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Telepsychiatry Is Leaving Behind the Most Seriously Mentally Ill

I have broken all my promises to Katie* since I last saw her in early March. “I don’t feel like talkin’ today. I didn’t want ta come,” she snapped at me that day during the short walk to my office. Her Irish lilt never failed to make me smile. I told her she didn’t have to say anything. I knew she was angry before I even greeted her—when I paused at the door, she glared from across the waiting room. This small action only took a moment, but it is one of hundreds that stand to be lost as psychiatrists embrace telepsychiatry.

Katie is a 90-year-old woman suffering from schizophrenia, meaning she has severe disturbances in thought, communication, and perception. She also has poor insight into her illness, meaning she does not believe she is ill. Yet Katie is sick, whether she knows it or not, and she sees me once a month for both medication and therapy to keep her well. Thanks to this routine, she has been stable for nearly 30 years. She is often wary of people, but she has not tried to harm others or herself. It has taken me two years to chip away at her gruff exterior. The first chip was accidental. Two months in, I broke her silence by asking, “Did you ever leave milk out for the pixies in Ireland?”

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