SCDMH Emergency Department Telepsychiatry Consultation Program
- Need: The shortage of mental health professionals in rural South Carolina resulted in an influx of patients admitted to emergency departments who were in need of psychiatric care.
- Intervention: South Carolina Department of Mental Health (SCDMH) partnered with The Duke Endowment to create the SCDMH Emergency Department Telepsychiatry Program. Rural emergency departments can now reach a psychiatrist to assess a patient via telehealth.
- Results: The program has improved access, affordability, and provided quality care for rural providers and patients with mental illness.
In response to long wait times for patients experiencing
mental health crises, the South Carolina Department of
Mental Health (SCDMH) partnered with The Duke Endowment
to create the Partners in Behavioral Health Emergency
Services (referred to as the SCDMH Emergency Department
Telepsychiatry Program). This statewide program made it
possible for emergency departments to reach a
psychiatrist to assess a patient via telehealth.
The program's goal was to increase access to mental
healthcare throughout the entire state, with a focus on
underserved and rural communities. What started with 4
hospitals and 6 psychiatrists in 2007 has since expanded
to 28 participating hospitals and 20 telepsychiatrists.
South Carolina was the first state to successfully
connect patients in emergency departments (EDs) to
off-site psychiatrists via telehealth.
Since implementation of the ED and Community
Telepsychiatry programs predate the COVID-19 crisis,
there was a different context for developing the
practices and operations supporting the programs. This
steady growth, rather than rapid program expansion in
response to the pandemic, has benefited patients, program
staff, physicians, and administrators by providing time
for individual and system acclimation to changes,
including the increased use of technology.
Key partners in this program include:
The SCDMH Emergency Department Telepsychiatry Program
received early financial support from the South Carolina
Department of Health and Human Services, and initial
program support from the South Carolina Hospital
Association, with program evaluation from the University
of South Carolina School of Medicine. Today, the program
is supported by a combination of state appropriations,
grants, and earned revenue.
The following services are included with the ED
Regular availability – Psychiatrists
rotate schedules and are available 7 days a week, 365
days a year, 18 hours a day.
Enhanced Communication – Participating psychiatrists provide approximately 750 services per month to hospital EDs across the state. Prior to the video exchange, the
SCDMH psychiatrist reviews the patient's medical
Assessment via telemedicine – After
the encounter, the SCDMH psychiatrist provides a
diagnosis and recommended course of treatment to the
patient's physician in the hospital as well as to the
nearest SCDMH community mental health center for
Training – The program's medical
director provides comprehensive training on how to
conduct an evaluation through a telemedicine platform
to participating psychiatrists. A complete training
manual is provided to every physician for reference.
Peer Evaluations – Peer reviews are
performed quarterly for all SCDMH telepsychiatry
physicians. New psychiatrists are scheduled with
experienced physicians until they are comfortable
enough to work independently. The Program's medical
director and experienced psychiatrists are also
available should new psychiatrists have questions.
IT Support – SCDMH offers 24/7 IT
support for the Telepsychiatry Program.
In addition to the ED Telepsychiatry program, SCDMH
offers several other telepsychiatry programs:
- Community Telepsychiatry
- Nursing Home Telepsychiatry
- Highway to Hope Mobile Telehealth Services
- Telepsychiatry partnership with South Carolina Department of Juvenile Justice
- Inpatient Services Telepsychiatry
- School Mental Health with Telepsychiatry Component
SCDMH is the largest provider of telepsychiatry services
in the state. In FY2022, SCDMH's Emergency Department
Telepsychiatry program provided more than 9,000
psychiatric services rendered via telehealth, which is
approximately 750 psychiatric consults per month.
Ongoing evaluations have found that the program has
improved and increased the quality and timeliness of
triage, mental health assessment, and initial treatment
of patients. Other successes for patients seen through
the telepsychiatry program include:
- Higher follow-up and retention of patients seen using
telepsychiatry services compared to a those in a control
group in an outpatient setting
- Shorter lengths of stay
- Fewer inpatient admissions
- Significantly lower total charges at the encounter
level for the index emergency department visit including
subsequent inpatients admissions
- The average wait time for 2022
reduced to 4.93 hours for psychiatric consults in EDs.
Built on the success of the SCDMH Emergency Department
Telepsychiatry Program, SCDMH has equipped its community
mental health centers and mental health clinics to
provide psychiatric treatment services to its patients
via telepsychiatry. In FY22, SCDMH's Community
Telepsychiatry program delivered over 64,000 services.
These services are for patients of all ages and the
Community Telepsychiatry program has provided psychiatric
treatment services to DMH patients since August 2013.
Almost exclusively (in 99% of cases), the Community
Telepsychiatry program service codes are for psychiatric
The 2022 SCDMH Patient Satisfaction Survey was
administered via text and online from April through June
and 5,714 patients who received outpatient treatment
services responded. Survey participants commented
favorably about increased access to care through
telepsychiatry. One patient stated, "Today I had a
virtual appointment, so I didn't have to worry about
finding a ride."
Another patient wrote, "No matter where I am or if I am
in a lot of pain, I can still make my appointment." In
addition, 93% of respondents who had a telepsychiatry
appointment with an MD agreed or strongly agreed that
"After coming here today, I believe I will get better."
These survey responses suggest that telepsychiatry
patients have positive expectations about treatment
In the beginning, the effectiveness of using telemedicine
to treat patients was a general concern raised by
established clinicians. Additional concerns included care
coordination logistics, definition of responsibilities
among clinicians and psychiatrists, and the
qualifications of on-call psychiatrists. Initially, SCDMH
addressed these concerns in materials sent to all
participating medical facilities. Program organizers also
followed up in person with each site to discuss
additional hesitations, answer questions, and provide
- Host stakeholder meetings regularly to collaborate,
share best practices, and brainstorm ideas for program
- When building partnerships with hospitals, look for
those that already have a strong relationship with their
community mental health centers and other agencies that
can take referrals quickly following a telepsychiatry
- Be intentional with follow-up care for patients.
Involve family members and caretakers and ensure that
patients take the next steps recommended by their
- Broaden your partnerships to include those at the
healthcare, academic, and state levels. Having these
representatives involved with a telemedicine program,
whether through delivery of care, recruitment, or policy,
can enhance its effectiveness.
Emergency department and urgent care services
December 5, 2017
Date updated or reviewed
February 2, 2023
Suggested citation: Rural Health Information Hub,
SCDMH Emergency Department Telepsychiatry Consultation Program [online]. Rural Health Information Hub. Available at:
[Accessed 27 September 2023]
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