From Tele-Psychiatry to Collaboration, Ohio Tries to Reach its Mental Health Deserts

Jun 8, 2018
Originally published on August 31, 2018 10:31 am

Editor's note: Mike Quirk was originally misidentified in this story.

Mental-health care can be hard to access in much of Ohio, especially away from the larger cities. This installment of our series Navigating the Path to Mental Health looks at the challenges along the way to finding and getting mental-health services.

There are nearly 12 million people in Ohio. But there are just 3,300 licensed psychologists and only about 1,100 psychiatrists.  According to state licensing data, these practitioners are concentrated around larger cities.

That means wide-spread mental health deserts for rural and small-town Ohio, where first contact with care often comes in emergency rooms or crisis centers after behavioral issues have grown severe.   

Delayed first contact

John Carroll is a crisis intervention specialist in Tuscarawas County. He says that’s a hard way to start mental health treatment.

“It’s challenging to meet people when they need things peeled off the wall.”

Mike Quirk lives in Akron.  He has struggled with his mental health since childhood and says he’s found that even a city can be a kind of mental-health desert. Concentrated or not, he says, there are so relatively few psychiatrists and psychologists that they each may have thousands of potential patients; making it hard to get to see them.

“It just feels too hard, you know.  And I gave up a few times.”

Another Akron resident, Jonathan Kinzel, has been in treatment for post-traumatic stress for years. He says mental-health deserts can be defined in yet another way, and it has nothing to with geography. He believes some kinds of care are just not available because many psychiatrists are locked-in on treatment with medication.

“Doctors, they don’t want to hear you anymore. They go directly to the pad. ‘Let’s see what this does for you, and if this doesn’t do it, then we’re going to follow it up with this.'”

There are attempts to make mental-health providers more available and more responsive to patients’ needs.

Collaborative Care

Dr. Bill Resch is president of the Ohio Psychiatric Physicians Association. He points to collaborative care, which he says can do both. A care-team is led by a primary-care provider. There are care managers, and mental-health professionals; and they create an integrated plan for each patient.

"Collaborative care is realizing the front line is usually the primary-care doctor -- and putting psychiatrists and mental-health professionals in those offices.”

Tele-psychiatry

Resch also says tele-psychiatry can help address the problems many patients have with not being able to travel to a therapist’s office. It’s basically video-teleconferencing. The doctor can talk screen-to-screen with a patient and can send and receive data and images in real time to and from health-care professionals assisting at the patient’s location.

Resch says there are still issues about how to pay for tele-psychiatry, but state lawmakers may fix that.  

“One of the bottlenecks  is that insurance companies don’t always reimburse that the same. So there is the (Ohio) House bill right now being looked at to make sure insurance companies pay so it’s continuing to be utilized.”

That’s House Bill 546.  Meanwhile, Johnathan Kinzel of Akron says he has had some experience with tele-psychiatry, and if it’s not handled right, it can actually magnify a problem he’s seen in general in psychiatric care that he has received.

“When you talk to these people a lot of the times, it not only feels judgmental, it’s very impersonal, and that’s not the way you go about helping somebody.”

Patient-centric thinking

Mike Quirk, who has struggled with mental-health issues most of his life, also says new ideas aimed at reducing mental health deserts need to be created with patients in mind because patients themselves may not say much about it.

“Given the stigma that surrounds admitting that you have a mental-health problem, they’re not going to shout that they need quality mental-health care.  They’ll probably just suck it up, you know -- and get worse.”

The WKSU series: “Navigating the Path to Mental Health"

Part I (May 29): Achieving Acceptance: Overcoming Stigma on the Path to Mental Health. One out of five Americans, this year, will experience a mental health disorder. Yet, for all its prevalence, many people dealing with mental health crises still face stigma and shame.

Part II (June 4): Mental-health care can be hard to access in much of Ohio, especially away from the larger cities. This installment looks at the challenges along the way to finding and getting mental-health services.

Part III (June 11): Mental-health treatment evolves through meds, mindfulness and motivational interviewing.

Part IV (June 18): Mental-health treatment can be expensive, and the financial incentives may be a barrier, rather than incentive. 

Part V (June 25): Police and the courts are increasingly on the front-line of mental-health care, and are getting better training to do it. 

Part VI (July 3): Pink-slipped, a personal story

Join us June 27 for a community forum on mental health at the Akron-Summit County Public Library  at 7 p.m.

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