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Telepsychiatry can extend psychiatric expertise to institutional and forensic settings, but effective care requires more than a video connection. This webinar will examine practical approaches to evaluating and consulting with people who have serious and persistent mental illness, complex treatment histories, cognitive or sensory limitations, and understandable mistrust of systems and clinicians. Participants will consider how room selection, lighting, acoustics, camera control, staff roles, privacy, and emergency procedures affect clinical quality and safety. The session will also address strategies for building rapport through video, preparing on-site staff to support the examination, responding when urgent intervention is needed, and maintaining consultation and peer connection for remote clinicians. Examples from long-running telepsychiatry consultation programs will illustrate benefits, limitations, and implementation lessons.