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Lessons Learned on Telehealth in Inpatient Psychiatric Facilities: Quality, Continuity, and Models of Care


Little inpatient telepsychiatry research exists, especially in regard to rural behavioral health services where the need for services far exceeds the number of providers. This case series included 12 inpatients of a non-metropolitan psychiatric hospital treated at a distance for 2 days (i.e., 24 visits) by a remote inpatient psychiatrist utilizing telehealth, who teamed with an on-site resident, medical student, nurse, and social worker. A direct care model was used, remote electronic health record order entry, and documentation for patients with schizophrenia, bipolar disorder, or depressive disorders. Three types of patients were seen: (1) previously seen and followed in person by the same provider, (2) previously admitted with a different provider, and (3) new admissions. Patients consented to telehealth as part of regular care and quality improvement and patient feedback was collected at the end of every session. There were no differences between telehealth and non-telehealth patients in use of emergency medications, codes, and length of stay. Two patients with schizophrenia were too disorganized to go to the tele-interview room; these patients cannot be interviewed on site, either, due to concerns. Patients expressed positive experience with telehealth and no preference for in-person care; all patients seen by the teleprovider preferred this continuity. Telepsychiatry was versatile, was effective, and enabled continuity of care in this small series.

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  • American Psychiatric Association Cultural Formulation Interview. (2013). Patient Version. Retrieved from:, and Informant Version:

  • New Freedom Commission on Mental Health. (2012). Subcommittee on rural issues: background paper. Retrieved from:

  • Bush, N. E., Skopp, N., Smolenski, D., Crumpton, R., & Fairall, J. (2013). Behavioral screening measures delivered with a smartphone app: psychometric properties and user preference. Journal of Nervous and Mental Disease, 201(11), 991–995.

    Article  Google Scholar 

  • Frydman, G. J. (2009). Patient-driven research: rich opportunities and real risks. The Journal of Participatory Medicine, 1(1), e12.

    Google Scholar 

  • Glover, J. A., Williams, E., Hazlett, L. J., & Campbell, N. (2013). Connecting to the future: telepsychiatry in postgraduate- medical education. Telemedicine Journal and E-Health, 19, 1–6.

    Article  Google Scholar 

  • Goldsmith, S. K., Pellmer, T. C., Kleinman, A. M., & Bunney, W. E. (2002). Reducing suicide: a national imperative. The American Journal of Psychiatry, 160(8), 1534–1535.

    Google Scholar 

  • Grady, B., & Singleton, M. (2001). Telepsychiatry “coverage” to a rural inpatient psychiatric unit. Telemedicine and e-Health, 17, 8.

    Google Scholar 

  • Hilty, D. M., Ferrer, D., Parish, M., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. The Official Journal of The American Telemedicine Association, 19(6), 444–454.

    Google Scholar 

  • Hilty, D. M., Crawford, A., Teshima, J., Chan, S., Sunderji, N., Yellowlees, P. M., et al. (2015). A framework for telepsychiatry training and e-health: competency-based education, evaluation and implications. International Review of Psychiatry, 27(6), 569–592.

    Article  Google Scholar 

  • Hilty, D. M., Chan, S., Hwang T., Wong, A., & Bauer, A. M. (2018a). Advances in mobile mental health: opportunities and implications for spectrum of e-mental health services. Journal of mHealth, In Press.

  • Hilty, D. M., Maheu, M. M., Drude, K., Hertlein, K., Wall, K., Long, R., Luoma, T., & Ford, D. (2017). Telebehavioral health, telemental health, e-therapy and e-health competencies: the need for an interdisciplinary framework. Journal for Technology In Behavioral Science.

    Article  Google Scholar 

  • Hilty, D.M., Evangelatos, G., Valasquez, A., Le, C., Sosa, J. (2018b). Telebehavioral health for rural culturally diverse populations: Approaches for clinical services, competencies and administration. Journal Technology in Behavioral Science, In Press.

  • Hilty, D. M., Zalpuri, I., Stubbe, D., Snowdy, C. E., Shoemaker, E. Z., Joshi, S. V., … & Liu, H. (2018c). Social media/networking as part of e-behavioral health and psychiatric education: competencies, teaching methods, and implications. Journal for Technology In Behavioral Science, In Press.

  • Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The national academies press.

  • Maheu, M., Drude, K., Hertlein, K., Lipschutz, R., Wall, K., Long, R., et al. (2018). An interdisciplinary framework for telebehavioral health competencies. Journal for Technology in Behavioral Science.

    Article  Google Scholar 

  • Office of the Surgeon General Center for Mental Health Services and National Institute of Mental Health. (2001). Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the surgeon general.

  • Pakyurek, M., Yellowlees, P. M., & Hilty, D. M. (2010). The child and adolescent telepsychiatry consultation: can it be a more effective clinical process for certain patients than conventional practice? Telemedicine Journal and E-Health, 16(3), 289–292.

    Article  Google Scholar 

  • Pollard, S. E., & LePage, J. P. (2001). Telepsychiatry in a rural inpatient setting. Psychiatric Services, 52, 1659.

    Article  Google Scholar 

  • Probst, J. C., Laditka, S., Moore, C. G., Harun, N., & Powell, M. P. (2005). Depression in rural populations: prevalence, effects on life quality and treatment-seeking behavior. Retrieved from

  • Salmoiraghi, A., & Hussain, S. (2015). A systematic review of the use of telepsychiatry in acute settings. Journal of Psychiatric Practice, 21(5), 389–393.

    Article  Google Scholar 

  • Simpson, S., Knox, J., Mitchell, D., Ferguson, J., Brebner, J., & Brebner, E. (2003). A multidisciplinary approach to the treatment of eating disorders via videoconferencing in north-east Scotland. Journal of Telemedicine and Telecare, 9(Suppl 1), 37–38.

    Article  Google Scholar 

  • Sunderji, N., Crawford, C., & Jovanovic, M. (2015). Telepsychiatry in graduate medical education: a narrative review. Academic Psychiatry, 39, 55–62.

    Article  Google Scholar 

  • Thomas, C. R., Miller, G., Hartshorn, J. C., Speck, N. C., & Walker, G. (2005). Telepsychiatry program for rural victims of domestic violence. Telemedicine Journal and E-Health, 11, 567–573.

    Article  Google Scholar 

  • Tseng, K. C., Hemenway, D., Kawachi, I., Subramancian, S. V., & Chen, W. J. (2008). Travel distance and the use of inpatient care among patients with schizophrenia. Administration and Policy in Mental Health, 35(5), 346–356.

    Article  Google Scholar 

  • U.S. Department of Agriculture. What is rural?

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The authors would like to thank the Kaweah Delta Health Care District, Office of Graduate Medical Education, and Behavioral Health Center.

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Correspondence to Gregory Evangelatos.

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Ethical Considerations

IRB approval was not necessary due to this being a clinical care practice typical for this community and patients agreeing to participate in telepsychiatric care.

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The authors declare that they have no conflict of interest.

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Evangelatos, G., Andrew Valasquez, G. & Hilty, D.M. Lessons Learned on Telehealth in Inpatient Psychiatric Facilities: Quality, Continuity, and Models of Care. J. technol. behav. sci. 3, 221–225 (2018).

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  • Telepsychiatry
  • Rural
  • Culture
  • Behavioral health
  • Child
  • Adolescent
  • Underserved
  • Telebehavioral