With initial funding from The Duke Endowment, the South Carolina Department of Mental Health Telepsychiatry Consultation Program works with participating hospital emergency departments (ED) and patients to address overcrowding and scarce resources through videoconference-based behavioral assessments. Many patients are able to be safely discharged from the hospital and returned to their families the same day they are assessed, cutting lengths of stay substantially. The program psychiatrist supplies the patient and ED staff with their written clinical recommendations and also with information about the local mental health center and other local resources. In turn, the mental health center is able to immediately access the electronic record of the psychiatrist’s assessment and recommendations. Patients seen through the program who are discharged from an ED have a far higher rate of following through with aftercare at a mental health center. For those patients who are retained in the emergency department, the psychiatrist’s treatment recommendations have generally improved the quality of care they are receiving.