Behavioral telehealth, the use of electronic and communication technologies to provide and support behavioral health care when distance separates the participants, has the potential to address the nationally significant problems of access, cost, and distribution of behavioral health care and providers. Using examples of developing behavioral clinical practice, research, and policy opportunities, this article outlines the promise of this field while discussing the barriers to the development of behavioral telehealth networks, including the lack of clinical protocols, solid evaluative research, payment for telehealtldtelemedicine services, uniform state licensure, and uniform privacykontidentiality policy. It is argued that behavioral practitioners, researchers, and advocates must actively participate in this rapidly developing field, and these professionals are ideally suited to supply ongoing federal and state policy initiatives with much needed empirical clinical data and evaluative research that w i l l help to generate sound policy.
In an extreme rural county in western Wyoming, on a windy, cold, and snowy winter Sunday evening, the county Sheriff is called to a distant farmhouse. At the door he is greeted by two middle aged parents, who report that their adult son, who has a paranoid-schizophrenic diagnosis, has refused to take his medication for the last few days and has begun to threaten to harm them and himself. While an emergency commitment is allowed under state law, the nearest inpatient psychiatric facility is over 125 miles away, and a trip at this t h e of night will entail waking another deputy to be placed on call, as well as overtime for the already financially strapped Sheriffs office. Instead, the young man is taken to a local clinic, where he is met by the local nurse practitioner, who has served as the primary health care and psychotropic medication provider to the young man and his family for the last five years. Using a two-way interactive audio-video hookup, she connects with the psychologist on-call at the state hospital. The psychologist assesses whether the patient meets the commitment criteria, but also engages the patient in a discussion of his concerns about not taking his medication. After this brief discussion, the patient's agitation decreases, the threats disappear, and he agrees to resume taking his medication. The patient is reassessed, and the decision is made to have the patient remain at the clinic after the nursepractitioner administers his medication, until he is judged to be stable.