It looks as though telepsychiatry, which is rapidly expanding in popularity in various countries, is limited only by the imaginations of those who want to practice it.

As of 2004, for instance, 70 psychiatric interviews using telepsychiatry had been conducted in prisons in New York state (Psychiatric News, June 18, 2004). As of 2005, telepsychiatry programs operated by the University of Colorado Health Sciences Center in Denver were serving American-Indian patients hundreds of miles away in several surrounding states (Psychiatric News, July 15, 2005). Quite recently, a young American psychiatrist, who wanted a working life that allowed her more time with her husband and two young children, opened a private telepsychiatry practice in her home office. Even though she is situated in Missouri, all of her patients are in Arizona (Psychiatric News, July 4).

And now a Canadian psychiatrist—Robbie Campbell, M.D., of London, Ontario—is using telepsychiatry to make "house calls" on some 20 Canadian patients with serious mental illness.

As Campbell reported at the Canadian Psychiatric Association annual meeting in Vancouver in September, "All the patients have to do is touch their telly screen, and it lets me into their lives! The pictures are very clear."

Thanks to more than 60 Assertive Community Treatment (ACT) teams in the province of Ontario, which are funded by the province, many Ontario residents with serious mental illness can now live at home. The ACT teams, which include primary care physicians, nurses, occupational therapists, social workers, and consulting psychiatrists, pay such residents frequent home visits.

However, it is physically taxing and financially expensive to have ACT-team members traveling to the home of each patient up to 14 times a week, especially when the team members are located at some distance from patients. So Campbell and his Lawson Health Research Institute team, in partnership with Telesat Canada and the Canadian Space Agency, received a grant from the European Space Agency to pilot a project. Its purpose was to see whether it could enhance the quality of ACT patient care while reducing the cost per patient so that the money saved could be used to serve more patients.

Although Campbell is located in London, Ontario, he serves as a consulting psychiatrist to an ACT team headquartered in Woodstock, Oxford County, Ontario—about 50 miles from London. In his role as consulting psychiatrist, he treats some 20 patients with serious, persistent mental illness who live in rural areas of Oxford County. So Telesat installed small satellite dishes on the houses of these patients and individual telepsychiatry units in their houses so they could receive telepsychiatry visits from Campbell without leaving home. Telesat set up similar equipment in Campbell's London office building so that he could pay virtual house calls on the patients.

Campbell "visits" each patient via telepsychiatry three times a week and also in person once a month, he said. Whenever patients need medication adjustments, hospital pre- and post-discharge planning, or crisis intervention, he is available by "telly" to assist the ACT team that provides the patients with hands-on care.

"Patient satisfaction is high and considered by many to be as good as, or better than, face-to-face visits," Campbell said. "My patients are also excited about participating in this novel project."

He has likewise learned that with his routine monitoring of patients via telepsychiatry, they require hospitalization less often than would otherwise be the case.

Other ACT teams in Canada might want to consider setting up a similar telepsychiatry system, he said. ▪