Technology could improve state's mental health

By RAY WILBUR
Capital News Service
LANSING — A lack of psychiatric counselors across the state and an increase in people with mental illness have created the need for mental health care that transcends county and city lines.
Telepsychiatry – psychiatric therapy provided through video and phone conference – is the answer, some health officials say.
In Michigan, some lawmakers are pushing to join a compact expanding the network of telepsychiatry providers. Opponents have raised concerns over how it would be regulated.
As of 2012, there were 3,669 mental health professional shortage areas containing almost 91 million people, according to the federal Health Resources and Service Administration.
It would take 1,846 psychiatrists and 5,931 other practitioners to fill the needed slots.
“The basic issue is we have a real shortage of psychiatric services and a real maldistribution,” said Jed Magen, associate professor and chair of the psychiatric department at Michigan State University. “There are some counties in the state where you might have to drive 40 or 50 miles to get these services.”
The distance could be further for people seeking specialized therapy such as for children and geriatric patients, he said.  
This shortage of professionals is not evenly distributed, as 55 percent of U.S. counties, all rural, have no practicing psychiatrists, psychologists or social workers, according to the Mental Health Services Administration.
Michigan has about 1,200 psychiatrists and ranks 28th in the nation for ratio of patients to psychiatrists.
A bill introduced by Rep. Jim Tedder, R-Clarkston, that passed the House earlier this year would enter Michigan into an interstate licensure compact, allowing Michigan physicians to remotely treat patients in 12 other states and allow health providers in those states to treat Michigan patients.
“The impetus for the bill was to address health care shortages in rural and other underserved urban areas,” Tedder said. “You would now have psychiatrists be able to better serve people in the member states of the compact.”
A doctor in Illinois could counsel a patient in rural Michigan with just an internet connection and a computer, as long as the patient is at a local mental health facility.
Magen said the compact would allow for greater access to care and would hopefully begin to lower the number of mental health patients who have nowhere to go for help.
Not all health officials are convinced. Licensing and regulation of physicians is handled on a state basis and entering into a compact could cause problems with how rules are enforced, said Colin Ford, senior director of state and federal government relations for the Michigan State Medical Society.
“There appears to be very little upside for physicians in the states that have joined this compact,” he said. “Why don’t we wait and see what the rules are and if other states adopt it and if there is value in this before we commit to something.”
Hospitals in the state have already attempted to expand telepsychiatry services to rural areas. A $50,000, two-year grant from the Blue Cross Blue Shield of Michigan Foundation and the BCBSM Social Mission Department expanded phone-based consultations and telepsychiatry services to assist providers at three rural health clinics in Crawford and Roscommon counties in 2014.
And in 2015, hospitals in Wexford County used a $35,000 state grant to make psychiatry more available in rural Michigan by expanding telepsychiatry efforts.
This expansion should continue on a state level, but entering into an interstate compact does nothing to increase the effectiveness of care, said Scott Monteith, a psychiatrist based in Traverse City.
“Where are those resources going to come from?” he said. “If all states have a shortage of physicians, then how does that help?”
The solution to mental health care can’t just come from increasing numbers, it has to be a discussion about a better model of collaboration among health professionals, he said.
“Telepsychiatry is a tool and it’s a good one,” Monteith said. “But you need more than tools to build a good design.”