Rural Child and Adolescent Telepsychiatry: Successes and Struggles

Research consistently shows that as many as one in five children and adolescents have mental health problems, and primary care providers (PCPs) identify 19% of children with behavioral and emotional disorders. Although these providers frequently refer children for mental health treatment, significant barriers exist to referral, including lack of available specialists, insurance restrictions, appointments delays, and stigma. Approximately 25% of the population lives in rural settings, and rural departments of health report an even greater problem with access to specialists for rural residents than their urban counterparts. In adults, and probably children and adolescents, the lack of mental health services leads to undertreatment, poor outcomes such as higher rates of suicide and homicide, as well as increased use of emergency services, hospitalizations, and placement in mental health institutions.ABOUT THE AUTHORSDonald M. Hilty, MD, is Professor of Psychiatry and Behavioral Sciences, and Director, Rural Program in Medical Education (Rural-PRIME), UC Davis School of Medicine and Medical Center. Peter M. Yellowlees, MD, MRCP, is Professor of Clinical Psychiatry and Behavioral Sciences and Director of Academic Information Systems, UC Davis School of Medicine and Medical Center. Priya Sonik, MD, is Resident of Psychiatry and Behavioral Sciences, UC Davis School of Medicine and Medical Center. Mikla Derlet, MD, is Assistant Clinical Professor of Pediatrics, UC Davis School of Medicine and Medical Center. Robert L. Hendren, DO, is Professor of Psychiatry and Behavioral Sciences, and Chief; Child and Adolescent Psychiatry; Tsakopoulos-Vismara Chair and Executive Director, M.I.N.D. Institute, UC Davis School of Medicine and Medical Center.Address correspondence to: Donald M. Hilty, MD, Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817; fax: 916-734-3384; or e-mail dmhilty@ucdavis.edu. Dr. Hilty; Dr. Yellowlees; Dr. Sonik; Dr. Derlet; and Dr. Hendren have disclosed no relevant financial relationships.