May 23, 2014 | General
In rural areas of the United States, mental healthcare has long been difficult to obtain. For face-to-face consultations with psychiatrists and psychologists, rural residents must often make long, difficult car trips that sap their finances and inconvenience their friends and neighbors. Such trips are particularly hard on those who suffer from poor physical health.
A newly developed model of mental and general healthcare may change this situation. Recently, the Louisiana State University Health Sciences Center New Orleans School of Medicine’s Department of Psychiatry issued new guidelines that leverage telemedicine in the service of psychiatric and general medicine protocols to provide comprehensive healthcare to rural residents who require “whole patient” care.
A Model for Ordinary (and Extraordinary) Times
Although the motivation for these new guidelines was the devastating Deepwater Horizon oil spill that affected huge areas of the sparsely populated Louisiana coast in 2010, it has broad implications for everyday rural healthcare as well. According to Dr. Howard Osofsky, the LSU Health Sciences Center New Orleans School of Medicine Psychiatry Department Chair, existing care models simply didn’t take into account the mental health needs of geographically isolated patients who lacked easy access to psychiatric professionals.
This absence was particularly glaring in coastal Louisiana, a tight-knit, culturally cohesive community that has been struck by repeated disasters since 2005, including Hurricane Katrina, Hurricane Rita and the Deepwater Horizon oil spill. Despite alarms raised by healthcare professionals who noted an increase in the number of mental health disorders in local residents, few if any of the area’s primary healthcare providers included a mental health unit in their practice. The key to alleviating this shortage, says Dr. Osofsky, is a healthcare framework that integrates “behavioral health with primary care to build sustainable services along with community resilience.”
How Bad Was the Problem?
The work of Dr. Osofsky’s team was particularly pressing in light of the Centers for Disease Control’s apparent undercounting of post-spill mental health disorders in coastal Louisiana. LSU’s study found higher rates of classical depression, general anxiety and PTSD-like symptoms than the CDC’s own report. It also indicated that locals were suffering physical symptoms at greater masses than before the spill. The combination of the community’s deteriorating mental health and greater incidences of debilitating physical symptoms drove home the need to integrate mental and physical healthcare in a single unit.
Finding a Sustainable Solution
Outside of New Orleans and Baton Rouge, the bayous of southern Louisiana lack major population centers and robust transportation networks. As such, establishing onsite mental healthcare facilities at existing primary care centers wasn’t practical on short notice.
Dr. Osofsky’s team determined that telemedicine could play a key role in connecting local residents with on-demand psychiatric and psychological care without requiring excessive travel or time commitments. LSU’s scholars worked with the Gulf Region Health Outreach Program, an initiative funded by the Deepwater Horizon Medical Benefits Class Action Settlement, to set up a sustainable care model that physically places a limited number of competent, well-trained mental health professionals at the five local primary care centers that use the model. In turn, these professionals are managed via telemedicine by centralized teams of experienced, highly qualified specialists who use the technology to issue directives to the on-the-ground professionals and consult directly with patients on a 24-7 basis.
These on-the-ground mental health workers operate alongside physicians, physician assistants, nurse practitioners and other healthcare workers to deliver comprehensive care within the confines of their facilities. Dr. Osofsky notes that many primary care providers, who don’t have specialized psychiatric training, are equipped to handle everyday mental healthcare issues and merely use the telemedicine-enabled network of specialists to address issues that fall outside of their comfort zones. Still, telemedicine clearly has the potential to reduce transfers to non-local hospitals and mental healthcare facilities.
Results and Future Initiatives
The early results of this new model of care are encouraging. Although the model can currently handle about 75 patients per week, new primary care facilities are being added to the network in an effort to increase its capacity. Meanwhile, participants in the initiative showed significant declines in both physical and mental symptoms at their one- and three-month checkup dates. Going forward, it’s clear that telemedicine has a central role to play in the provision of physical and behavioral healthcare for residents of rural regions like coastal Louisiana.