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Mental illness affects 18% of American adults and 8.0% of American children. Untreated mental illness can increase mortality, influence treatment of other conditions, and impose unnecessary burdens on individuals, families, and communities. Despite the prevalence and burdens of untreated mental illness, there are still numerous financial, social, and organizational barriers to the availability, utilization and quality of mental health services. In the last two decades, many efforts have been made to improve healthcare access through legal and regulatory overhauls, health insurance reform, electronic health system infrastructure expansion, and development of new models of care. These efforts are perhaps most easily observed through the implementation of telehealth and telemedicine. Telehealth is an umbrella term indicating the use of technology for the provision of healthcare, health administration, and health education while telemedicine is a more specific term referring to the use of technology for the delivery of healthcare across distances. While telemedicine is used in almost all subspecialties, implementation and research are more developed in some specialties than in others. Research on telepsychiatry shows that 1) telepsychiatry can be used to effectively diagnose and treat a variety of mental illnesses in a number of populations in many locations; 2) telepsychiatry has the potential to be a cost effective alternative to treatment as usual for patients, providers, and communities; 3) telemental health can function successfully within the legal and regulatory landscape in United States; 4) the technology for telemental health is already available and continually improving; 5) There are resources available to facilitate the use of telemental health by patients, providers and healthcare organizations. Telepsychiatry has the potential to improve access to mental health services by connecting patients with the right providers, reducing the costs of receiving and providing mental healthcare, lowering social barriers that prevent individuals from seeking and providers from offering care, and facilitating organizational practices and goals. This paper summarizes published data concerning the clinical, financial, legal and regulatory, and technological aspects of telepsychiatry and explores how telepsychiatry might be used to improve the availability, utilization, and quality of mental health services in the United States.