me that proper study of such treatment efforts needs to be undertaken. In fact, in my letter I raised a series of research questions that might be considered after I suggested that any study of telepsychiatry should include the costs per contact of the service provided. These were research questions, not an opinion about what services should be used. The issue of cost was addressed in an earlier paper (1); because of advances in technology, costs now should be lower than what we estimated in 1998.
A strong case can be made for using an expensive technology when alternatives are not available. Because of the interactive nature of telepsychiatry, one of its most promising aspects is its use as a teaching medium. For example, after conducting a number of consultations with a psychiatric nurse practitioner for a particular problem, one would expect an improvement in the nurse's ability to handle similar problems. It strikes me that expanding the capabilities of professionals in rural mental health centers is critical unless we either provide distant consultation indefinitely or decide to move to the Upper Peninsula of Michigan ourselves.
I hope Dr. Alessi will share his data with us, including the numbers of telepsychiatry contacts per year, the types of contacts—new patients, medication management sessions, emergency evaluations—and the cost per contact, as well as any data on outcomes as they compare with outcomes in similar populations treated in other ways.