Telemedicine--clinical applications in mental health.

Video conferences and the Telepsychiatry applications allow for an alternative approach to service delivery in rural areas. They rely heavily on user support and access to a suitably wide network. The ISDN transmission medium is capable of excellent audio and visual quality, but the consequence of this high grade quality is higher transmission costs. Our experiences have so far been positive. No patient has refused to use the medium, nor has any patient walked out of an interview without returning. It is possible to assess patients with a wide range of psychiatric disorders from personality disorders through to frank and severe psychosis. It is hard to see how the system could be used for formal insight oriented dynamic psychotherapy, but there is no reason why it should not be used for review type case management assessments and consultations as discussed in this paper. The interviewing techniques used on Telemedicine require further evaluation but are exciting and interesting, and can probably teach us a great deal about how we might improve our clinical interviewing style. The difficulties in providing equitable services extend beyond access to country centres. Low population densities and cultural diversity, typical for much of remote Australia, demands an alternative approach for effective service provision. While video conferences cannot solve the inequity in service delivery, they can work as a useful adjunct to current service delivery strategies.