Upper Valley hospitals use video-chat programs to help with mental health care

  • Chief medical officer Josh White talks to the Green Mountain Care Board about tele-psychiatry as one of the mental health care solutions of Gifford Medical Center during the board meeting in Randolph, Vt., on Wednesday, May 29, 2019. Tele-psychiatry is a program for the emergency department so patients can video chat with a psychiatrist and get proper treatment sooner. Across the state there is a backlog of people waiting for mental health beds. (Valley News - Joseph Ressler) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Green Mountain Care Board member Jessica Holmes asks a question, while from left, Executive Director Susan Barrett, associate general counsel Lynn Combs and Chair Kevin Mullin listen, during the board meeting at Gifford Medical Center in Randolph, Vt., on Wednesday, May 29, 2019. Holmes inquired about tele-psychiatry, which Gifford is starting to adopt by contracting with Alpine Telehealth. (Valley News - Joseph Ressler) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Published: 5/31/2019 10:02:41 PM

RANDOLPH — A shortage of mental health beds and providers has spurred many of the region’s hospitals to use secure video-chat systems to bring psychiatric care to patients when a psychiatrist might not be readily available in person.

Dr. Josh White, Gifford Medical Center’s chief medical officer, told the Green Mountain Care Board during a meeting in Randolph on Wednesday that he is hopeful that a tele-psychiatry program the hospital recently adopted will help patients recover from mental health crises more quickly and reduce the backlog of people waiting for mental health beds around the state.

“Key here in understanding the value is that, as is true in most emergency departments, a lot of these patients are essentially being housed,” White said during the board’s meeting. “They’re in a safe place. They have a place to sleep and they get fed, but they do not get acute treatment for whatever mental health condition that they’re facing until they reach their designated receiving facility. It’s a problem that they’re not receiving care that they need.”

Hospital emergency departments in the Twin States and beyond often act as holding stations for people experiencing mental health crises, with patients waiting days or even weeks in rooms intended for treating patients in a couple of hours. In Vermont alone, there were 10,100 discharges of mental health patients from emergency departments in the fiscal year that ended in September 2018.

Through Gifford’s contract with Brattleboro, Vt.-based Alpine Telehealth, patients at the emergency department at the Randolph hospital will be able to speak via a video link with a psychiatrist who will be able to start a treatment plan, enabling the hospital to provide the patient with a prescription drug to address their mental health issue. That, coupled with time to decompress from whatever event may have triggered their crisis, may mean patients can go home rather than requiring a higher level of care, White said.

“The whole state will benefit from this as their triage list gets smaller,” White said.

Tele-psychiatry — which will be available 24 hours a day, seven days a week — is one of a number of quality initiatives that Gifford officials described to the Green Mountain Care Board at the Wednesday meeting. Other efforts include reducing the use of antibiotics and reducing the length of patients’ hospital stays. The board, which is responsible for reviewing hospital budgets and insurance rates, also is tasked with monitoring efforts related to reducing health care costs and improving quality across the state.

Board member Jessica Holmes asked for more information about the tele-psychiatry program during the meeting at Gifford.

“I’m intrigued by this, but I also recognize that part of psychiatry is human-to-human interaction, and through a screen … I’m just curious about your success with it,” Holmes said.

Gifford has yet to use it with a patient, but White said he expects that the care from a psychiatrist linked in by video will be better than no care at all.

“It’s equivalent to in-person care in terms of quality,” Mark McGee, president of Alpine Telehealth, said in a Thursday phone interview.

So far, McGee, the former chief medical officer at the Brattleboro Retreat, which specializes in psychiatric care, said research has not identified any “patient subgroups for whom tele-psychiatry is not appropriate.”

In fact, McGee said that a digital interaction can work better for people who suffer from certain conditions that might make them feel uncomfortable by having someone physically near them.

Ed Paquin, executive director of the Montpelier-based Disability Rights Vermont, said the organization has heard mixed reactions from patients about the use of tele-psychiatry.

“As you can imagine, it adds access for those for whom it is a comfortable modality, but for others, whose need is something more personal, or who may be engaged involuntarily, it is not a good solution,” Paquin said in a Thursday email. “Then again, if it can obviate the trauma of a long stay in an emergency department in a positive way, it could be a positive addition to a hospital that has no inpatient psychiatry.”

Tele-psychiatry is being deployed in a variety of settings across Vermont — including designated mental health agencies; small, rural hospitals like Gifford, and inpatient psychiatric hospitals such as the Brattleboro Retreat, Vermont Mental Health Commissioner Sarah Squirrell said in a Friday phone interview.

Given the shortage of psychiatrists, especially in rural areas, the new approach is able to expand access to care that would otherwise be unavailable, Squirrell said.

For people “experiencing a psychiatric crisis, the timeliness of access to care is really important because your condition will worsen if you don’t have access to treatment,” Squirrell said.

Deploying the technology, which she said is supported by research that shows that patients and providers are satisfied by this form of delivering treatment, in a variety of settings keeps patients moving through the system to the levels of care that they need, she said.

“If we didn’t have access to tele-psychiatry … our inpatient capacity would be diminished,” she said.

Though White said that he expects the service at Gifford will be reimbursed partially by insurance providers, the hospital likely will offer tele-psychiatry at a slight loss.

The “general feeling is it’s the right thing to do for the patients,” he said.

Three of the Upper Valley’s other smaller hospitals also have adopted tele-psychiatry programs. Dartmouth-Hitchcock’s Connected Care program provides the service to 10 hospitals in Vermont and New Hampshire, including Alice Peck Day Memorial Hospital in Lebanon, Mt. Ascutney Hospital and Health Center in Windsor and New London Hospital.

Of the patients who speak with one of the D-H psychiatrists through the tele-psychiatry program, 30% are able to go home afterward, Dr. Kevin Curtis, medical director for D-H’s Connected Care program, said in a phone interview on Thursday. That means those patients do not need to remain overnight, or even longer, in the emergency department, he said.

That said, Curtis said tele-psychiatry on its own will not solve the challenge of patients boarding in emergency departments.

“I don’t want anyone to believe there still isn’t tremendous need for mental health providers,” he said.

Mt. Ascutney CEO Joseph Perras said in a Friday phone interview that his hospital’s adoption of tele-psychiatry about 18 months ago helped bridge a gap between when a psychiatrist left and another could be found. It also helps on nights and weekends when the psychiatrist isn’t around. But it does not help when a patient arrives who needs to be held involuntarily.

Though the psychiatrists D-H uses through its Connected Care program are licensed to practice in Vermont and New Hampshire, they may not be aware of the statutes that govern involuntary mental health holds.

“We haven’t been able to use it as much as I’d like,” Perras said.

Instead, Mt. Ascutney continues to rely on Health Care & Rehabilitation Services of Vermont, the designated mental health agency for the area, to assist when a patient needs to be held involuntarily, he said.

Though Perras said Mt. Ascutney is lucky to have a good working relationship with HCRS, a psychiatrist on staff and back-up assistance from the tele-psychiatry service, he still is looking for more help. In fact, shortly before speaking with the Valley News on Friday he had interviewed another psychiatrist for an opening in Windsor.

“There’s a tsunami of need that we need to respond to,” he said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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