WICHE Mental Health Report
October 01, 2007
Volume 1, Number 9
RECENT ISSUES: February 2007 . March 2007 . April 2007 . May 2007 . June 2007 . July 2007 . August 2007 . September 2007
In this Issue:
InFocus: Telemental Health
Mental Health Care from a Distance
Telehealth is the delivery of health related services and information via telecommunications technologies. It may be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a video consultation between providers in remote locations. Telehealth is much broader than telemedicine, and in addition to direct services, encompasses administrative and support services.
Telemental Health is the use of telehealth to provide mental health services, especially to those in remote locations with shortages of service providers. Telemental health is useful for therapy and direct services including, medication management, psychiatric consultations, and psychiatric referrals. In addition to clinical work, telemental health can be used for case management, continuing education, consultation, and professional peer support.
In a healthcare environment that is technology-oriented, providers and patients are recognizing the benefits of telemental health services. Technology has the potential to decrease the gap in services by increasing education, support, and connectedness between the client and the provider. Healthcare providers are leveraging the power of video networks to link patients, specialists, and clinicians, thus extending the reach of specialized healthcare to rural regions. Due to the use of telemental health, rural patients experience lower out-of-pocket costs, less travel and shorter wait times.
Despite this glowing vision of the future, the majority of facilities that list mental health as an area of service delivery in addition to general medical services do not have a formal link to their associated systems of mental health care. Frequently, hospital and primary care networks organize mental health projects around existing medical services that may lack strong collaborative traditions with the mental health systems of care.
Telemental Health Issues
Despite the potential value of telemedicine technology, there are barriers to the successful integration of these advances from an administrative perspective, which can include technology costs, professional issues, and legal and confidentiality issues. Furthermore, census data indicate that Americans’ access to usage of the internet varies greatly depending on socioeconomic level. Lower income urban residents are more than two times as likely to have internet access as those in rural areas at the same lower income levels.
Professional issues can include reframing the doctor-patient relationship and licensure, mobility, and reciprocity for healthcare disciplines. The Telehealth Improvement Act of 1999 and the Comprehensive Telehealth Act of 1999 created a Joint Working Group charged with compiling data on the number of health care providers performing telehealth services across state lines and tracking efforts to develop uniform national sets of standards for telehealth licensure. A provision of these Acts is that if states are not making progress in facilitating telehealth services across state lines by eliminating unnecessary requirements and adopting reciprocal licensing arrangements for such services, then the secretary of Health and Human Services should make recommendations concerning the scope and nature of Federal actions required to assist telehealth services.
Advantages and Disadvantages
The obvious advantages taken from the above section are the increased access to professional, anonymous care. Another major advantage is the cost savings to service providers, given the reduction in travel expenses for clients. Clients also have increased access to immediate care when needed with reduced disruption to their jobs or home life.
There are a number of challenges to working with the system. Potentially not having a workforce dedicated to working on the videoconferencing system could be one of the larger issues. It can be frustrating to have the professionals and the clients ready, but not have the technical staff time available to operate the system. This lack of dedicated technical assistance can lead to scheduling challenges, if both the behavioral and the medical systems share the telehealth system. While a system may have a myriad of connection sites, it is also a finite system with bandwidth limitations. Overuse of the system at peak hours can lower the reception and quality of the screen. The technology is constantly changing for the better; however, this leads to outdated technology needing upgrades, which can involve significant amounts of money. Confidentiality can be another issue that professionals will need to address at each end of the system and in transit. The live video data transported through the internet are subject to HIPPA regulations. This prevents the use of inexpensive store-bought webcam systems, which are unencrypted and therefore susceptible to hackers. Finally, providers could encounter a number of possible client issues. Not everyone will be willing to use this new technology due to unfamiliarity with the system, though we presume that children are more likely to be open to the technology than older adults are.
Empirical Support
Despite promising preliminary research, telemental health is not an established evidence-based practice. The National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) are currently conducting research to establish the preliminary data needed to formally label telehealth as an EBP. There is little data on telehealth mental health care performance beyond consumer satisfaction surveys and process measures. Proponents have held forth telehealth mental health care as a significant tool in improving the chronic lack of access to mental health services among rural populations. However, there simply are not enough data available to measure the ability of such telemental health strategies to enhance access and affect behavioral outcomes.
This is an area where rural service providers could prove invaluable. Developing a systematic way to gather information from rural providers who have already successfully implemented telemental health into their services and assist them in gathering the rigorous data needed to develop them into an EBP will be an invaluable resource.
Telehealth Resources
Telemedicine Information Exchange
The Association of Telehealth Service Providers
Funding Opportunities through the U.S. Department of Health and Human Services
Telehealth Funding Guide from Health Resources and Services Administration
American Telemedicine Association: Telemental Health Special Interest Group
FYI...
The Science of Improvement: Accelerating Your Capacity to Change
October 16 - 17, 2007
St. Louis, MO
Do you have a desire to improve care systems, but need a roadmap to guide your improvement journey? Whether you're new to the science of improvement, or simply want to strengthen your already foundational improvement skills, The Science of Improvement: Accelerating Your Capacity to Change seminar with Robert Lloyd, PhD and Richard Scoville, PhD is perfect for you!
This two-day course, scheduled for October 16-17, 2007, in St. Louis, MO will provide you with the hands-on learning required to gain a firm grounding in the concepts, tools, and methods needed to plan and execute an effective quality improvement journey. This seminar is ideal for those who wish to accelerate their ability to create an environment for change and is a great way to get new employees up to speed with the quality improvement work already in under way at your organization.
For more information, or to enroll, please visit:
http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/ScienceofImprovementOctober2007.htm
Mental Health America News Release
September 19, 2007
Senate Passes "Mental Health Parity"
Mental Health America commends Senators for moving to end insurance discrimination and calls on the House to now pass S.558
Contact: Heather Cobb, (703) 797-2588 or hcobb@mentalhealthamerica.net
ALEXANDRIA, Va. (September 19, 2007)—Mental Health America commends the United States Senate for passing critical legislation to end mental health insurance discrimination, and its sponsors, Senators Pete Domenici (R-N.M.), Michael B. Enzi (R-Wyo.) and Edward Kennedy (D-Mass.) for their leadership. The bill – S. 558, the Mental Health Parity Act of 2007 – will ensure that Americans with employer-sponsored health insurance and their families receive mental health care coverage at the same level as coverage for general health problems.
"The support of this legislation is overwhelming as it should be," said David Shern, president and CEO of Mental Health America. "The science is clear. Tomes of research demonstrate the interconnectivity of mental and general health. Public policy is finally catching up with science through passage of this important legislation."
S. 558 has a wide range of supporters that, for the first time, includes business and insurance leaders, as well as mental health advocates. For details on the legislation and more information, go to www.equitycampaign.net.
"With passage earlier this summer of legislation that would provide parity in mental health coverage under both Medicare and the State Children's Mental Health Program, Congress has a historic opportunity this year to end discrimination against people with mental health disorders in both private plans and federal health program," said Shern. "As we celebrate this first step, we urge House and Senate leaders to make history."
Mental Health America and its national network of affiliates now looks to members of the House to pass S. 558 and make history.
Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our more than 320 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation—everyday and in times of crisis. For more information, visit www.mentalhealthamerica.net.
Job Opportunities
Recent Job Announcements Webpage
On this page you will find recent job announcements pertaining to either the WICHE West or to rural mental health areas.
The Department of Psychiatry at the Milton S. Hershey Penn State College of Medicine announces a PSYCHIATRY POSITION We are currently recruiting a full-time BC/BE psychiatrist who will be presented with the wonderful opportunity to split their time between clinical services and dedicated research time. This position is a joint effort between the Tioga County Department of Human Services, a progressive rural mental health center, and The Department of Psychiatry, Penn State College of Medicine. The clinical responsibilities incorporate many facets of treatment to include assessment, consultation, supervision of staff, and treatment. The consumers cut represent the age spectrum and the expectation is that the psychiatrist be able to work with children and adults. The Tioga County Human Services Agency is located in lovely north central Penn. surrounded by a myriad of recreational opportunities. The agency has gained national recognition for its fully integrated programming that tie into a single setting all of the critical services mental health consumers require. The Penn State College of Medicine’s Department of Psychiatry is a well established program with the full scope of clinical practice available. Additionally, there are child and adult residency programs and several post doctoral opportunities. The Department has an ever expanding research portfolio which enjoys an international reputation in several areas to include, anxiety, stress, trauma, and sleep medicine. The Department of Psychiatry is excited about the prospects of this partnership with rural mental health. This venture should allow for cutting edge research in the area of rural mental health. The psychiatrist will hold the rank of Assistant/Associate Professor within the Department of Psychiatry, depending upon experience. The Department’s Division of Research will offer full research support. The Penn. legislature has provided funding for this dual position and it is the goal that this partnership will become a model for rural Penn. as well as a national model. This will then be a highly visible position with the potential for great professional growth. Again, this position will be split between the Medical College and Tioga County. The Medical College is in lovely Hershey, Penn. and Tioga County is an outdoors lover’s paradise. There will be flexibility in the scheduling to allow for maximum clinical and research efforts. The Department of Psychiatry at the Milton S. Hershey Penn State College of Medicine is committed to affirmative action, equal opportunity and the diversity of its workforce.
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Chief, Mental Health Services
Position Number RH33
Location: Olympia, Washington
Division: Mental Health Division
Salary: $69,500 –$78,340
Closing Date: October 15,2007
POSITION RESPONSIBILITIES:
This position is responsible for working closely with the Assistant Director of the Mental Health Division (MHD) in managing the state public mental health system. This position oversees program and services implementation, development, and monitoring of a wide array of community mental health outpatient and inpatient services. Duties include program development, oversight, implementing legislative initiatives, developing request legislation; analysis of legislation; adherence to federal requirements and lawsuits; RFP/Q and contract development; technical assistance to providers; contract monitoring; and reporting to the legislature.
Number of employees in the Unit: 16 currently but subject to increase.
Submit all materials by October 15, 2007 to:
PughKM@dshs.wa.gov
(Please indicate in the subject line: Chief, Mental Health Services)
OR
Kathi Pugh
Mental Health Division
PO Box 45320
Olympia, Washington 98504-5320
WICHE MH Personnel
Dennis Mohatt, MA, Mental Health Program Director
Mimi McFaul, Psy.D., Associate Director
Chuck McGee, MA, Project Director
Scott Adams, Psy.D., Senior Research Associate
Candice Tate, Ph.D., Research Associate
Fran Dong, Statistical Analyst
Jenny Shaw, Administrative & Project Coordinator
Tell Us How the WICHE Mental Health Program Has Impacted You
The Western Interstate Commission for Higher Education is seeking your comments on how our services have affected mental health services in rural communities. Please send an e-mail telling how WICHE has influenced you to ctate@wiche.edu. We would also love to hear your nominations for promising rural practices. Feel free to also contact us with requests for state-specific rural assistance or to just ask us a question about our experience with rural mental issues and public policy.
Subscriber Services
To subscribe or unsubscribe to the WICHE Newsletter send an e-mail to ctate@wiche.edu
