Bridging the Mental Health Gap

Bridging the provider gap through telehealth

You often hear it said that the first step to solving a problem is admitting you have one. when it comes to mental health, the good news is that more of us who have a problem are willing to admit we do. The bad news is that there are more of us who need help, a whopping 56% in the U. S. who currently seek behavioral health care.

The National Alliance on Mental Illness estimates that there are about 10 million American adults living with a mental health condition. A startling one-in-every-five teenagers would need to be added to that number to begin to appreciate the scope of the nationwide crisis.

Flip over from the demand side of the issue to the supply side, and you encounter another bad news / good news scenario. The bad news is that there are just not enough behavioral health professionals to go around. That’s especially true the farther you get from major metropolitan areas. A recent HRSA study determined that Kansas will need about 3200 more behavioral health professionals by 2030 to cover our projected deficit.

In two places at once

The good news? We have the technology to begin addressing the problem now. It’s called telehealth, but it’s a sophisticated (or unsophisticated, depending on your point of view) as the Facetime app on your phone.

Rita Zeller, LSCSW

“Telehealth has been around now for a number of years, but its application in behavioral health is proving to be especially timely,” said Rita Zeller, GraceMed’s Director of Behavioral Health. “We’re suddenly confronting a compelling need to be in two or more places at the one time just to respond to the gap between patients we need to serve and our capacity to serve them.”

Currently, GraceMed has three behavioral health providers on staff: Rita Zeller, LSCSW at our Capitol Family Clinic in Topeka, Steven Stiel, LSCSW at our Highland Park Clinic also in Topeka, and Jeff Hubbell, LSCSW at our Helen Galloway Clinic in Wichita. Although they see patients of all ages, as GraceMed looked to expand our capacity for care in this area, we wanted to focus our efforts initially on stemming the rapidly rising tide of juvenile problems, including substance abuse, depression and suicides, and obesity. So last year, GracMed applied for and received an HRSA grant that will enable us to install telehealth technology in all seven of our school-based clinics, connecting them with the locations at which our behavioral health team has their offices. The pilot application, which has been up and running since last fall, connects our Healthy Family Clinic with our three providers.

Jeffery Hubbell, Behavioral Health Consultant

“Here’s how it works: One of our medical providers might be seeing a teenager who presents with suicidal thoughts,” explained Jeff Hubbell. “While they are there for the medical visit, the provider now has the option to offer the patient a private consult with either Rita, Steve or me in a separate room that has been set up to put us in the clinic through a telehealth call.”

Face to face with the problems

This seamless, immediate handoff between providers solves a few problems that have limited access to behavioral health care. The first is that there’s no need to schedule another appointment at another location. “For a lot of the patients we see, that referral appointment is hard to keep,” Jeff said. “Taking the time, and in some cases, getting the transportation to another appointment is just hard enough that some just won’t make it.”

Steven Stiel, LSCSWAnother problem this technology-based approach addresses is the stigma that is still associated with needing help. “There are studies that indicate we are beginning to recognize that treating mental health is as important as treating a physical condition,” noted Steve Stiel. “But it’s still something that many of us are not prepared to admit and certainly want to keep private. A telehealth consult allows us to integrate the care into a medical appointment which patients will often find easier to accept as an extension of the care they are already receiving from GraceMed.”

Sandrine Nkouga, APRNIt’s also true that many family medicine providers either fail to identify a behavioral health disorder or are reluctant to address it. That may be because many medical providers get relatively little training in mental health. Sandrine Nkouga, APRN is the referring provider for the pilot program at Healthy Family. She sees the new technology as a way to treat the whole health of the patient. “The World Health Organization defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ That’s why our telehealth team links behavioral health and medical providers in close collaboration to take care of our patients physical, mental and social needs. So far, our approach has been a success.”

But training is critical. As Jeff explained, “part of what we’re doing with this program is to train our providers in what to look for, symptoms that would identify patients as candidates for behavioral health care.”

Very soon, GraceMed will be adding three more telehealth installations at its school-based clinics. The plan is to have the capability at all seven clinics by the time school opens again this fall.

It’s hard to pinpoint one reason for the mental health crisis. The stress of the ever-faster pace of our lives can’t help. For many in the younger generation that accounts for much of the increase, social media has been a legendary cause of depression and suicide. As Jeff put it, “the proliferation of technology in our lives hasn’t made us happier. It’s supposed to connect us more, but there’s also a sense in which it has left us more disconnected.”

That’s ironic, of course. But so is the fact that the same connective technology that fails to connect us is now making it possible to bring help where it is needed most for our patients at GraceMed.