Using telehealth to provide timely mental healthcare in rural Illinois

Various factors are driving the mental healthcare crisis in America, not least of which is the rising demand for services and the concurrent dwindling supply of mental health professionals. As a result, Americans with pressing mental healthcare needs who are seeking help face long wait times. Health systems, like Illinois-based OSF HealthCare, are increasingly turning to telehealth technology to bridge the gap and enable quicker access to care.

According to a 2022 survey conducted by the American Psychological Association, 79 percent of psychologists reported patient increases in anxiety disorders, 66 percent reported increases in depressive disorders and 64 percent said trauma-related and stressor-related disorders were growing.

The survey, which polled 2,295 active licensed psychologists in the United States, also revealed that 60 percent of psychologists had no openings for new patients, and 38 percent maintained a waitlist with varied lengths.

For OSF HealthCare, the push and pull of demand and supply was evident in emergency departments (EDs) across its 16 hospitals in Illinois and Michigan. OSF’s Director of Virtual Behavioral Health, Dominique Dietz, said in an interview with mHealthIntelligence that the health system saw over 11,000 patients with behavioral health needs in its EDs in 2023. This year so far, that figure stands at 5,300.

The health system conducted a community health needs assessment in Peoria County and found that individuals could not access behavioral health services because they were either unaware of the services available or faced extensive wait times.

“I mean, we used to be able to get patients in [for a mental health visit] between two to four weeks, and now we're looking at three months upward for counseling and longer for our psychiatry services,” Dietz said.

To expand timely access to mental healthcare, OSF HealthCare has partnered with telehealth provider Amwell to pilot a telepsychiatry consult service in EDs at nine hospitals.

DEPLOYING THE TELEPSYCHIATRY SERVICE

The telepsychiatry service connects OSF’s ED physicians to Amwell’s behavioral health specialists, who can conduct mental health assessments virtually.

First, an attending provider in the ED identifies a patient who may benefit from a psychiatry evaluation, explained Dietz. They then fill in a consultation order in the EHR and an intake form through the Amwell portal. Once an Amwell provider is notified about the request for a consultation, they conduct a complete chart review of the patient’s EHR. After the review, they call the attending provider to discuss the patient’s needs.

“Then, they will have a conversation with the patient, which I think is so important,” Dietz said. “We have a tele-cart in the patient's room with them [and] we have another individual, whether it's a nurse or a behavioral health sitter, sit with [them for] that conversation for safety. And then that Amwell provider will just have a great dialogue with the patient back and forth and kind of try to understand the needs and assess that patient appropriately.”

After consulting with the patient, the Amwell provider will document their recommendations within the EHR. They also close the loop by calling back the attending provider to offer those recommendations and answer any questions that may arise from them, Dietz said.

The recommendations vary, from suggesting the patient be admitted to the inpatient psychiatry program to the patient be discharged back to the community for outpatient psychiatry services. Amwell providers can also help when a person needs to be involuntarily committed to psychiatric services.

“A second certificate [for involuntary admission] has to be signed by a licensed psychiatrist,” Dietz said. “And that's kind of where we were falling short and really needed for Amwell to come in and help provide that support.”

This support is one of the main reasons OSF partnered with Amwell for the telepsychiatry service. The company offers an extensive provider network that can cover mental healthcare demand 24/7/365 across the system, Dietz noted. Additionally, Amwell is Joint Commission-accredited, enabling quicker turnaround when privileging their providers at OSF facilities.

OSF and Amwell initially launched the pilot at three hospitals last October: OSF HealthCare Saint Francis Medical Center, a level 1 trauma center in Peoria, Illinois, OSF Saint Anthony's Health Center in Alton, Illinois, and OSF St. Francis Hospital & Medical Group in Escanaba, Michigan. Using a phased approach, the service was expanded and is now live in six other OSF hospital EDs.

ADVANTAGES OF TELEPSYCHIATRY ACCESS

The telepsychiatry service has provided a wide array of provider and patient experience benefits, according to Dietz. For providers, the service offers much-needed support.

“Having those providers feel the support that they may not have had by getting a behavioral health expert, a psychiatrist, to do a formal evaluation, bounce ideas off of, and [provide] recommendations for medication really helps our providers feel supported at a time where we're seeing that increased need and complexity,” Dietz said.

Still, change is difficult, especially when physicians are used to a specific workflow. Dietz noted that physicians in the ED tend to be focused on treatment and shortening ED stays, so adding a technology component can feel like a hurdle.

To ease the transition and gain physician buy-in, OSF worked with hospital presidents to ensure each facility had a champion advocating for the telepsychiatry service.

“And then we worked on educating CNOs [chief nursing officers], directors of nursing, managers of nursing, charge nurses, all the way down to our bedside nurses to really get everyone in full wraparound support of this change,” Dietz said. “And we also acknowledge that each facility is very different. This cannot be a one-size-fits-all process map.”

For instance, some OSF facilities did not have any psychiatrists on site, while others had a team of psychiatrists and behavioral health therapists that provided care in the ED. The health system collaborated with each facility to find a workflow for the telepsychiatry service that worked best for them.

Dietz said the health system offered the nursing and physician teams various options for virtual and onsite education. It also conducted monthly and quarterly check-ins with each facility and provided technical support.  

For patients, the most significant boon of the telepsychiatry service has been a shorter wait time to receive a mental health assessment.

“We really want to shorten that length of stay as much as possible for our patients, especially behavioral health patients, who are coming in with anxiety or depression and even suicidal thoughts, [and] sitting in an emergency department room for hours on end is not going to be beneficial for them,” Dietz said. “And we want to get them linked to the appropriate level of care, whether inpatient or outpatient.”

OSF plans to track numerous metrics to assess the efficacy of the service. Understanding utilization trends, including the recommendations from Amwell providers, patients’ length of stay in the ED and their discharge status, and timeliness of transfers to inpatient or outpatient care, is critical to evaluating the effects of the service, Dietz noted. The health system also plans to track patient and provider satisfaction as it scales the telepsychiatry service systemwide.

Telehealth is proving to be a critical tool in delivering mental healthcare, especially in underserved areas. By utilizing virtual and digital options for behavioral healthcare, OSF is aligning with national trends.

“I just really feel like it's the way that we are moving nationally,” Dietz said.