Nearly half of adult Americans reported experiencing symptoms of anxiety or depression in 2020, according to U.S. census surveys. This reported number spiked during the pandemic, and is expected to linger. The mental crisis is reaching a breaking point for children, too.
Unfortunately, this is a classic case of a supply and demand balancing act. In other words, there just aren’t enough behavioral care professionals available to primary care practices, clinics, and hospitals to address these issues. Patients are waiting months for behavioral care appointments, while emergency departments and PCPs already burdened with patients presenting with mental health issues are being asked to provide behavioral health care they aren’t trained for nor have the resources for.
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Jim Varrell James R. Varrell, M.D. is the founder and Chief Medical Officer of Array Behavioral Care and the CFG Health Network. Dr. Varrell is American Board certified in Psychiatry and Neurology, and certified in American Academy of Child and Adolescent Psychiatry with a specialty in autism. Dr. Varrell has been at the forefront of […]
The good news? Collaborative care models between PCPs and behavioral care specialists are gaining popularity and addressing these issues at the roots by tackling underlying or co-morbid behavioral issues that may be present with a physical condition. Behavioral care integrated in primary care practices, when done right, is proven to set teams of PCPs, behavioral health clinicians, and patients up for success and improve outcomes.
Collaborative care models aren’t new. But for many PCPs and health plans that support them, there’s one key strategy that’s elevating collaborative care by correcting the supply-demand imbalance—telepsychiatry.
A Growing Need Among a Shrinking Pool
Behavioral health clinicians can currently only meet 27% of patient needs across the U.S. And today, there are only 28,000 practicing psychiatrists to serve more than 327 million Americans – roughly 9 per 100,000 people. This lack of coverage is magnified in rural, remote and underserved areas.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
So, in communities without a behavioral health specialist or psychiatrist, what typically happens? The available, accessible healthcare professionals, especially primary care physicians, pick up the slack, and fill the gaps. As many as 1 in 4 primary care visits in the U.S. are for mental health conditions. And, one study found that 70% of antidepressants are prescribed by PCPs, rather than psychiatrists—professionals trained to diagnose and treat complex mental health conditions.
PCPs Need Help to Support the Influx Of Demand
While primary and preventive care are important first lines of defense for patients facing mental health issues, appointment times tend to be brief, challenging clinicians to cover physical and mental health needs adequately in a single session. When it’s all said and done, patients leave their doctors’ offices without the appropriate help they need.
How can we make quality behavioral care more accessible when and where people need it most? At the intersection of these challenges lies collaborative care enabled by telepsychiatry—an innovative bridge between available behavioral care specialists and PCPs managing these needs. If fully embraced, virtual collaborative care models can treat a wider range of conditions more effectively and empower PCPs with the resources to address the whole patient by adequately caring for their body and mind.
Executing a Telepsychiatry and Behavioral Health Integration Game Plan
Realizing the promise of collaborative care means reprioritizing our strategy. In these models, a behavioral care case manager works with a PCP to identify patients who are eligible for an integrated behavioral care program. Together, along with a consulting psychiatrist, the collaborative team works to develop individualized treatment plans as well as measures for evaluating symptoms and tracking progress. The teamwork creates shared accountability for the patient’s outcome across all providers and stakeholders within the collaborative care team and can help each player—the patient, PCP, care manager, and consulting psychiatrist —play to their strengths.
Telepsychiatry moves the collaborative care paradigm a critical step further. By establishing a virtual relationship with consulting telepsychiatrists, psychiatric nurse practitioners, and licensed clinical social workers, PCPs and their behavioral care managers have access anytime to the appropriate support for patients’ mental health needs. This model allows for more efficient use of the scarce resources of psychiatry professionals. Through virtual telehealth models, we’ve seen that up to 150 patients can be addressed in a two-hour session between the behavioral care manager and psychiatric consultant. In a typical psychiatric care model, that two hours might be only two to four patients. With more efficient care delivery, primary care practices can then be freed up and more empowered to manage the health of their patient population fully. And patients can access behavioral care in the comfortable, familiar environment of their PCP’s office, removing any stigma that might be a barrier to them seeking treatment on their own.
Integrating behavioral health services through telehealth is a natural fit. A collaborative care team united by telepsychiatry unlocks behavioral health integration that can increase access, quality and efficiency across the continuum of care. The sooner more healthcare organizations open their doors to telepsychiatry, the better chance our collaborative care team has to overcome America’s mental health crisis.
Photo: alphaspirit, Getty Images
James R. Varrell, M.D. is the founder and Chief Medical Officer of Array Behavioral Care and the CFG Health Network. Dr. Varrell is American Board certified in Psychiatry and Neurology, and certified in American Academy of Child and Adolescent Psychiatry with a specialty in autism. Dr. Varrell has been at the forefront of telepsychiatry across the nation and continues to educate the medical community regarding the benefits of telepsychiatry through various presentations and forums as a panelist and presenter. His recent presentations have included engagements with the American Psychiatric Association, the National Rural Health Association, the American Telemedicine Association, and multiple Grand Rounds presentations. Dr. Varrell performed the nation’s first involuntary psychiatric commitment via a televideo unit in 1999. Today, Dr. Varrell still regularly performs telepsychiatry evaluations and manages a staff of telepsychiatry clinicians.
