Expanding access to mental health care through telemental health

Cara Towle Optimized

Cara Towle, MSN, MA, RN

Nurses are ideally positioned to take on many different functions in telemental health and integrated care and play an impor­tant role in providing and increasing access to mental health care even — and sometimes especially — in remote and under­served areas of our region. Nurses are an increas­ingly essen­tial part of the telemental health team at the Univer­sity of Washington.

The Psychi­atry Consul­ta­tion and Telepsy­chi­atry (PCAT) program partners with commu­nity hospital-based doctors, nurses and social workers to provide inpatient, hospital-to-hospital” telepsy­chi­atry services. UW psychi­a­trists provide curbside” (provider-to-provider advice) consul­ta­tion, as well as more formal consul­ta­tions using real-time, inter­ac­tive video inter­views with patients who are admitted to a med-surg hospital bed but who are in need of mental health services, or for evalu­a­tion of single bed certi­fi­ca­tion” patients. UW psychi­a­trists find that nurses are vital to the success of this program, especially with detained patients. In many instances, it is actually more impor­tant to get input from the nurse than from the patient: nurses often have the most patient care contact and can share keen obser­va­tions that help inform the consulting psychi­a­trist. Moreover, the safety of the patient and the safety of the staff are prior­i­ties for the hospital, and a quick huddle that includes psychi­atry and nursing is an effec­tive way to address these issues. 

The UW Psychi­atry and Addic­tions Case Consul­ta­tion series (UW PACC) is a weekly CME-accred­ited telehealth program designed to develop a regional peer learning and support network for treating mental health and addic­tions, ultimately leading to better patient care. Using inter­ac­tive video, UW faculty offer a short didactic presen­ta­tion, followed by highly inter­ac­tive clinical case discus­sions with PACC partic­i­pants from locations throughout Washington. Several of the key PACC partic­i­pants are nurses and ARNPs in primary care settings caring for patients experi­encing complex mental health issues, and they gener­ously contribute to this case-based learning format. Not surpris­ingly, they also frequently impart valuable insights about patient care, especially in rural and remote locations, and often share infor­ma­tion about regional resources. 

Finally, PCAT and the UW AIMS Center are begin­ning to combine exper­tise in Collab­o­ra­tive Care and telepsy­chi­atry in order to provide access to better mental health care for more remote and under­served popula­tions. Collab­o­ra­tive Care is a model of integrated behav­ioral health care that enhances usual” primary care by adding two key services: care manage­ment support for patients receiving behav­ioral health treat­ment and regular psychi­atric inter-specialty consul­ta­tion to the primary care team. In some cases, such as in the UW Neigh­bor­hood Clinics and at some Commu­nity Health Centers, telepsy­chi­atry comple­ments the Collab­o­ra­tive Care model, allowing for the distant psychi­a­trist to interact directly with the patient when needed. Nurses serve a key liaison role, helping to identify patients who could benefit from a telepsy­chi­atry visit, managing the patient through the telepsy­chi­atry process and telep­re­senting. Another example of Collab­o­ra­tive Care + Telepsy­chi­atry is an innov­a­tive new project in a frontier area of the WWAMI (Washington-Wyoming-Alaska-Montana-Idaho) region where resources are extremely scarce. The model uses a centrally-based specialty team comprised of a psychi­a­trist consul­tant as well as a central care manager and LCSW, both of whom work closely with nurses at the patient site to co-manage patients using telepsy­chi­atry. Nurses are crucial to this model. Based at the patient site, nurses provide services in person with the patient and maintain a contin­uous relation­ship with the patient, as well as a collab­o­ra­tive, integrated relation­ship with the distant psychi­a­trist and care manager/​LCSW.