The finding:
Through a qualitative study evaluating the experiences of psychiatrists and psychologists involved with rural telehealth delivery, this study identified the motivations and barriers to delivering specialized mental telehealth care to rural settings. These factors varied based on the model of care delivery: collaborative care or telemental health referral care. Barriers included difficulty with coordination with emergency resources, lack of recognition of the expertise of the mental health expertise provided by the consultant, the necessity of delegating tasks to other providers, and achieving appropriate credentialing as well as adequate access to the electronic health records. The motivations for continued provision of care through this model included rewarding patient interactions and the cohesion experienced with clinic staff. All participants noted regardless of barriers, these models of care were important to continue.

Strength and weaknesses:
As a qualitative study evaluating the experiences of fourteen mental health care providers, the generalizability of this study is inherently limited. The study is also limited by the states involved in the original study (Washington, Michigan, and Arkansas) which also limits generalizability as each state and each rural setting has unique cultural and environmental factors that can impact the implementation of new models of care and may affect the acceptance of specialized mental health care. Nonetheless, this study identifies important barriers to be addressed by mental health professionals work using these systems to expand mental health care access.

Relevance:
As collaborative care models proliferate, this study identifies important factors leaders of rural health care systems can consider to ensure recruitment and retention of consulting mental health experts. If psychiatrists or psychologists have the opportunity to be involved in implementation, an additional emphasis can be placed on the factors identified in this paper. This includes the importance of direct lines of communication and access to primary care providers to ensure adequate and appropriate coordination of care, clarity and information on the best emergency resources available, and adequate orientation of members of the health care team to the expertise of the mental health team and the unique model of care being delivered.

Type of study (EBM guide):
Qualitative