Telehealth Mental Health Integration Program

Rural communities are severely disadvantaged by limited or non-existent access to psychiatric specialists. This lack of mental health services leads to under-treatment, higher rates of suicide, increased use of emergency services, and hospitalizations. Compounding the problems related to inadequate access to mental health care, primary care providers in rural areas report having inadequate skills to manage mental health problems, especially serious psychiatric disorders and conditions aggravated by co-occurring substance abuse.

In MHIP, psychiatrists use telehealth to consult with patients but also to consult with primary care providers and care managers in the context of Collaborative Care. Collaborative Care is a population-focused approach to treating mental health problems that leverages the small number of mental health professionals that exist. Staff responsibilities are as follows:

• The psychiatric consultant typically speaks with a care manager in a remote primary care clinic weekly to review the treatment plan for patients who are new or who are not improving as expected
• The psychiatric consultant may suggest treatment modifications for the primary care provider to consider, recommend the primary care provider see the patient for an in-person consultation, or consult on patients who are clinically challenging or who need specialty mental health services
• The psychiatric consultant most often uses the telephone for consultation, but also uses televideo when seeing the patient, provider, or care manager makes sense
• The psychiatric consultant is available to the care manager and the primary care provider during business hours for ad hoc consultation as needed

In the Mental Health and Opioid/Pain Management Consultation project, psychiatrists support and collaborate with rural healthcare providers using telehealth-based specialty consultations and provider/patient education for patients with common mental disorders or opioid abuse. Services include:

• Video teleconferenced patient evaluations
• Recommendations to patients’ local primary care providers
• Systematic caseload supervision
• Access to an array of educational offerings via video teleconferencing

Telehealth supports primary care providers by reducing provider isolation, allowing them to provide mental health care in their clinics rather than sending patients to a distant mental health center, and by providing an opportunity to learn how to treat patients by participating in consultations and receiving case management support. Telehealth can also provide training opportunities for developing a workforce of people who can effectively treat common mental health disorders.