Health networks are looking at creative ways to support an increasing demand for mental health treatment at a time when healthcare workers are in short supply.
Some are using hybrid models of care that use partial inpatient treatment with outpatient support, some are increasing space for inpatient care, and most are using telemedicine to keep the lines of communication open between patients and caregivers.
Dr. Courtney Chellew, a psychiatrist at Lehigh Valley Phyicians Group-Muhlenberg, said there was a big increase in demand for care even prior to the pandemic. The demand has increased even more since the start of the pandemic. The problem, she said, “is there is a severe shortage of providers in the country right now.
“We are trying to look at ways to handle referrals to deliver outpatient and inpatient care in a timely manner,” she said.
Dr. James A. James III, vice chairman of psychiatry and behavioral health at St. Luke’s University Health Network, agreed. “We continue to hire exceptional people, but we can’t keep up with demand.”
Being pulled in two directions, employee shortage and increased demand for services, means patients may not get services as quickly as they would like, he said. They might sit in the emergency room longer than doctors would hope.
“We are trying to work with the ER to get interventions as soon as we can,” James said. In addition to arming emergency room staff with videos about depression, anxiety and other disorders that patients can view while waiting, James said SLUHN has hired a nurse navigator who develops care programs, connects patients with caregivers, follows up with patients to ensure they are taking prescribed medications, and finds ways to get patients help without inpatient stays.
Stephanie Lee, CEO, Tower Behavioral Health, said, “we are aware of the increased need for care.” The network has three adult inpatient units and one adolescent unit but between January and July of this year, demand has increased by more than 30 %, she said.
“Nearly half of our patients had to be deferred to get a bed. We stay in touch with them to make sure treatment is available once they are released,” said Dr. Eduardo Espiridion, chairman of Department of Psychiatry at Tower Health’s Reading Hospital.
Tower Health has a plan to grow to 144 beds in the behavioral health inpatient units. “We have to open slowly because of the need for support staff,” Lee said. “We started with 12 beds and now we have 80 open beds.” She said the beds in four of the six units planned are in use. The others will be opened in two units as soon as nurses, doctors and support staff are hired.
Dr. Rory Marraccini, vice chair of psychiatry at LVHN-Cedar Crest, said he works with primary care physicians to get patients treatment. LVHN is using virtual visits for consultations which, he said, helps those patients who have trouble getting to a facility for a variety of reasons.
“We are trying to hone in on consultant work. Where it may have traditionally been inpatient treatment, we now work with more outpatient programs,” he said, as long as there is no risk of harm to the patient or others.
Using a community outreach approach, Marraccini said, “we are able to offer good care and keep people out of inpatient treatment.”
Dr. Chellew added that LVHN is investing in psychiatric care. “It (demand) has grown so much; we are doing our best.”
To that end, LVHN has initiated a psychology residency program and psychology fellowships. “We may be able to keep the people that are in the programs,” she said. “With the fellowships, we can provide better services to teens and kids.”
Dr. Chellew said schools are an important resource. “We are integrating into schools to work with students, families and staff,” she said. Currently LVHN works with five local school districts. But the school closures were an issue.
“The students lost access to their caregivers, and, at the same time, virtual learning contributed to psychiatric symptoms,” she said.
Lee agreed. Students and adults alike had to deal with quarantine, job loss, loss of family members, and the children lost the peer-to-peer interaction schools gives them.
According to the Henry J. Keiser Family Foundation, a healthcare watch group, 39 % of children suffered academically, 36 % showed social and emotional stress and 26 % sought help for mental and behavioral issues due to the pandemic.
Lee said the high demand for services hit individuals with established care particularly hard because they lost their services. “These people need to keep up their treatments,” she said. “There were more hospitalizations, but many were limited to telecommunications.”
While teleconferencing can help, Lee said patients are isolated which can exasperate symptoms.
Dr. Marraccini said telecommunications have been key. “We are able to offer good care and keep people out of inpatient treatment by using this technology,” he said. The increase in patients with depression and anxiety will probably continue even when the pandemic subsides. “Sometimes symptoms don’t show up right away. The challenge is to be as creative as possible to deliver needed care.”
All the caregivers agreed that the pandemic has highlighted the need to talk about mental health issues and start to look at psychological illnesses the same way physical ailments are treated. “The more people that seek help, the more the stigma will go away,” Dr. Chellew said.