ADDRESSING MENTAL HEALTH CARE SHORTAGES

ADDRESSING MENTAL

HEALTH CARE SHORTAGES

By BECKY GILLETTE

The shortage of mental health care providers isn’t new to Arkansas, and it existed before the pandemic, but the situation has now become even more critical with 97% of counties in Arkansas classified as Behavioral Health Professional shortage areas.

“This includes psychiatrists, psychologists, licensed mental health counselors, social workers and nurse practitioners with special training in mental health,” said Laura Dunn, M.D., chair of the University of Arkansas for Medical Services (UAMS) Department of Psychiatry and director of the Psychiatric Research Institute. “While the shortage of behavioral health professionals is most severe in rural areas, there can still be challenges in accessing mental health care in urban areas due to long wait times because the practices are already very busy. I would also note that this is also a problem that is being seen nationally.”

It has been widely reported, by organizations such as the Kaiser Family Foundation, that the pandemic has had a major negative impact on mental health, particularly for anxiety, depression and substance abuse. Dunn said even with many services going virtual during the pandemic, demand for mental health services accelerated. State data from the Kaiser Family Foundation also revealed the significance of the need for mental health care in Arkansas.

UAMS is working with members of the legislature, other providers and leaders of state agencies to leverage all currently available resources to better meet the needs of those seeking care.

It is a problem that not only affects patients, but providers who may feel under pressure to work longer hours with less time off.

UAMS programs to increase the availability of mental health professionals include more residencies for training psychiatrists such as a new psychiatry residency program in collaboration with Baptist Health in North Little Rock. UAMS also has very active psychologist training programs, which includes interns, fellows, and other students training in a variety of specialty areas.

“We would very much like to add residency slots in other areas of the state as well – stay tuned,” Dunn said. “Psychologists and other providers also work toward increasing mental health services through community engagement and by working in programs that train other professionals to recognize and treat mental health disorders, including trauma and addiction. UAMS continues to work with our congressional delegation, state legislators and other providers to increase the number of residencies available to train physicians, not only in psychiatry, but in all aspects of medicine. In addition, a cross section of providers, state agency leadership and members of the legislature have been meeting since February to discuss various approaches to increase the number of providers.”

The pandemic highlighted the opportunities that telemedicine can

provide. Some patients may have to travel hours from home to see a provider. Telemedicine is a tool that helps remove some of the barriers for access to care.

The UAMS AR ConnectNow virtual mental health program started with a federal grant in May 2020.

“People couldn’t get out,” said AR ConnectNow Program Manager Tony Boaz. “They couldn’t visit their therapist in person, so we started a virtual clinic. The overall goal of our therapists is to get people established in their community. We usually see them for four to six sessions. If that is not enough, we will set them up with longer-term care in their community.”

It can take two months or longer to get an appointment with a psychiatrist. According to the National Alliance on Mental Illness (NAMI), 1,426,349 people in Arkansas live in a community that does not have enough mental health professionals.

AR ConnectNow, is a free resource that fills the need for immediate care and is available to anyone. If a patient has insurance, the visit will be billed to the insurance company.

In addition to psychiatrists and therapists, AR ConnectNow has four care coordinators who help get patients approved for insurance, and meet other critical needs such as for housing, food, education and treatment in other aspects of health care.

“It is awesome that we can provide this service,” Boaz said. “If you are feeling stressed, give us a call. We can help you. Since we started this, we have taken 3,500 calls and treated more than 2,000 people who might not have gotten help otherwise. The grant will sunset in the spring of 2023. We’re hoping that continues. I think it is too valuable to let it end. There is too much need in the state, so I’m fairly confident we are going to find a way to continue it.”

There are important implications for the economy.

“Obviously, when people are feeling better about their mental situation, they are able to perform better at work,” Boaz said. “With

clinical depression, you don’t feel like getting up or doing anything, let alone keeping a job and paying the bills. If you can get medication, therapy or both, sooner rather than later, you can get on with the good parts of your life.” The AR ConnectNow toll-free number, 1-800-482-9921, is answered 24/7 by a nurse triage group at UAMS. In an emergency, callers are advised to call 911 or visit the closest emergency department. If it is not an emergency, Boaz said UAMS usually schedules patients within a day or two. Boaz said UAMS has seen very little differ97% of ence between virtual and in-person appointments. counties in “Obviously, you have to get used to interacting virtually,” he said. “We have seen a lot

Arkansas are of success with adolescents all the way up to 90-year-olds we have had in the clinic. People classified as love the convenience of it. Our therapists love it. They have a lot of success stories. We’ve even Behavioral Health done it at high schools. We see a lot of adolescents and referrals from the Arkansas Chil-

Professional dren’s Hospital. Those kids are used to being on their phones, so doing a video session is nothshortage areas. ing new for them.” This has also been helpful in fighting the stigma surrounding mental health treatment, as patients can attend visits virtually, without anyone knowing. The lack of stigma increases the likelihood of people being able to get help. Boaz is also the director of STRIVE, a school-based mental health program serving the Greater Little Rock area. STRIVE has offices in the schools. Instead of having to check out children and take them to an appointment, they can be seen at the school. The kids don’t miss half a day of school, but just an hour. And if children ares having a crisis, they can get immediate help. Depression and anxiety in youth during the pandemic have shot up; the suicide rate for the teenage population has gone up significantly. “The fact we are onsite helps out a lot,” Boaz said. “If the school has an issue, they know exactly who to call to get services.”

PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONERS PLAY VITAL ROLE MEETING PROVIDER SHORTAGES

Arkansas is currently ranked 39th in the nation based on prevalence of mental illness and access to care for children and adults by Mental Health America. When you break it down by age groups, Arkansas ranks 48th in the nation for children and adolescents, said Crissy Allen-Doyle, DNP, APRN, a Psychiatric Mental Health Nurse Practitioner (PMHNP) with the Department of Psychiatry at the University of Arkansas for Medical Sciences, who treats psychiatric patients in Arkansas Children’s Hospital’s emergency room.

According to Mental Health America, there are about 460,000 adults in Arkansas with a diagnosable mental, behavioral or emotional disorder with only about half of those reported as receiving treatment. Mental Health America also reports there are also about 33,000 children and adolescents who have experienced severe depressive symptoms alone.

By Becky Gillette

“Only about 7,000 of those children and adolescents reported receiving some form of consistent treatment, and this doesn’t even account for the myriad of other mental health disorders that also need treatment,” Allen-Doyle said. “Research published in Mental Health Clinician indicates only about half of the pediatric population is diagnosed with depression before adulthood, which increases the risk of this untreated disorder still being present as an adult.”

Patients in need of mental health services can often be faced with barriers such long appointment wait times or a lack of mental health providers nearby. The County Health Rankings and Roadmaps recently estimated there is only one mental health provider for every 400 residents of Arkansas. This also includes mental health providers who do not provide medication management for psychiatric disorders, and according to Allen-Doyle, this data does not reflect the true need for mental health providers who can offer those specialized services.

According to Mental Health America, there are about 460,000 adults in Arkansas with a diagnosable mental, behavioral or emotional disorder with only about half of those reported as receiving treatment.

“PMHNPs are trained to provide psychiatric medication management, therefore playing a vital role in closing the gaps for this service throughout Arkansas,” Allen-Doyle said. “There are various types of graduate nursing programs in mental health that may include online, traditional in-person or hybrid plans of study. We are fortunate to have a rigorous but exceptional program at UAMS. UAMS PMHNP graduates are advanced practice registered nurses educated at the masters or doctoral level with expertise in the care of mental illness across the lifespan.”

In addition to the core curriculum at UAMS, PMHNPs are required to complete curriculum specific to the specialty and complete practicum hours in tandem with a specialist in the psychiatric field. Masters level students complete three practicum courses, totaling 540 hours and doctoral students complete four practicum courses, totaling 1,080 hours. After successful completion of the program, the nurse must pass the national PMHNP certification exam through the American Nurses Credentialing Center.

“We are trained to care for pediatric, adult and geriatric patients,” Allen-Doyle said. “Psychiatric Mental Health Nurse Practitioners can work in any setting such as outpatient clinics, hospitals, emergency departments, psychiatric private practice, school systems, prisons and so many others. We perform comprehensive psychiatric evaluations to diagnose and formulate plans of care for diagnoses in the DSM-5, such as depressive disorders, bipolar disorders, anxiety disorders, trauma and stress related disorders, obsessive compulsive disorder, schizophrenia and psychotic disorders, neurocognitive disorders, personality disorders, sleep disorders and substance abuse. This also includes disorders related to pediatric patients such as oppositional defiant disorder, disruptive mood dysregulation disorder, attention-deficit hyperactivity disorder, conduct disorders and eating disorders.” PMHNPs provide assessment and evaluation of the patient to rule out any medical or substance induced causes of symptoms using interventions such as ordering labs, identifying risk factors and analyzing medical and mental health history. Allen-Doyle said they can prescribe necessary psychiatric medications, order pertinent lab work prior to beginning treatment and during treatment to monitor therapeutic benefit, explain the test results to patients and families and provide patient education regarding medications, risks, benefits and reasonable outcome expectations. “At each encounter, we evaluate a patient’s physical symptoms and health to determine the potential for underlying medical conditions and possible side effects of medications and collaborate with primary medical providers to address medical needs,” she said. “When needed, we perform crisis intervention, de-escalation, risk assessment for suicide and self-harm and formulate treatment plans to address the patient’s needs. The PMHNP is trained to perform psychotherapy, but often works in collaboration with psychologists, licensed social workers, licensed professional counselors and marriage and family therapists who provide these specialized services. Patient and family education is also a very important component of the PMHNP role.”

Primary care providers are also vital.

“Our goal as mental health providers is to collaborate with primary providers to improve the overall well-being and quality of life of the patient,” she said. “For example, patients with chronic medical conditions have an increased risk of developing a mental health disorder. Likewise, untreated mental health disorders can impede the patient’s ability to effectively manage a chronic medical condition. This correlation is not just isolated in adults; it is also seen in pediatric and adolescent patients. For example, adolescents with diabetes have a higher risk of developing a mental health condition, with the most common being depressive disorders. Research has shown adolescents with diabetes who experience depressive symptoms are less likely to adhere to recommended treatment, experience longer episodes of depression and have a higher rate of suicidal ideation.”

PMNHPs can solely focus on the overall mental health of the patient during each encounter. “This allows us to monitor the patient closely and assess for improvement or worsening of symptoms of the disorder or disorders, efficacy of psychiatric medications, potential adverse effects of medications and provide education,” Allen-Doyle said. “We are also able to build relationships with patients and families and partner with them to create plans of care specific for their mental health.”

WE ARE HERE TO HELP

Rivendell provides mental health treatment for ages 4 and above along with detox and recovery programs for adults with substance use issues.

For more information or a no-cost, confidential assessment, call us today at 501-300-2939. Telehealth and mobile assessments available.

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