Defending Telepsychiatry

To the Editor: I suggest that the follow-up headline to "Rural Telepsychiatry Is Economically Unsupportable: The Concorde Crashes in a Cornfield" should be "The Concorde Crashes in a Cornfield: Tele-Villagers Rescue Survivors." Werner and Anderson have taken a very shortsighted approach, which predictably would indicate that telepsychiatry is economically unsupportable.

The successful projects in the nation, which have now routinely integrated interactive telecommunications technology, understand that a broad base of applications and users is necessary to gain the systemswide support required to remain viable. Every traditional face-to-face mental health service is now being provided by way of "telemental health." This wider systems approach is often referred to as the "Tele-Village."

Is any public mental health system economically supportable? Long-term supportive treatment approaches, which those with severe and persistent brain disorders require, would not exist without public tax-supported funding of programs such as Medicaid and Medicare. This funding is similar to the grants that Werner and Anderson mention as the economic base of telepsychiatry projects. It is the mission of these projects to equalize access to and continuity of care for those rural and frontier residents who have been underserved or uncared for, not to prove economic viability.

Regionwide advances in continuity of care, treatment, and discharge planning are far-reaching benefits of telepsychiatry, along with increased consumer and family involvement and greater opportunities for staff education and training. These benefits can be cost-factored as returns on investments. Our entire mental health care system in Virginia has become more integrated since the implementation of the Appal-Link Network more than three years ago. Patients leave the psychiatric hospital sooner and stay out longer as a result of advances in continuity of care

The majority of rural individuals with serious mental illness can't even afford transportation to the mental health center, much less a ticket on the Concorde. But you can be certain that if the Concorde crashed in their cornfield, they and all their neighbors would rush to the scene to try to save the survivors. The authors, in their attempt to base their arguments against the use of this technology on its excessive cost, let their rural prejudice show through.

Mr. Smith is director of mental health services at Cumberland Mountain Community Services in Cedar Bluff, Virginia, and project director of the National Telemental Health Project.