(July 18, 2019) Individuals in rural localities face particular challenges in receiving mental health treatment compared to those in more urban communities. For rural residents, the nearest hospital with a practicing psychiatrist may be hours away, and outpatient services may be scarce. As a result, providers have been experimenting with new technologies and collaborative efforts to bring critical psychiatric care to people who need it, regardless of where they live.
Outlined in a recent program report, a new partnership between the University of Washington (UW) and Dayton General Hospital in Washington State may be the first to combine the comprehensive services of an academic medical center with the accessibility of a “critical access hospital” in a rural locality.
By definition, critical access hospitals, such as Dayton General, are located in areas without close proximity to another hospital. Their services are crisis-oriented, facilitated by a 24/7 emergency room, short stay requirements, and a limited number of inpatient beds. For many people in the overwhelmingly rural state of Washington, these hospitals and their primary clinics may be the only sources of mental health care. While critical access hospitals are therefore an important part of healthcare in rural Washington, they do not supplant the need for regular access to a psychiatrist and to non-crisis mental health services.
The Solution
To bridge the gap between treatment access in urban centers, like UW’s home base in Seattle, and rural communities, university psychiatrists have started collaborating with providers at Dayton General Hospital and its affiliated clinics to offer more comprehensive mental health services in remote areas.
Before the partnership, provision of outpatient mental health care was solely the responsibility of a single licensed clinical social worker, located on-site at the Dayton clinics. With the addition of resources from UW, patient progress is now monitored by one of two clinical social workers and a participating UW psychiatrist on a medical team. Each team meets via video chat on a weekly basis to discuss new and existing patient treatment, and records all treatment information into a shared clinical registry. The psychiatrist also maintains weekly phone consultations with a patient’s primary care provider to promote a holistic understanding of his or her health and treatment challenges.
The program is designed to achieve technical efficiencies, but it is also has the ability to adapt to unique patient needs. Patients with complex health concerns, especially those who might not be responding to treatment plans, may receive 25-30-minute video consultations with a UW psychiatrist, and the patient’s clinical social worker.
In addition to outpatient services, UW psychiatrists also provide video consultation services for hospitalized patients in the Dayton General Hospital medical wards. Using HIPAA-compliant video software and a mobile laptop unit, psychiatrists can all but be in the room with social workers, physicians, and patients from hundreds of miles away.
Provider partnerships in healthcare have become a relatively accepted strategy to address problems of patient access to mental health care. However, the collaboration between the University of Washington and Dayton General Hospital may be the first involving an academic medical center and a critical access hospital, serving the needs of rural communities. In just the first few months of operation, the program saw an increase in both outpatient and inpatient caseload, highlighting the need for this unique service in areas often forgotten by America’s healthcare system.
References:
Jessica Walthall
Research and Advocacy Associate
Treatment Advocacy Center