The South Carolina Department of Mental Health partnered with the University of South Carolina School of Medicine and 18 predominantly rural hospitals from the South Carolina Hospital Association to establish the statewide telepsychiatry initiative. This public–private–academic partnership makes psychiatrists available via teleconference 16 hours a day, 7 days a week, to assess and treat patients with mental health issues at hospital emergency departments. Clinicians call the psychiatrist on duty whenever they have a patient who needs a mental health assessment and provide relevant medical records and details. Through a secure video link, the psychiatrist assesses the patient and makes recommendations about needed treatment and followup, including referrals to community-based resources. The program has reduced emergency department wait times, inpatient admissions, and costs; increased attendance at followup outpatient appointments; and generated high levels of satisfaction among patients and clinicians.