James Kauzlaurich sits in a room at Oaklawn's South Bend offices where his psychiatrist appears on a TV screen.
She tunes in live from her Chicago office, and they chat about the depression that he's fought almost his entire, 47-year life.
The sessions seem to stretch longer than the scheduled time because, he said, "She's gabby."
It enables the doctor to make any changes to the drugs that Kauzlaurich takes. Kauzlaurich basically sees no difference in the quality of care.
"It's more intimate in person," he said, grateful to at least get the sessions he needs. "But no care is less personal."
Oaklawn started these sessions via camera and TV -- known as telepsychiatry -- in October as a way to make up for a national and local shortage of psychiatrists.
It is among the alternatives the Goshen-based mental health provider is trying as a way to fill the gap. Oaklawn inherited the shortage in 2010 when it took over outpatient care in St. Joseph County after the Madison Center's financial collapse. Just months before, a handful of psychiatrists had left Madison Center to go into private practice.
Two psychiatrists tune in for telepsychiatry from Chicago to serve Oaklawn's outpatient clients in St. Joseph County, where the shortage is most keen.
One of the Chicago doctors works with youths. The other drives to South Bend each week for in-person sessions, too. And an Indianapolis doctor soon will start doing telepsychiatry with kids for a short six hours a week.
Another psychiatrist from Sacramento, Calif., tunes in for Elkhart County patients.
None of them wants to live in South Bend -- and yes, they've been asked, said Oaklawn CEO Laurie Nafziger. But they're willing to do the work here.
For now, she doesn't foresee adding more telepsychiatry for adults, still feeling a preference for face-to-face.
"People who hear about it have the hardest time believing that patients really like it," said Jonathan Neufeld, a Goshen psychologist who worked from 1998 to 2005 on one of the oldest and largest telemedicine projects. It was at the University of California-Davis Medical Center, where the staff looked at ways to use various kinds of telemedicine -- not just psychiatry -- to bring medical care to remote areas.
Professionals can spend more time working in rural areas and less time driving.
"Nobody has ever been able to find -- and believe me, they've been trying -- any measurable difference in the quality of care or the outcomes," Neufeld said of telepsychiatry.
A few studies hint that patients with substance abuse are willing to share more information via telepsychiatry, he said.
And patients in rural areas have said they feel more comfortable with an out-of-town psychiatrist who they're less likely to run into at a grocery store or public event, he added.
The glitches of technology can be fixed, like a garbled sentence, he said.
Today, apart from his private practice, Neufeld directs the Upper Midwest Telehealth Resource Center, one of 10 federally financed centers across the country that provide guidance and support to telemedicine centers in their regions.