The goal of this mental health services research application is to improve access to and quality of community-based psychiatric consultation to persons who are dually diagnosed with both mental illnesses and deafness or loss of hearing. There is a critical shortage of community-based mental health specialists who are trained in American Sign Language (ASL). Their numbers and ability is driven by individual initiative since signing is not a skill that is encouraged in mental health professional training programs. Deaf or loss of hearing mentally ill persons, specially those living in rural areas are expected to travel long distances to communicate directly with a provider, or instead, to rely on the use of interpreters available to their community's health system. From a public health perspective, the expectation of long distance travel in order to access services is bad policy since it is unlikely to yield clinically satisfactory treatment outcomes. From a humanitarian perspective, mentally ill people who use sign language have a right to communicate with and understand their providers. This population will remain underserved in the absence of significant change in service delivery methods. This is a common public health problem that is shared by all the states. This application argues for a better solution. What is needed is a system that can provide a real-time link between a consumer and a signing provider (regardless of the geographic distance between them). This may be possible through the use of the developing technology to provide live, two-day, audio-video clinical interactions. This technology may soon be at a level of refinement and costs to merit national dissemination as a routine service delivery mechanism. The proposed research will take place in South Carolina SC. There is only one signing psychiatrist in SC. She previously traveled throughout the state seeing referred patients, in effect, spending more time driving than providing direct services. To increase patient access to the signing psychiatrist, the SC Department of Mental Health is wiring its community agencies with "telepsychiatry" equipment (video and audio hardware and software) at a very good price. The research project will help assess the viability of a low cost teleconferencing system that can allow direct communications between consumers and a signing psychiatrist. It will study the perspectives of stakeholders about potential advantages of "telepsychiatry" over the use of interpreters to facilitate clinical consultations, and evaluate the dimensions of importance perceived by deaf community members, consumers, and providers that should guide future services research, including research instrument development, for use with this population.