The Mississippi Delta—in northwest Mississippi—has its claims
to fame. The Delta is the birthplace of playwright Tennessee Williams, actor
Morgan Freeman, and a spate of blues musicians, but it also is home to some of
the poorest and least visible people in America. Along with that poverty has
been minimal access to psychiatric services—that is, until a year ago,
when telepsychiatry arrived in the Delta.
The program was spearheaded by Grayson Norquist, M.D., chair of the
Department of Psychiatry at the University of Mississippi Medical College
(UMMC) in Jackson.
Two years ago, Norquist approached the Delta Health Alliance about setting
up a telepsychiatry service in the Delta. The alliance, which was founded in
2001 to support community-based health care initiatives, liked the idea and
gave him a grant to do it.
Norquist and his colleagues at UMMC decided to set up their telepsychiatry
service between their psychiatry department in Jackson and community mental
health centers in two small Delta towns—Clarksdale and
Greenwood—which are more than 100 miles from Jackson. "But then we
had to figure out how to do it," Norquist said in an interview.
The "major hassle," he said, was getting the phone company to
put the requisite cables into place. But it was finally completed, and they
got their telepsychiatry service up and running a year ago.
At first adult patients were not especially comfortable with two-way live
communication via a television screen, Norquist said. However, "the kids
adapted to it immediately," he reported. "They love it! They call
us the TV docs."
And now a year later, adult patients indicate that they are happy with the
system as well. In fact, it is so popular that Norquist and his team are
having difficulty meeting the needs of their patients in Clarksdale and
Greenwood, along with all of their other responsibilities at the University of
Mississippi, but nonetheless they are working on an expansion.
"We hope to install telepsychiatry communication between community
mental health centers in Clarksdale and Greenwood and the state hospital to
improve the continuity of care of mentally ill patients from those regions. We
hope to expand telepsychiatry communication to some other community mental
health centers in the Delta as well. And if equipment could be set up for
broadband wireless telepsychiatry communication, it would expand our
capabilities even more. For instance, we might be able to use it to reach
elderly persons at home."
In five years, in fact, he visualizes having a "seamless
telepsychiatry system in place in the Delta." Also, he is making
progress in working with the state on reimbursing psychiatrists for
Another facet of their program, Norquist reported, is using telepsychiatry
to train staff in the community mental health centers in Clarksdale and
Greenwood to practice evidence-based medicine. "A psychologist is
helping us conduct training in motivational interviewing," he said."
We are also using the telepsychiatry system to provide ongoing case
supervision after the training to ensure fidelity to the practice."
Although there are a number of other telepsychiatry programs throughout the
United States that deliver patient care and training, he said, this continued
training through case supervision appears to be unusual among telepsychiatry