Not long ago, a patient in a rural emergency department served by Renton, Wash.-based Providence might have waited two days, sometimes up to a week, for a mental health professional to evaluate them. Today, that same patient is typically seen within an hour or two — connected by camera to an on-call psychiatrist or licensed clinical social worker hundreds of miles away.
That shift is the result of Providence Telepsychiatry, which delivers virtual psychiatric care in acute care settings — intensive care units, medical surgical units and emergency departments — across 42 hospitals in six states: Alaska, California, Montana, Oregon, New Mexico and Washington. In 2025, the program logged 11,880 consultations with a median response time of two minutes.
Stacia Fisher, executive director of Telepsychiatry and Virtual Care and Digital Health at Providence, and Joshua Jones, MD, medical director of Telepsychiatry and executive medical director of Virtual Care and Digital Health at Providence, told Becker’s how the program has evolved and that it has learned valuable lessons along the way.
Team-based care model
The program launched as a psychiatrist-only service before Providence added licensed clinical social workers to the team. Ms. Fisher said the change has allowed psychiatrists and social workers to each work at the top of their license, with social workers able to escalate cases to physicians and physicians able to lean on social workers for complex child and adolescent cases that require family involvement or safety planning.
Dr. Jones said the most surprising finding since joining the program has been how virtual care compares to in-person psychiatric care.
“I thought the evidence was going to come out that traditional sit-down talk with your psychiatrist or social work therapy and acute care work that we do was going to be better if it’s face to face,” he said. “What we found is that’s not true. The uptake and the desire of patients to actually have a little bit of distance between them and the mental health professional is pretty compelling.”
Studies comparing the two head-to-head have shown virtual psychiatry is at least equivalent to in-person care, and in some cases may be better, particularly given the access it provides in emergency departments, medical surgical units, ICUs and rural areas, according to Dr. Jones.
The technology behind the visit
Ms. Fisher said Providence Telepsychiatry uses the same camera and audio technology deployed for the health system’s stroke evaluations, including directional microphones to filter background noise and pan-tilt-zoom cameras that can bring a family member into view.
Providence is also investing in placing wall-mounted cameras — which the team calls “co-caring cameras” — into patient rooms systemwide, rather than relying solely on mobile carts. The carts house the camera, video screen and microphone on wheels and must be brought into a patient’s room for a visit. Dr. Jones said patient resistance to the technology has become rare.
“I can count them on one hand, patients who said, ‘No, I don’t want to do that, because this is unfamiliar technology,'” he said. “It’s been vanishingly small in recent years.”
Every visit includes a consent process in which clinicians disclose the modest risk of signal or sound issues and, if asked, explain that the connection is encrypted and not recorded.
Dr. Jones said Providence is moving away from the term “telepsychiatry” in favor of “virtual behavioral health,” noting the technology allows for more than a phone conversation. He uses the same technology within the acute care setting to complete ophthalmologic exams, analyzing the eyes to determine whether a condition is psychiatric or neurological.
Quality metrics and continuity of care
Providence tracks response times at multiple points in a consult, from the initial call confirming the consult question to the video visit itself, and reports back to each site on consult reasons and recommended patient dispositions. Documentation is completed in real time to support handoffs to the next step in a patient’s care.
The team also administers a structured suicide assessment scale to every patient it sees, regardless of whether the visit is for a physician or social worker. Dr. Jones said that standardization means the health system doesn’t have to track down separate reports from each site.
“We’re able to ensure that a patient is getting the same level and quality of behavioral healthcare, whether they’re in Apple Valley, California, [or] in Kodiak Island, Alaska,” he said.
Ms. Fisher said crisis safety plans developed during a behavioral health virtual visit are integrated into Providence’s EHR and visible to patients through their patient portal, allowing a patient’s primary care provider or therapist to update the same plan rather than fragmenting care.
Reach and workforce diversity
Recruiting clinicians nationally rather than from a single market has expanded both access and the diversity of Providence’s clinical team, according to Dr. Jones. He said patients in some rural sites the program serves used to wait up to a week in the emergency department for a mental health evaluation before the program launched; they’re now typically seen within an hour or two.
The program’s scale also exposes clinicians to a wider range of complex cases than they’d typically encounter at a single site, Ms. Fisher said, giving them more exposure to emerging best practices and treatment options. Providence also runs a quarterly, CME-eligible education series for the hospitals it serves.
Dr. Jones said the psychiatry service has a 95% annual clinician retention rate.
“You’re at home, you get to portal yourself into these places that are kind of unique with new challenges, you get to see really interesting patients, and then we are able to have the people log off and continue their family life almost uninterrupted,” he said. “It’s highly satisfying for our clinicians as well.”
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