Tag: Mental Health

Employers, Employees, and Mental Health

Employee Wellness Affects More Than You Think

A healthy employee is a productive employee. WHO (the World Health Organization) estimates about 1 trillion dollars are lost globally each year from depressive and anxiety-based illnesses in the workplace.  Employees unhappy at their jobs, whether due to bullying, harassment, career fatigue, or general discontent, are much less likely to be engaged in their work.  The CDC (Center for Disease Control) reports that depressed employees perform about 20 percent worse at physical tasks, and 35 percent on cognitive tasks.  A difficult job environment can lead to diminishing physical and mental health, substance abuse, absenteeism, and an overall lack of effort.  Companies which routinely address and support their employees’ mental wellness have less turnover, less costs, and higher productivity.

The Workplace Can Be an Environment for Success

The workplace offers a number of innate advantages: communication and program policies are set and centralized; social interactions and networks are readily available; and employers can issue incentives for appropriate and healthy behaviors.  For larger companies, data collection (e.g. satisfaction surveys) is an invaluable tool used to inform trainings, management techniques, and budget direction of employee health services.  Team-building events, huddles, one-to-one sessions, and so on are all great opportunities for an employer or their Human Resources personnel to touch base.  Clueing into an employee’s mindset and needs can determine how best an employer should offer their support.

Employers Play a Critical Role

Improving employee mental health is a meaningful cost-saving measure in the long-term, but might require some initial investment; employers should consider a number of solutions depending on their budget.  Free clinical screenings would help employees identify the need to seek out a professional psychiatrist or therapist.  In an ideal environment, employees would have insurance with negligible out-of-pocket expenses for medications and psychiatric counseling.  Free or subsidized access to life coaching, lifestyle experts, and self-management programs can help round out an employee’s wellness journey.  As WHO suggests: every dollar put into mental wellness treatment means four dollars in employee health and productivity.

Every employee will have different needs.  Seminars, workshops, and/or classes on mindfulness and stress management teach autonomy to employees in dealing with their issues.  Scheduled moments for meditation and alone time provide respite to employees needing to reconfigure and breathe.  Likewise, encouraging holistic activities such as yoga and tai chi during and outside of work could embolden employees in managing their anxiety (especially during stressful moments).  Employers might even consider providing a dedicated quiet space for employees.  Perhaps most importantly, giving employees the ability to share and collaborate with trusted members of upper-management helps both parties be on the same page.

Employees Should Advocate for Their Needs

All employees should feel safe and confident at work.  To ensure this, employees might better define their relationship with their employers and colleagues by laying down expectations and boundaries – particularly when concerning a medical disorder.  Of course, employees are not obligated to divulge their illnesses, but might consider doing so if comfortable – talking openly helps remove the stigma, and paves the path forward for others.  Employees should take advantage of resources provided for mental wellness whenever possible, and champion for programs they think would benefit themselves and their colleagues. 

Closing

The suggestions above are just a few examples of how to promote a successful work environment; employers should conduct their own research and consult with their Human Resources department to determine their best path.  After all, each workplace is its own living, breathing organism, complete with different needs.  Whether as an employer or employee, investing in mental health today is a guaranteed return for the future.

The City of Laredo: A Model for Border Town Behavioral Health

As the third-most populated city along the Mexico-United States border, Laredo, Texas is a unique microcosm of behavioral health challenges.  Laredo’s nearly 96 percent Hispanic population, which is predominately uninsured (31 percent) or underinsured (41 percent; through Medicaid, Medicare, or CHIP), has routinely struggled with affordable access to behavioral health care. With only eight or so licensed psychiatrists treating approximately 300,000 people, mental health treatment has traditionally been a reactive solution, rather than a proactive one.

The Times Are Changing

The City of Laredo Health Department (CLHD), the only Local Health Department in Webb and its surrounding counties of Jim Hogg, Maverick, and Zapata, has proved an invaluable resource for these rural Americans.  Thanks to their recent partnership with Televero Health, Laredo is finally able to offer comprehensive behavioral health care to its underserved and struggling citizens: women; adolescents; those living with HIV/AIDS; those struggling with addiction.  To quote CLHD’s Director, Dr. Hector Gonzalez: “once we found out more than 60 percent of our patients had an abnormal behavioral health screen, where did we send them?  We are a Health Professional Shortage Area and the most needed are psychiatrists.”  Many of these patients now get their evaluations and treatment exclusively through Televero providers.

Our approach is to deliver a turn-key behavioral health program, complete with a collaborative care team of licensed therapists and counselors (vetted, dedicated, and bilingual); provide integrated behavioral health programs (primary care, HIV child/adolescent, SUD/addiction, and more); enable telehealth visits through a HIPAA-compliant platform (care coordination, automated patient communications, scheduling, billing, and records integration); and guide the operation until it is self-sustaining.  With several hundred consults provided and a no-show rate of less than 15 percent, our joint efforts speak for themselves.

Our partnership with CLHD is a continuous process of growth and support. As their Chief of Health Preventive Services, Dr. Luis Cerda, puts it, “Televero has provided CLHD with an excellent service that I now feel is an in-house service.” 

We are proud of our shared accomplishments, and together, look forward to a future where behavioral health resources are at everyone’s disposal. 

Spotlight: The Adolescent Suicide Crisis in Our Schools

Suicide Is a Pervasive Problem

Suicide is the second leading cause of death among 10 to 24 year-olds in the United States, behind a broader category of unintentional fatalities (e.g. auto collisions, drug overdoses, accidental gunshots). The story is similar for Texas youth; the CDC recently reported that nearly 1 in 8 Texas high school students attempted suicide in 2017, highlighting just how common these mental health challenges are.

Suicide Impacts Our Schools

Although many are quick to blame external or interpersonal factors as the catalyst for suicide among students (bullying, academic stress, disciplinary issues), suicide is more often rooted in personal, emotional crisis.  Extreme emotional or psychological pain; the belief that one’s situation will not improve; desires of escapism – these have all been routinely cited as the overarching reasons by those who attempted suicide.

With nearly 80 percent of the approximately 5 million students suffering from suicidal symptoms unable to receive counseling or medication, it’s no surprise that rates of attempts continue to rise.  It’s not a simple issue to tackle, either.  Most teachers, school counselors, school nurses, and administrators all lack the appropriate training and tools to spot the signs and trends.  And even with training, isolating one high-risk student out of hundreds or thousands is a difficult ask.  Without state and federal provisions to address the systematic causes of suicidal behavior –funding, evidenced-based programs, mandates to prioritize mental health support – improvement is unlikely.

A student’s welfare reflects on their school as much as it does on their parents or guardians.  Students in crisis often perform worse and participate less.  It’s worth noting that suicides and attempts affect the student body at large: every time someone harms themselves seriously, a district performs damage control, over-extending resources into forums, speakers, presentations, and so on.  Intervention not only mitigates risk, it protects time, money, and resources.

The Tides Are Changing

States and cities all across the U.S. are now taking notice, in no small part due to the continued epidemic of mass gun violence:

∙ In January, Virginia passed HB1729, requiring that every school counselor spend a minimum of 80 percent of their staff time directly counseling students in individual or group settings

∙ In April, Florida implemented the controversial SB 7030, which finances armed safety officers in its schools

∙ In June, Texas put forth Senate Bill 11, which implements multi-hazard emergency operation protocols and screenings for potential student threats, and Rep. Four Price’s HB 18, 19, 1070, which provides educators with mental health training for times of crisis

In our home city of Austin, Texas, our district leadership is making great strides to combat this issue.  Under the guidance of Tracy Spinner, Director of Comprehensive Health and Mental Health, Austin ISD has made considerable progress in expanding behavioral health resources across its campuses.  Thanks to a $2.1M grant, Austin ISD has set-up on-site clinics in 24 of its elementary schools, many of which are zoned in socioeconomically-limited and culturally-diverse areas.

As the call for behavioral health care sounds nationwide, many districts are now looking for help on how best to take advantage of the increased funding.

What Televero Is Doing to Combat This Problem

At Televero, we offer custom behavioral health programs for student health and welfare. With our turnkey tele-behavioral health solutions, we equip schools with the tools they need for suicide prevention, intervention, and follow-up care.  As part of our crisis support triage model, we provide school nurses, counselors, and administrators on-demand on-campus access to behavioral health screenings and psychiatric evaluations to avoid the expensive ED visit and the traumatic experience of the student riding at the back a police car to the ED. Post-crisis, students receive access to ongoing care programs through scheduled weekly or monthly follow-up visits with the same licensed therapists and counselors.

We’re passionate about making a difference in student health and welfare, and through a partnership with your school, we can strengthen your resources in this fight. In this Suicide Prevention Week, we ask that you share your story with us and join us in a call to action and compassion in tackling this issue head-on.

What Are On-Site Telepsychiatry Services?

Telepsychiatry Defined

Telepsychiatry is the use of telemedicine, or “remote medicine”, technology, to provide psychiatric assessment and treatment to patients.  When implemented properly, telepsychiatry services are indistinguishable from in-person care.   While there are some limitations to telepsychiatry depending on the U.S. state of operation – the ability to prescribe certain classes of medicine; reimbursement rates for CPT codes – the quality of care is always equivalent.

Recent Developments and Their Impacts

With over 5,000 mental health care Health Provider Shortage Areas (HPSAs) in the United States, more clinics and hospitals have turned to telepsychiatry for solutions.  States like Texas are acknowledging the efficiency and reach of this technology by enacting parity laws – laws which guarantee equivalent reimbursement by private payers for services rendered through telehealth technology.  These laws are encouraging for physicians at the forefront of healthcare advancement, as they facilitate the low-risk methods that will be needed to address the growing demand for behavioral health services.

Improving Access to Care

For many clinics, telepsychiatry might be the only practical solution to treat patients needing behavioral health care.  As psychiatrists and other mental health professionals primarily practice within or close to major city limits, rural areas often rely on a single practitioner to treat hundreds, if not thousands, of potential patients.  Most general practitioners are not adequately equipped or specialized to serve those with mental ailments, and too often must refer their patients to emergency care.  Adding remote screenings, evaluations, and treatment to your current practice model would be useful in bridging this gap in care.

The Advantages for Your Clinic

As a fixture of your clinic, telepsychiatry is non-intrusive and cost-effective.  Depending on how you choose to finance your behavioral health services – whether by accepting commercial insurance; offering a sliding fee schedule; seeking external funding – you might be able to greatly increase your practice’s revenue.  Expanding your reach of care through behavioral health is also a good way to introduce new patients to your practice, and satisfy existing ones.

Getting Up and Running

Adding behavioral health services in your clinic comes with its own challenges: hiring the best-fit psychiatrist or counselor; understanding the billing and reimbursement structure; implementing a web portal and video client under HIPAA-compliance; and so on.  Thankfully, there are companies that will work with your clinic to operationalize the process (do the heavy-lifting).  Whether you are a physician, nurse, or practice manager, your priority is caring for your patients.  An external solution can help you focus on what you do best.

Understanding Senate Bill 10: Chapter 113: Texas Mental Health Care Consortium

On February 19, 2019, Texas laid the groundwork to comprehensively address its statewide mental health care shortage.  Senate Bill 10, passing with near unanimous consent, amended the Health and Safety Code to include “Chapter 113: Texas Mental Health Care Consortium”.  Said consortium, paneled by representatives from twelve health-related institutes of higher education, as well relevant non-profit organizations, has been tasked with strategizing solutions to the diminishing psychiatric workforce and broad challenges patients experience in accessing mental health care.

Improved Access to Care

In an effort to reduce mental health care shortage areas (M-HCSAs), Sec. 113.0152, Access to Care; Child Psychiatry Access Network and Telemedicine and Telehealth Programs directs the committee to create a statewide network of child psychiatry access centers (CPACs) within the twelve participating medical institutes.  These centers are to work alongside community care providers to offer psychiatric consultations to adolescents with behavioral and/or mental health disorders.  Per Sec. 113.0152, Mental Health Research Plan, the consortium is to compile and inventory available research on mental health and substance abuse disorders and delegate funding to further study in these areas.

An Expanded Physician Workforce

Sec. 113.0154, titled Psychiatry Expansion Workforce Project, aims to improve and increase psychiatric residency training via collaboration between medical colleges and community care providers.  Committee members have been permitted to fund one full-time psychiatric medical director and two rotating resident positions per provider.  Within the course of their duties, medical directors are expected to develop training opportunities for medical students and their residents.

Telemedicine’s Role

From a technology perspective, SB10 emphasizes the role of telemedicine in restructuring the state’s mental health care crisis: Sec. 113.0152.b instructs the consortium to create or redefine telehealth programs at the participating medical institutes to better recognize behavioral health needs and to supply statewide care; likewise, Sec. 113.0154.b.2 necessitates the application, education, and promotion of telehealth tools by directors employed through this project.

In her testimony at SB10’s hearing, developmental-behavioral pediatrician Nhung Tran, M.D., espoused support for the bill, noting that the establishment of CPACs and their application of tele-consultation services would “support primary care pediatricians in meeting the mental health needs of children” and “free up the behavioral health workforce to address higher-acuity concerns.”  Dr. Tran concluded her statement by acknowledging that while “telehealth and telemedicine are not the sole solution”, the bill “takes a critical step in leveraging technology to fill the gap … to create long-term solutions and improve care.”

Looking Towards the Future

Texas continues to have one of the largest discrepancies in mental health care access versus population of any U.S. state; however, SB10 is an informed, relevant, and dedicated approach to tackling these issues at their roots.  As this project grows, physicians, institutes, and telehealth services are certain to embrace its potential, hopefully reshaping the future of care for Texas patients.

The Looming Shortage of Texas Psychiatrists

The demand for mental health services grows daily; it’s estimated that nearly one in five Americans suffer from a form of mental illness, of which only 41 percent receive the necessary treatment.  And while many factors contribute to this lack of care, perhaps the most significant culprit is the drought of qualified physicians. 

Texas’ Health Professional Shortage Areas

Hundreds of counties across the U.S. are absent psychiatric professionals, with Texas leading the pack.  A 2015 study by the North Texas Regional Extension Center found that 185 of Texas’ 254 counties did not house a general psychiatrist.  Texas, generally, is ripe with Health Professional Shortage Areas (HPSAs).  A 2018 review by the Henry J. Kaiser Family Foundation placed Texas right behind California in number of mental health care HPSAs: 430 areas with a combined population of over 12 million people whose needs go unmet, dependent upon an influx of almost 600 practitioners in order to satiate demand.

The Physicians’ Struggle

Medical professionals are concerned.  Joseph Parks, M.D., of the National Council for Behavioral Health, was quoted in 2017 as having said:

“Two-thirds of primary care physicians report that they have trouble getting psychiatric services for their patients. So, they go to the emergency room. There has been a 42% increase in the number of patients going to the emergency room for psychiatric services in the past three years, but most of them are not staffed with psychiatrists … people end up stuck in emergency rooms for hours and at times days … finally, they try to get into an inpatient psychiatric bed, but hospitals have been closing their psychiatric units because they can’t find psychiatrists to hire and staff to run them. It is truly becoming a crisis.”

Psychiatry Careers Are Dwindling

This division of care will continue to grow.  Merrit Hawkins’ 2017 Review of Physician and Advanced Practitioner Recruiting Incentives notes that of the approximately 30,000 active psychiatrists in the U.S., 60% are fifty-five years of age or older, and “set to retire soon”.  New American Economy’s The Silent Shortage: How Immigration Can Help Address the Large and Growing Psychiatrist Shortage in the United States (2017) emphasizes that “just 4 percent of medical students decide to practice psychiatry each year … the number of psychiatrists has only increased by 12 percent since 1995, not enough to keep up with the growing U.S. population.” 

Texas’ own Department of State Health Services announced in its Texas Projections of Supply and Demand for Primary Care Physicians and Psychiatrists, 2017 – 2030 (July, 2018) that each of Texas’ eight primary regions, already experiencing shortage, will not produce enough psychiatrists to meet the scaling population demand by 2030. 

Solutions

What can be done?  One recommendation, as outlined by the Association of American Medical Colleges in Physician Supply and Demand Through 2030: Key Findings (April, 2018), is a multi-faceted approach, of which “innovative delivery” and broadened applications of technology are pillars.  Perhaps now more than ever, clinicians, schools, and other medical service providers should look towards telemedicine for solutions.  As medical schools and state/federal governments work from within to better incentivize psychiatric residencies, providers at the ground level should use the tools currently available to them.  In doing so, those seeking care can receive care.