Just about anyone who has sought behavioral or addiction treatment from a mental health professional will tell you how difficult it can be to summon the courage to open up to a total stranger. Now imagine that stranger looking back at you from a large television screen. Is high-tech progress affecting our ability to connect?
WVU Healthcare psychiatrist Kari Law, MD, will quickly shoot down that theory. As director of the telepsychiatry program at WVU Healthcare’s Chestnut Ridge Center, Dr. Law sees the growing program building deep connections in communities across the state daily.
“The success of this program is mainly due to the buy-in of not only physicians and patients, but also the staff of our remote site partners and local pharmacists,” Law explained. “We’re only going to be as strong as our partners on the other side – they are our eyes and ears. They are aware of the community, they know who’s at high risk, and they are committed to what they are doing for their communities.”
West Virginia’s demand for high quality mental health services outpaces the number of providers and hours in the day. While this scenario is common across the United States, the Mountain State’s geography and population distribution present unique challenges. Long waits for appointments and a shortage of local services can make the search for specialized care difficult at best.
Selling telepsychiatry around the state wasn’t always easy, said Ashley Six-Workman, RN, telepsychiatry coordinator. Since the program’s inception in 2009, Six-Workman has logged thousands of miles traveling the state, meeting with local mental health providers, and describing the benefits of long-distance treatment via a computer and secure server.
“I remember going to visit a well-seasoned, veteran psychiatrist, who was completely dedicated to her community and her county, staff, and patients. I walked in, and realized right away that it was going to be a challenge,” she laughed. “Eventually, she came around because I kept pounding away that I get it. I’m from a rural community in West Virginia, and I understand the hardships of the state. We had to prove that telemedicine is simply a modality to improve access, not a barrier.”
Parkersburg-based Westbrook Health Services needed a little convincing, said Westbrook Chief Executive Officer JoAnn Powell.
“Staff and the people we serve were worried about privacy issues and skeptical of this ‘new-fangled’ idea,” Powell noted. “Acceptance was a big factor at first. Overall, the agency was guarded because of our lack of knowledge; however, once we were up and running, the clients’ surveys indicated a consistent positive reaction.”
Westbrook gambled on the approach and led the expansion of services across rural West Virginia. The telepsychiatry program is growing yearly as a result. Starting with 281 consults in its first year at Westbrook, WVU telepsychiatry staff completed over 1,600 patient visits remotely in 2014. In total, the WVU Telepsychiatry program completed 6,486 patient visits at all sites in 2014.
“I have found most of the other comprehensive behavioral health centers in West Virginia are similar to Westbrook,” Powell said. “They struggle with their rural service areas. People who do not have access to transportation, Medicaid reimbursement rates do not cover their costs, and there’s a huge difficulty in the recruitment of psychiatric staff.
"The fear of the unknown was not great enough to outweigh the desire to do the right thing and open up access. Someone just needed to break ground so others could follow suit. I was glad Westbrook did just that. If you show people how telepsychiatry works, others will follow.”
One of the highlights of Six-Workman’s work across the state has been taking these success stories on the road.
“It became about connecting people throughout the state and providing that avenue of service because you knew they had a need,” she said.
Valerie Justice understands that need all too well. She and her family live in Delbarton, West Virginia, a tiny Mingo County town just outside of Williamson, home to around 3,000 residents. Like other boys his age, Valerie’s 17-year-old son Benjamin loves music, swimming, and riding four-wheelers. He also loves doors.
“Doesn’t matter what kind, as long as he can bang them,” Valerie laughed.
Severely autistic and suffering from seizures and cerebral palsy, Benjamin is nonverbal. Pair that lack of communication with the subtle nature of oncoming seizures, and school becomes a very worrisome situation for the Justice family, pictured at left. Benjamin has had to be flown to hospitals out of the area for emergency treatment for seizures. A properly-trained aide is needed at school, and Benjamin currently spends his days at home to receive the services he needs.
When he hit puberty, Benjamin also started exhibiting some behavioral issues, which led Valerie to Law’s Logan-Mingo area mental health telepsychiatry clinic. Making decisions regarding Benjamin’s care has been very difficult all around for Valerie. His condition keeps him at his mother’s side at all times, and the closer to home Benjamin can receive care, the better. When telepsychiatry was initially suggested to her as a treatment alternative for Benjamin, Valerie was skeptical.
“I figured I would have to take Benjamin somewhere else to the doctor,” she said. “I thought, ‘There's no way this can work.’ I had no clue how it would work.”
“In a typical visit, Dr. Law talks to Benjamin and asks how he is. He’s nonverbal, so I usually answer her. Benjamin pays some attention to the screen but not much,” Valerie explained. “She always asks how he is with his medicine, and if I feel there needs to be a change, then she gives me all our options and lets me make the decision. I don't know what I would have done without Dr. Law listening to me and helping Benjamin. Going through medicine changes is hard, and she has done more than most doctors would for their patients, including calling and checking on him daily.”
Valerie sees no drawback to telemedicine. As few specialists are nearby, a visit to any doctor other than Benjamin’s pediatrician could mean a four-hour round trip.
“I am very thankful for this experience,” she added. “I know that people probably don’t want to try seeing a doctor this way, but with my experience, I would recommend it to anyone.”
WVU telepsychiatry providers are essentially becoming a part of the far-away communities they serve. Ironically, a lot of things end up being done the old-fashioned way. Each remote telepsychiatry site designates one pharmacy, chosen by site staff based on reputation and services, to serve each of their patients receiving addiction treatment via telepsychiatry.
Marydea Rowe is a staff pharmacist at Family Pharmacy, one of the pharmacies for WVU telepsychiatry patients at Logan-Mingo Area Mental Health. The South Williamson, Kentucky. business is nestled in a bend of the Tug Fork River, just across from Williamson, West Virginia. Close community relationships are the result of lots of hard work and 26 years in business, Rowe explained.
“At an independent pharmacy, you get a friendly ‘good ol’ down-home’ greeting, and the staff often addresses patients by their first names,” Rowe said. “This helps a patient clearly see that they’re a person, not a number or dollar sign.”
“Most of us here are born and raised,” she added. “In these small communities, you not only see patients at the pharmacy, but out in the community as well. I feel that is an advantage to their progress. It gives us a better opportunity to ward off problems with the patients, which in turn will help the doctors give them the best medical care possible.”
Physicians in charge of addiction clinics must do their best to stay aware of what their many patients are doing out on their own. While drug testing is performed onsite at Chestnut Ridge Center in Morgantown and various remote sites around West Virginia, patients are responsible for filling and managing their own prescriptions.
For example, Suboxone, a powerful and valuable aid used to treat opiate addiction, can easily be abused if it falls into the wrong hands. Heavily sought for recreational use, legally-acquired Suboxone is an easy seller on the street and can be traded for other drugs of choice. Pharmacists’ roles in monitoring this activity and double checking charts for potential interactions with existing prescriptions are invaluable to Morgantown physicians, Law said.
“I have an unbelievable amount of respect for the pharmacists committed to serving our rural communities,” Law said emphatically. “You build a relationship with them that you just don’t get to develop in larger communities. When you come to these communities and talk to the different pharmacists, who I’ve called 102 times, I know their stories. I know they’re committed to these communities and want to keep them healthy and strong and revitalize them.”
Rowe noted that in her rural community, many people are retired, on welfare, disabled or out of work due to coal industry cutbacks. She sees telepsychiatry as an easily accessible, confidential, and trustworthy solution to area residents getting the services they need close to home. Her one wish for the program? Rowe hopes to someday meet some of the Morgantown providers in person.