Telepsychiatry has the power to bridge distances between psychiatrists and
patients everywhere, and especially between the relatively few black
psychiatrists and the many African-American patients who need their
Michelle Clark, M.D. (left), chair of APA's Committee of Black
Psychiatrists, presents the Solomon Carter Fuller Award to Phyllis
Harrison-Ross, M.D. The award honors an individual who has pioneered in an
area that has benefited significantly the quality of life for black
So said Phyllis Harrison-Ross, M.D., in a lecture at APA's annual meeting
in New York City last month. Harrison-Ross received the 2004 Solomon Carter
Fuller Award for lifetime achievement. The award honors an individual who has"
pioneered in an area which has benefited significantly the quality of
life for black people."
Drawing on personal anecdotes and case histories, Harrison-Ross issued a
compelling call for psychiatrists—especially black
psychiatrists—to use the new technology of modem and digital
videoconferencing to expand the reach of public and community psychiatry to
"With a computer and a camera, patients and their psychiatrists can
see and talk to one another through telepsychiatry," she said.
Noting that only 2 percent of the nation's psychiatrists are African
American, she added that "telepsychiatry can make psychiatrists
available to people in prisons, people who are housebound, armed services
personnel on ships, seniors in nursing homes, teenagers who are uncomfortable
in a psychiatrist's office, and black people who need an African-American
psychiatrist in places where there are none."
Harrison-Ross is the founder and managing partner of the Black
Psychiatrists of Greater New York and Associates and the Emerita Professor of
Psychiatry and Behavioral Health Sciences at New York Medical College.
In her address, titled "I Am a Fact, Not a Fiction,"
Harrison-Ross contrasted a host of facts with what she called the fictions
they are meant to refute—including the fiction that seeing a patient in
an office is the only way to help the patient on an outpatient basis.
"The fact is, in this day and age, there are many who need our
services and can get them only over a cable or modem," she said."
We must not turn our backs on them, and we cannot allow ourselves to be
intimidated by the technology. The need for psychiatry in our communities is
Harrison-Ross said she began using telepsychiatry in the treatment of a
patient whose work required him to travel frequently. "I was treating
him individually and in family sessions with his families from several
marriages," she said. "He wanted to continue individual and family
sessions when he was out of the country, no matter where he was in the
"It was immediately evident that as a rare African-American
psychiatrist, I could use this new technology to make myself available for
African Americans anywhere who would trust only an African-American
physician," she said. "It also gave me the means to be available
to physicians from other cultures who wanted to have a consultation or
supervision session around one of their patients who happened to be African
Harrison-Ross recalled the immediate aftermath of the terrorist attacks in
New York City on September 11, 2001, when teleconferencing allowed agencies in
the city to consult with each other while phone service was dead. She
recounted the case of another patient with a broken leg, unable to leave her
home, who benefited from telepsychiatry.
But she especially emphasized the benefits of telepsychiatry for black and
other minority patients who may not have access to the culturally sensitive
care they require.
"I don't believe that every black patient must have a black
psychiatrist," she said. "But I do believe that there are very
good reasons why the mental health needs of some black people can be addressed
only by black psychiatrists.
"As our profession welcomes people from many countries and
backgrounds, we must learn how to treat patients across racial and ethnic
lines," she said. "Patients with psychiatrists of different racial
or ethnic backgrounds may need help in letting the psychiatrist know when they
are experiencing communications problems. Telepsychiatry can be very helpful
in these situations by providing the means for consultations with culturally
sensitive psychiatrists who can help the patient or the psychiatrist face
Harrison-Ross drew special attention to the ways that teleconferencing
could help reach the burgeoning numbers of mentally ill people in jails and
"Imagine what telepsychiatry means for prisoners' families,"
she said. "Children need to maintain connection with their incarcerated
parents. They need to see their fathers and mothers. They need to talk with
their parents even if the parents are locked up. Plus, these children also
need the support and guidance of therapists—therapists who can help them
preserve the bonds with the parents, while breaking the behavioral cycle that
makes going to prison a way of life."
She reported that a total of about 70 psychiatric interviews using
telepsychiatry have been conducted in prisons in New York State. The New York
State Office of Mental Health and the Black Psychiatrists of Greater New York
are undertaking a study of patient satisfaction with telepsychiatry, she
In a broad defense of medical professionalism against incursions on
practice by managed care—especially the use of preferred medication
lists—Harrison-Ross argued that a "one-size-fits-all"
approach to prescribing would damage many patients, especially minority
She noted, for instance, that some research suggests that African Americans
may metabolize drugs differently from the way in which white people do,
requiring a more individualized approach to prescribing.
Much work remained to be done in combating the special stigma associated
with mental illness—and treatment for mental illness—in the
African-American community, said Harrison-Ross.
She recounted the case of an African-American woman who, upon being advised
to start medication, responded, "Black people don't do
Another barrier is religious faith traditions within the African-American
community that encourage the belief that prayer, and prayer alone, can heal
disorder and disease. "The fact is," she said, "no matter
how hard we try, we can't pray our way out of some things." ▪