Bringing telepsychiatry to rural primary care: a 12-month observational evaluation in severe mental illness.

BACKGROUND

Specialist psychiatric access and continuity remain difficult in rural communities, particularly for adults with severe mental illness.

OBJECTIVES

To describe 12-month clinical, functional, and risk changes during a family physician-led telepsychiatry model embedded in rural primary care.

METHODS

This prospective uncontrolled cohort was conducted in rural Türkiye in 2018-9. Of 37 adults enrolled, six relocated to urban areas. Two of these participants had shown marked clinical improvement and obtained employment before moving. One additional participant with schizophrenia died from myocardial infarction. Thirty completed assessments at baseline and months 3, 6, 9, and 12. A joint home assessment was followed by quarterly mobile visits with synchronous psychiatric consultation. Linear mixed-effects models with Holm adjustment evaluated longitudinal changes.

RESULTS

Disability, CGI-Severity, PANSS General Psychopathology, and four CMHC risk-domain scores changed significantly over time (all Holm-adjusted P < 0.001). Model-estimated month-12 versus baseline differences were -12.63 for the Sheehan Disability Scale [95% confidence interval (CI) -14.70 to -10.57], -2.17 for CGI-Severity (95% CI -2.49 to -1.85), and -29.90 for PANSS General Psychopathology (95% CI -34.52 to -25.28). Self-harm, harm to others, vulnerability, and relapse risks also decreased. CGI-Improvement and side-effect scores showed no significant overall time effects; Time × Diagnosis and Time × Gender interactions were not significant.

CONCLUSION

Disability, clinical severity, general psychopathology, and risk scores improved over time. Without a control group and standardized, fully recorded treatment components, these findings indicate temporal associations rather than effectiveness and require confirmation in adequately powered controlled studies.