Expanding access to mental health care through telemental health

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.