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.