Picture if you will, the classic cliché of a visit to the psychiatrist: an elderly man looking like Sigmund Freud sits with a notebook in back of a patient stretched out on a couch in a studiously appointed office. The patient talks, the doctor makes notes and may or may not issue a prescription for medication.
In the early days in the field of mental health, this may have been the case, but today however, those in need of treatment for behavior and mental health issues may see a person who is not a man, not elderly and not even in the same room as they are.
Today, and increasingly in Kenosha, psychiatric needs are being met through the technology of telepsychiatry.
According American Telepsychiatry, a Wisconsin-based provider, telepsychiatry is “the provision of mental health and related services over the internet, using video and and audio conferencing.”
Advanced Practice Nurse Practitioner Barbara Logan lives in Maine, but for 30 hours each week “sees” Kenosha patients through the Kenosha Human Development Services Behavioral Health Clinic.
Her colleague, Alexia Smith, who lives in Michigan, sees children and adolescents for 20 hours each week.
As APNPs, both help manage medication for their patients via video-conferencing.
The telepsychiatry program through Kenosha Human Development Services opened at 700 55th St. in October of this year after receiving funding in 2017 from Better Together, a program administered through Aurora Health Care.
Although the clinic was originally slated to open earlier this year, “there was a lot of rigamarole of contracts and finding providers licensed in Wisconsin,” noted Janine Field, KHDS executive director.
Because KHDS is a low-barrier provider that accepts Medicaid and Medicare, initial site visits were very strict, noted telepsychiatry clinic manager Angela Martin. “We were even told that there were already too many (mental health) providers here, but that’s not true.”
Currently KHDS has two providers: Logan, who works with adults, and Smith, who works with children.
“We are bringing on clients really quickly,” Field said.
Advanced Practice Nurse Practitioner Sheryl Hansen is one of 14 off-site providers who conduct wellness checks and prescribe medication to clients at American Telepsychiatry, 3410 80th St.
“I’ve got a great staff, all types of people from Racine, Milwaukee and Wausau,” said Susan Schaffrick, clinic manager.
The company has been involved in telepsychiatry for about six years in Kenosha, and was formerly known as Horizon Healthcare, which operates clinics throughout Wisconsin.
Typically the process of becoming a telepsychiatry patient begins with a physical visit to a clinic. After seeing the receptionist, patients then meet with a person who is the liaison between the local office and the teleprovider, called a connector or an extender.
At KHDS, Antoinette Campbell is the connector; at American Telepsychiatry, Tiffany Sanchez is the extender.
Both facilitate the patient’s paperwork, take physical vitals, including height and weight, and forward them to the telepsychiatry provider.
The provider they see is determined by the type of insurance a patient has and his or her specific needs, Schaffrick said.
The clinic offers male and female providers of different ages and backgrounds and matches patients with the provider that fits bests, Schaffrick said. “We have providers who are fluent in different languages and even sign languages.”
For many of the patients, the video screen is less intimidating than face-to-face consultations, say telepsychiatry providers. “It helps some people get over the ‘white coat syndrome,’” Hansen said.
Martin and Hansen stress that telepsychiatry is not just a computer environment. “It’s a personal touch,” Hansen said. “Sometimes when medication isn’t needed, we help facilitate community resources.”
And even though the providers may not live in Kenosha, they know what resources are available for patients, Martin said.
Security and privacy is carefully managed for all internet-facilitated communication, noted Martin. KHDS contracts with information technology specialists who set up in-home televideo software and equipment for their patients.
“The main consideration is that the internet connection is reliable,” Martin said. “We want to be sure patients aren’t experiencing any disruption to their care.”
Telepsychiatry is helping many access mental health treatment who might otherwise go unseen or have to wait months for a provider, say area mental health advocates. “Telepsychiatry is another point of access to mental health,” said KHDS connector Antoinette Campbell. “It’s so important because of the lack of mental health providers in our area.”
“The alternative is waiting forever or going to Milwaukee to find providers who take Medical Assistance,” Martin said.
“The whole concept of telepsychiatry helps to meet a need,” said Jack Rose, Kenosha County National Alliance on Mental Illness board member.
“We’re all aware we don’t have enough psychiatrists; 55 out of 72 counties in Wisconsin have a shortage and we only have a handful in town.”
Transportation, often an issue for those with mental health challenges, is also taken out of the picture, added Rose. “(With telepsychiatry) you can utilize a psychiatrist who’s in Madison or Iowa.”
The advent of telepsychiatry is also helping to address the rise in need for services for those suffering from addictions.
“It is our belief that everyone needs a second, third or fourth chance,” Schaffrick said.
Telepsychiatry providers say that the technology is coming to be embraced and that the video screen has not proven to be a barrier to clients.
“Kids especially love it; they open up more to talking to a TV,” Hansen said.
“This is their world,” agreed Campbell.
“The current perception is that telepsychiatry isn’t as good as face-to-face care, but studies say otherwise,” Martin said.
“(Patient surveys) indicate that people feel that Barbara and Lexie are right there with them,” Campbell said.
And just as with traditional psychiatric care, providers build relationships with patients, notes Hansen.
“It’s not as different as you would expect; it’s about developing rapport,” says KHDS provider Logan.
Unlike the office visits of yore, where patient visits were ended exactly on the hour, telepychiatrists have the luxury of being able to extend sessions as needed.
“We don’t rush anybody,” Schaffrick said.
“It is good for both parties,” adds Hansen. “As a provider it is wonderful to be able to set your schedule with what is healthy and helpful.”
The telepsychiatry providers interviewed noted that at this time, their services focus strictly on the prescribing and management of medication and do not include counseling therapy.
Advanced Practice Nurse Practitioners are medication managers, but they generate counseling and therapy recommendations, Martin said.
For therapy, both KHDS and American Telepsychiatry refer patients to other settings that provide counseling.
“For group therapy we can refer people to Rogers (hospital for behavioral health, Racine) or NAMI or connect them to church groups,” Schaffrick said. “We’re a community, not just a business.”
Both added that they hope to expand video conferencing technology to counseling in the future.
“All prescribers agree that real change happens through therapy, but medication may help a person stabilize faster,” Martin said.
Because of the shortage in mental health providers in our area, the Kenosha Community Health Center is also looking into providing telepsychiatry services, according to Alan Marshall, KCHC chief executive officer and chief operating officer. “KCHC has been utilizing external organizations through referral arrangements with outside organizations for timely access to telepsychiatry and medication management services for KCHC patients.”
Telepsychiatry is a move in the right direction, Rose said.
“It’s important that we are trying to expand the number of professionals trying to help those in our community living with mental illness.”