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Employing telecommunication tools to deliver behavioral health services over a distance, referred to as telepsychiatry, is a technique that has been around since the 1950s. With more than 40 formally recognized active telepsychiatry programs, ample published studies have documented the technical feasibility and apparent satisfaction and acceptance by patients and providers. However, there has been minimal analysis regarding the formal programs delivering these services. This study collected data from 16 programs recognized as among the most active in the world. The results indicate a dearth of strategic business plans for the provision of telepsychiatry services; a focus on patient services above all and; the potential for telepsychiatry to eventually meld into the everyday practice of psychiatrists and psychologists.