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Psychiatr Serv. 2019 Jan 1;70(1):78-81. doi: 10.1176/ Epub 2018 Sep 17.

Delivering Collaborative Care in Rural Settings: Integrating Remote Teleconsultation and Local Supervision in Rural Nepal.

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Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang).


The collaborative care model can deliver high-quality mental health care. In rural regions, clinical supervision is conducted remotely rather than in person. The authors implemented a remote teleconsultation model in rural Nepal, where the consulting psychiatrist is over 30 hours away. This column describes strategies for several challenges: poor mental health competencies and high turnover among primary care providers; need for urgent consultations; psychiatrist discomfort with lack of direct patient contact; unreliable electricity, technological tools, documentation, and delivery of treatment recommendations; on-site clinicians' low motivation to accept psychiatrist recommendations; and mismatch between the psychiatrist's recommendations and the site's capacity to implement them.


Computer technology; Foreign psychiatry; Interdisciplinary issues; Service delivery systems


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