By Kristi Sidel, Director of Behavioral Health, Avel eCare (Published in Mental Health Weekly, Issue 33, Volume 10)
With virtual behavioral health care, we can address crisis levels of need while truly meeting patients where they are in their journey. – Kristi Sidel
There’s no getting around one simple fact about the healthcare system: we are staring down a shortage of thousands of behavioral healthcare and primary care providers. More than three-quarters of US counties are currently experiencing a severe behavioral health clinician shortage, By 2025, we are projected to need an additional 30,000 psychiatrists and up to 48,000 primary care providers just to keep pace with demand.
While the stats seem grim, there are actions we can take right now to close the gaps created by these significant shortfalls. We certainly need to think differently about how to recruit, train, and retain thousands more clinicians – but we can also extend the reach of the hardworking providers we already have by leveraging virtual care techniques to connect with patients in innovative ways.
Virtual behavioral healthcare, also known as telebehavioral health or telemental health, can combat shortages by transcending traditional geographic barriers and embedding behavioral healthcare services into the places where patients live, work, socialize, and learn.
With internet-enabled voice and video tools, we can create connections to experienced behavioral health clinicians in unexpected places, such as senior centers, schools, and other community organizations – as well as with law enforcement and EMS personnel who are the first to respond to a growing number of people in immediate mental health crisis.
The scope and scale of the nation’s behavioral healthcare epidemic
The projected shortages are due to a combination of factors, including fewer people choosing healthcare as a career path and more people needing a higher level of mental and behavioral healthcare.The COVID-19 pandemic exacerbated an already-dire situation: even before the pandemic, more than 21 percent of people over 12 years old acknowledged abusing illegal drugs or misusing prescription drugs within the prior year, according to the National Center for Drug Abuse Statistics.COVID-19 struck against this background, tripling depression rates and significantly increasing the incidence of suicidal ideation.
Meanwhile, access to timely care became even more difficult as lockdowns shuttered physical offices and providers scrambled to put virtual care programs in place to compensate.Three years later, research shows that patients find virtual behavioral healthcare both “appealing and effective,” and that telemental health may even be “superior” for some patients who feel less comfortable meeting with a clinician face-to-face. While telehealth use for other types of outpatient care has declined with the reopening of society, virtual mental and behavioral healthcare has remained very popular, still comprising more than a third of all visits.
Extending behavioral healthcare into the community with virtual tools
Many of these virtual visits still take place between traditional settings, such as a provider’s clinic and the patient’s home. But increasingly, we are able to connect with patients in other settings, such as their schools, community centers, or senior living residences.This can be a critical lifeline for rural residents who may not have enough clinicians living within driving distance, or school districts who already have to share nursing staff for routine care needs, let alone mental health services.
Younger patients may also feel more comfortable speaking about sensitive issues away from the home setting, where family members could overhear private conversations, while elderly individuals may not be able to easily travel to appointments and need access to care in the places they reside.With a centrally located behavioral healthcare professional at one end of the line, these and other types of patients with unique needs can access crucial care more quickly and conveniently in familiar, accessible, and trusted settings.
Equipping first responders with 24/7 access to telebehavioral healthcare
To compensate for provider shortages, we need to make behavioral healthcare mobile and immediate, particularly for people in crisis who may be at risk of harming themselves or others. Police officers and EMS crews are the first to respond to emergency calls about people in distress. Estimates show that up to 20 percent of police calls involve a mental health or substance use crisis, and that number appears to be growing over time. By embedding mental healthcare access into the emergency response process via telebehavioral healthcare on a tablet, first responders can immediately connect a person in need with a provider who can assess their circumstances and recommend next steps for law enforcement.
For many patients, having round-the-clock access to a personalized assessment can avoid transport to an inpatient facility, which could be hundreds of miles away in the more rural regions of the country. People in distress can remain in their communities more often and avoid unnecessary involuntary committals.
These and other virtual care strategies are urgently required to help address the twin problems of not enough clinicians and growing needs in the community. With the right technology and creative thinking about when and where behavioral healthcare can take place, we can relieve burdens on patients and providers while ensuring that we adequately meet people where they are to deliver timely, informed, and high-quality care.
Kristi Sidel, a registered nurse, is director of Behavioral Health Services at Avel eCare in Sioux Falls, South Dakota. Sidel’s background includes working in clinical environments of behavioral health, primary care and quality improvement.