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A novel idea for mental health care in rural Washington – High Country News

In Dayton, inhabitants 2,500, behavioral health care is woven immediately into main care appointments.

 


Wayne Pollard, on the health clinic in Dayton, discusses sufferers by way of Zoom, an encrypted video platform, with Dr. Matthew D. Iles-Shih in Seattle on Dec. 19, 2019.

This piece was initially revealed by Crosscut and is reproduced right here with permission.

In tiny Dayton in southeastern Washington, the native hospital district has developed an revolutionary mental health program that has caught the eye of rural hospitals across the state.

The Columbia County Health System beforehand retained an in-house psychiatrist, however monetary realities made persevering with that strategy unattainable. CEO Shane McGuire didn’t need to hand over, so he started the search for options.

Last July, McGuire discovered a chance to work with the University of Washington’s psychiatry program and its Advancing Integrated Mental Health Center (AIMS). The middle’s main focus is creating collaborative care fashions between main care suppliers and their mental health care counterparts. 

Dayton’s mannequin weaves behavioral health care instantly into main care appointments. In Dayton, a mental health screening that signifies the affected person would profit from specialty care prompts a referral instantly. 

McGuire says this system extends past the AIMS mannequin, as a result of the UW psychiatrists not solely help the medical employees, but in addition work immediately with sufferers.

“They were willing to think outside the box for us,” he says. “I don’t think they really have a name for what they’re doing here yet.”

Rural Washington has struggled with behavioral health care options, with most citing issues in recruitment, retention and the excessive monetary burden of offering specialty providers. These hospital districts have to be artistic in constructing packages strong sufficient to satisfy primary mental health care wants, particularly as Gov. Jay Inslee prepares to fully integrate behavioral health in the brand new yr.

“I don’t think they really have a name for what they’re doing here yet.”

The 2019-2021 state working finances offers $350.5 million to enhance the mental health system, with over $35 million devoted to group providers and beds. Close to $120 million in the capital-development finances was put aside for group-based mostly beds to maintain sufferers in their communities as an alternative of being despatched to Western or Eastern State Hospital.

Two payments making their means by way of the state Legislature would additional change telemedicine for rural communities. Currently in committee is Senate Bill 5385, which seeks to pay out telehealth providers on the similar price as in-person care. Senate Bill 5387, which took impact final July, permits the distant telehealth doctor to entry the affected person’s native health data.

For now, every district is predicted to seek out mental health options that may work greatest for them with the assets they’ve.


Columbia County is the third-least populous county in the state, but hosts one of the crucial strong behavioral health packages in rural communities.

“I think there’s 14 rural hospitals in the state that are operating in the red, year after year, working in their communities,” McGuire says. “We’re safety net organizations for our communities. We don’t turn people away.”

Rural communities are taking quite a lot of approaches towards mental health. Some, like Three Rivers Hospital in Brewster, present disaster providers solely in the emergency room via the county health division. Newport Hospital, an hour north of Spokane, has a visiting psychiatrist a few times a month. Cascade Medical in Leavenworth is taking a look at utilizing pharmacists for extra specialised prescribing help. Many cities have began constructing their mental health packages solely inside the previous two years, beginning with a number of social staff, a devoted nurse or a medical psychologist.

But even in rural hospital districts with present behavioral health care, psychiatrists are unusual. Those providers are often offered by month-to-month visits from a visiting psychiatrist or, in newer years, using telemedicine providers with psychiatrists in different cities utilizing video conferencing. 

Patients in Dayton do exactly that. They have entry to prime-tier psychiatric providers from UW utilizing Zoom, an encrypted video conferencing platform that meets federal HIPAA privateness laws.

“You’ve got some of the best psychiatrists in the nation working in guiding the care of our patients … which is really an amazing overlap,” McGuire says.

Leading the cost is Dr. Matt Iles-Shih, an grownup psychiatry and habit specialist from the University of Washington’s Medical Center. His workforce initially began working in outpatient care, however this fall they rolled out inpatient providers to the hospital with two further attending psychiatrists who dedicate two hours a day.

Iles-Shih does one-on-one telemedicine for each new affected person’s first appointment to start out them on their course of remedy, prescribing psychotropic treatment as wanted or managing their present doses. About three months later, the sufferers could have a comply with-up. If they have ongoing points that want extra remedy, repeat telehealth appointments could be made.

He additionally works immediately with the docs and social staff, offering curbside consultations to reply questions and supply clarification. He says this mannequin not solely advantages the sufferers, however permits the docs to develop in their information as properly, strengthening the staff throughout the board.

“Just through the process of clinical support that we’re doing through the program, there’s an upscaling and a sense that the PCP [primary care physician], she’s just absorbing a lot and actually changing their practice,” Iles-Shih says. “It’s not like you’re just reliant on someone else in another city, but this is an opportunity to really build up your own skills and capacities as an individual clinician.”

For outpatient wants, he communicates immediately with one among Columbia County’s two social staff, Wayne Pollard and Tasha Willoughby.


Social employee Tasha Willoughby talks about social work to Dayton High School college students, the place she or Pollard employees open workplace hours each Monday.

On Thursday mornings, Iles-Shih video conferences with Pollard about 4 to eight sufferers. Iles-Shih will enter notes into the shared digital database, which the affected person’s main docs can entry throughout common appointments. 

Physicians at Columbia County display their sufferers yearly for depression and nervousness. Those already in the newly created behavioral health program are rescreened with each go to. Depression and nervousness are the primary diagnoses, however publish-traumatic stress and bipolar issues comply with intently behind, Pollard says.

Pollard has been Columbia County Health System’s medical social employee for the previous two years. When he began, there was no program; McGuire created a completely new system from the bottom up. 

The first half a yr was clunky, Pollard says, however they noticed the variety of shoppers develop considerably. They employed their second social employee, Willoughby, to assist deal with the ever-rising caseload. Pollard averages about 60 shoppers, whereas Willoughby sees upwards of 90.

In disaster conditions, the place mental health providers are wanted as quickly as attainable, Pollard says the group can get sufferers in entrance of a UW specialist inside two hours. This sort of expedited service from a psychiatrist is nearly unprecedented in rural health methods, he says. 

Pollard says the workforce can get sufferers in entrance of a specialist inside two hours. This sort of expedited service is nearly extraordinary in rural health techniques, he says. 

There are not any face-to-face psychiatrists in the world, Pollard says, and whereas the Tri-Cities presents such providers, sufferers might have to attend as much as a yr to see one.

“It’s unusual that I could see somebody last week and tell her, ‘There’s a spot to see Dr. Matt next week. Let’s get you in front of him,’ ” he says. “That just doesn’t happen anywhere. People are blown away that they’re in front of this super specialist psychiatrist within a week or two.”

Both social staff are additionally licensed in EMDR, or eye motion desensitization and reprocessing, generally used to deal with trauma.

“We are offering a specialty care here, which is very hard to find anywhere, much less than little Dayton, to have some EMDR therapists dealing with psychological trauma [and] PTSD symptoms,” Pollard says.


CEO Shane McGuire has lived in Dayton for 16 years and been at Columbia County Health for virtually 10 of these. He says they do not flip individuals away and their providers are distinctive: individuals come from so far as Walla Walla.

The wraparound care sufferers obtain doesn’t cease at counseling, psychiatry and first care providers. The group additionally consists of Paul Ihle, one other social employee at Columbia County. He helps shoppers in every part from insurance coverage problems to housing, however Dayton has him fill a singular want with cellular outreach, which supplies transportation help for appointments.

About half of Ihle’s shoppers want transportation due to their mental health, and other people have been lacking appointments as a result of they lacked transportation, Ihle says. So the hospital licensed him to drive a hospital van, together with for referrals outdoors of the group. They’ve introduced sufferers from as distant as UW Medical Center in Seattle and Moscow, Idaho.

“The state provides People for People services, but it has a very rigid criteria for qualifying,” he says. “Some people are successful meeting that criteria, but there’s always circumstances that set up insurmountable hurdles to being successful and it tends to hit most profoundly the sick and the disabled and the poor.”

McGuire has additionally expanded into the native highschool, down the street from the hospital. Pollard or Willoughby spends each Monday on the faculty with an open-door coverage for college students to speak about the whole lot from normal “high school drama” to drug use and issues at residence, Pollard says. They work with college students over 13 years previous. so the scholars can entry providers without having parental permission, permitting college students to drop in throughout faculty hours.

“We are surprised at the amount of kids coming to see us already,” Pollard says. “We just started at the beginning of the year and easily there’s five or six kids popping in every day, which is pretty significant with being brand new there.”

McGuire needs to ensure the providers can be found to Columbia County’s entire community of providers, so the employees additionally visits the nursing residence hooked up to the hospital. Therapy is harder with cognitive points, Pollard says, however they attend month-to-month psychotropic conferences the place Iles-Shih is current by way of video conferencing.

This complete behavioral health care all stems from McGuire, Pollard says. He made an effort to construct a program, beginning at sq. one.

“He’s wanting to do much more than the minimum of what’s required in any community. … He has a heart to see people get better,” Pollard says. “He gets the support from the board and a small community here who just want … people feeling as good as they can, instead of shoving this under the carpet like we’ve done for hundreds of years.”

Emily McCarty is the Central Washington Reporter for Crosscut. She covers every part that occurs from Twisp to the Tri-Cities. Reach her on Twitter @emjmccarty or e mail her at [email protected].

Email High Country News at [email protected] or submit a letter to the editor. 


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