What This Big Grant Tells Us About How the Internet Can Expand Access to Care


The Duke Endowment just gave $1.5 million so the North Carolina Department of Health and Human Services could take their telepsychiatry program into the big time.

Telepsychiatry sounds like borderline quackery, you say? Well, that’s what we thought, until we read up. Turns out, the Duke Endowment’s support of this program in North Carolina and a similar program in South Carolina that’s been around a bit longer stands to save taxpayers millions of dollars. And it’s good for patients, too.

See, mental health problems often show up as “background noise” in a patient’s case history—hard to diagnose and harder to treat, mental health “episodes” or flare-ups often land sufferers in the emergency room, where emergency room personnel lack the training to properly evaluate the case. A meeting with a mental health specialist must be scheduled; the individual might be given an appointment card for a later date and time. But often, they never come back. All the while, the family member (or in many cases, the law enforcement officer) who brought them to the hospital may be missing work.

Simply put, the emergency room setting is just not properly equipped to meet mental health needs, until now. Since 2007, South Carolina has had a telepsychiatry program in place, in which mental health professionals at a call center can teleconference with mental health cases around the state, performing efficient assessments. It’s essentially a Skype session on steroids: The camera, which is controlled by the mental health evaluator, can pan, tilt, and zoom, and he or she has the ability to pull the patient’s case history for critical insights. The whole thing is designed to take only a few minutes, fifteen at most, and then everyone is free to get on with their lives. The telepsychiatry professional can write prescriptions, too.

The Duke Endowment—which is not, by the way, related to either Duke University or Duke Energy—gave South Carolina $8 million to help their telepsychiatry program go statewide, and now it’s stepping up its support to North Carolina to do the same. Since 2010, North Carolina has run three smaller, regional telepsychiatry networks that connect between three and ten hospitals to each other, enabling them to share mental health resources. It isn’t as good as a true statewide network, but it has shown some promising results. Which is why the Duke Endowment has decided to give them $1.5 million for a big expansion.

The grant, which was announced late last month, will be distributed in two installments: $800,000 this year, and $700,000 in 2015. Duke Endowment, which also has programs in Child Care and Higher Education, seems to make the majority of its Health Care grants in the realms of improving access to care and “breaking barriers,” which is a helpful thing in a state where so many people live in rural, relatively isolated communities.