Sparseness Of Mental Health Care Prompts Patients To Try Telepsych

Mar 21, 2014

Patients use videoconferencing to connect with psychiatrists out of state.
Credit Willow Belden

In many parts of Wyoming, it’s impossible to get mental health care. That means residents with mental conditions either don’t get treated, or they have to drive long distances to get services.

But that’s starting to change. Recently, more and more patients have been using telemedicine to get psychiatric care. Wyoming Public Radio’s Willow Belden reports.

WILLOW BELDEN: Because Wyoming is so rural, it’s hard to get health practitioners to move here. And mental health professionals are no exception. PJ Treide is with Health Link Now, a company that provides telepsych services. Telepsych is like other forms of telemedicine – it lets patients connect with doctors who live elsewhere, using video conferencing. Treide says Wyoming needs telepsych because it’s next to impossible to convince skilled psychiatrists to live here.

PJ TREIDE: The lifestyle and the way of life is difficult for providers. The turnover rate for psychiatry in the state, and other providers, is very, very high.

BELDEN: Even in towns where services are available, Treide says people don’t always feel they can take advantage of them, because of the stigma associated with seeking help.

TREIDE: The last thing somebody wants to do is have their car seen out in front of a mental healthcare center. … It’s the “pull yourself up by your bootstraps” mentality, and try to deal with issues on your own.

WILLOW BELDEN: One of the physicians trying out the telepsych system is Jed Shay. He’s a pain specialist in Rock Springs, and many of his patients battle depression and anxiety in addition to their physical ailments. He says it’s important to treat the mental problems along with the pain. So he’s made it possible for patients to connect with psychiatrists, using video conferencing.

JED SHAY: So the patients come in here…

BELDEN: “Here” is a small, sparsely furnished room. There’s no mood lighting, no soft couch, no plants or zen paintings on the walls. Just a beige armchair and a computer.

BELDEN: After logging in to the system, patients end up in a virtual waiting room. The psychiatrist’s face appears on the screen. She’s located thousands of miles away – in Brazil, currently. But she works with many patients in Wyoming and Montana. Shay says it’s crucial to have access to mental health professionals like her.

SHAY: When I moved out here, there was one psychiatrist, and then he left.

BELDEN: There are some counselors in Rock Springs, but Shay says it’s usually a long wait to get an appointment, and they can’t prescribe medications to treat mental disorders.

SHAY: The closest facility here for psychiatry service would be in Salt Lake City, and if you’re depressed, are you going to get behind the wheel and drive three hours?

BELDEN: Telepsych is one way to get around those problems, which is why it’s been growing across the state. In the past 10 years, dozens of facilities have gotten set up for telemedicine, and the state health department estimates that nearly 2,000 telepsych visits take place each month.

The system seems to be working well. Valerie Miller, the psychiatrist in Brazil, is one of the practitioners who’s doing telepsych sessions for patients in Wyoming. She says she’s pleased, even though it’s a little different than meeting people face to face.

VALERIE MILLER: There’s less information that I get from folks via video, and I find that it takes me longer sometimes – more meetings with patients – to learn as much about them.

BELDEN: But studies have shown that telepsych can be just as effective as face-to-face meetings.

MILLER: It’s psychiatry and it’s the work that I’ve always done with patients – you know, in terms of trying to figure out what’s going on and figuring out how to best treat it.

BELDEN: But the system isn’t perfect. Again, Dr. Shay.

SHAY: I would have liked to have a lot more of my patients receiving this service, but they are not because they can’t afford it or their insurance company doesn’t cover it.

BELDEN: Shay says about 70 percent of his patients have health insurance that will only cover in-person mental health care – not telepsych. At 150 dollars a session, paying out of pocket often isn’t an option. And Tammy Noel with the National Alliance on Mental Illness says telepsych doesn’t fix every problem. She says access alone won’t mean everyone gets care.

TAMMY NOEL: I think we need to be focusing on breaking the stigma of mental health, and understanding that it is not a choice to have a mental health condition.

BELDEN: Noel says telepsych is a good first step, but Wyoming has to get rid of its “cowboy up” mentality, at least when it comes to getting help for mental illness. And that could be a much longer process than simply setting up telepsych systems. For Wyoming Public Radio, I’m Willow Belden.