Psychosomatics 48:2, March-April 2007 http://psy.psychiatryonline.org 135 The e-Mental Health Consultation Service: Providing Enhanced Primary-Care Mental Health Services Through Telemedicine JONATHAN D. NEUFELD,PH.D., PETER M. YELLOWLEES, M.D., M.R.C.P. DONALD M. HILTY, M.D., HATTIE COBB, B.A. JAMES A. BOURGEOIS, O.D., M.D. This article describes the University of California, Davis Medical Center eMental Health Consul- tation Service, a program designed to integrate tele-mental health clinical services, provider-to- provider consultation, and provider distance education. During the first year of operation, con- sultations were provided for 289 cases. The most common diagnoses among children were for attention-deficit hyperactivity disorder-spectrum problems. Among the adult patients, mood disor- ders were most common. A convenience sample of 33 adult patients who completed the SF–12 health status measure showed significant improvements in mental health status at 3–6 months of follow-up. This model of comprehensive rural outpatient primary mental health care delivered at a distance shows promise for wider application and deserves further study. (Psychosomatics 2007; 48:135–141) Received October 19, 2005; revised March 6, 2006; accepted March 14, 2006. From the Dept. of Psychiatry and Behavioral Sciences, Univ. of California, Davis Medical Center, Sacramento, CA. Send correspon- dence and reprint requests to James A. Bourgeois, O.D., M.D., Alan Stoudemire Professor of Psychosomatic Medicine, Dept. of Psychiatry and Behavioral Sciences, Univ. of California, Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA 95817. e-mail: james.bourgeois@ ucdmc.ucdavis.edu Copyright  2007 The Academy of Psychosomatic Medicine S pecialty mental health providers have increasingly fo- cused their efforts on service delivery in the primary- care setting, where most mental health care is, in fact, de- livered. 1 Similarly, many existing telepsychiatry and “tele-mental health” programs provide their specialty men- tal health services in primary-care settings, often in remote rural and underserved areas, where access to these services would otherwise be limited or nonexistent. 2,3 Direct evaluation of patients via two-way videocon- ferencing is the backbone of most telepsychiatry services. Ample evidence exists that telepsychiatric evaluation ser- vices can be delivered economically and with levels of quality and patient satisfaction similar to those found with face-to-face evaluations. 4–6 Some outpatient psychiatric consultation programs have also explored the use of tele- phone consultations as a quick and efficient way to provide consultative, supplemental, and follow-up care, 7 as well as consultations provided by some form of electronic mes- saging (e-mail). 8 Also, provider distance-education aimed at improving rural providers’ capacity for managing mental health issues is a natural outgrowth of clinical telemedicine programs and is increasingly listed among their most im- portant benefits. 9,10 Few programs, however, have reported on efforts to integrate these multiple services into a com- prehensive “virtual mental health clinic” that can both pro- vide a wide range of clinical services and support rural providers by means of educational offerings. In this article, we describe such a project and report our findings on an overall case mix for a 1-year period and health status out- comes for a small convenience sample of referred patients. In reviews of the mix of psychiatric cases commonly seen in primary care, Katon 11 and Katon and Schulberg 12