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Alaska leads the country with the highest rate of deaths by suicide with the Mat-Su death rate being twice the national rate. Research has found that consumers are not accessing care until they are in a crisis situation which leads to over-utilization of Emergency Departments. Elizabeth Ripley, Executive Director of the Mat Su Health Foundation which operates Mat Su Regional Medical Center, stated the following in a February, 2015 blog, “Even though it doesn’t offer psychiatric services, it is the number one purveyor of mental health care in our community.” She goes on to report that the ED sees five times the number of behavioral health consumers than their community mental health center. Mat Su Regional Hospital charged services totaling 23 million dollars in 2013 which mostly went unpaid due to consumers being under-insured or having no coverage at all. The need to expand digital technology and Telehealth services in Alaska is at the forefront of agencies wanting to expand coverage, raise consumer satisfaction, and stream-line services.

What is a telehealth Assessment? Telehealth assessments are those assessments completed using video conferencing or phone. They are often used to complete behavioral and co-occurring assessments for mental health and substance abuse facilities, and, are showing to be highly effective when used by emergency departments. Qualified mental health professionals (QMHP’s) can be reached 24/7 in a centralized location to expand the number of clinicians available to rural Alaskan’s and bridge the gap between ED utilization and, on-going preventative care. For consumers who feels trapped geographically or who have limited access to transportation, telehealth could make the difference between having an unfilled, hopeless life or finally having a plan and means to make positive change. Consumers or family members who believe there is mental illness but have no means to get assessed often feel hopeless and helpless that life can get better.

Understanding why mental health utilization rates in preventative service areas are so low is imperative in developing a plan to bridge this gap. What are some of the barriers to receiving mental health services in Alaska? More than 60% of rural America live in mental health professional shortage areas; 90% of all psychologist and psychiatrists and 80% of MSW’s work exclusively in metropolitan areas.  Law enforcement officers are the number one responders in rural America for a mental health crisis adding an upwards of about 2 million to law enforcement costs. Primary care doctors are now providing more than 65% of rural America with mental health care which basically means they are not getting that specialized, individually tailored MH treatment.

Are there more mentally ill people living in rural areas than urban? No. Prevalence is not the factor here as rates between rural and urban areas are about the same. Factors that limit consumers in rural areas are accessibility (getting there and paying), availability (someone there when you’re available), and acceptability (choice, quality, knowledge).

When discussing accessibility it is paramount to understand that rural Americans travel further to provide and receive services. They are also less likely to have insurance benefits for mental health care and are less likely to recognize mental illnesses. Many rural Americans do not understand their care options.

Consumers in rural areas are reporting the wait for an initial mental health appointment to be anywhere from 30-120 days with the average wait time 90-120. Rural areas suffer from chronic shortages of mental health professionals with specialty providers rarely accessible. Comprehensive services are not often available which then puts the burden on CMHC to service all. Mat Su houses 12 to 13% of the state’s population and yet receives only 4% of community based behavioral health funding. The population in this area has doubled from fifty thousand people to almost one hundred thousand. yet the funding for mental health has remained the same. Mat Su Regional Hospital currently has only two psychiatric beds, limiting doctors choices of treatment to either sending the client home or hoping the Alaska Psychiatric Institute has availability.

The acceptability of treatment options is the third major barrier to treatment in rural Alaska. Few programs train professionals to work competently in rural places leading to a lack of choice in selecting a provider. Stigma and lack of psycho-educational programs to combat mental health stigma also play into acceptability of care. It is assumed that urban models will work in rural areas which are most often not the case. Rural people are often not well informed of mental health services with access often being confusing and complex. Providers are isolated from each other and lack accessibility to service rural areas. Rural people enter care later, sicker and often come with little to no means to support their illnesses.

How should mental health care look in Alaska? Consumers would have quick, easy and convenient access to care. There would be comprehensive continuums of care with providers who are culturally competent. Systems and providers would work together and share resources by utilizing the “no wrong door” policy. In practice, this means that every door in the public support service system would be “the right door” with a range of services accessible to everyone from multiple points of entry. This commits all services to respond to the individual’s needs by either providing direct services for both their mental health and drug and alcohol problems or linkage and case management instead of sending a person from one agency to another. Digital technology services such as Telehealth will be paramount in making this policy reality.

It is clear and evident that current in-places services are not enough to meet the mental health care needs in Alaska. There is a misalignment between providers and consumers with access to care being nearly impossible to a large population of the state. As a whole, the United States has one qualified mental health provider for every 790 citizens.  System reform is challenging, and will require change at the conceptual, organization and provider levels. So what can we do now? Expand mental health access through the digital sphere; expand telehealth services.

 

Resources:

Alaska Psychiatric Institute:  http://dhss.alaska.gov/dbh/pages/api/default.aspx

Alaska Public Media: http://www.alaskapublic.org/2015/02/05/mat-su-behavioral-health-report-reveals-lack-of-services/

SAMHSA: http://www.samhsa.gov/

Alaska Psychiatric Institute: http://dhss.alaska.gov/dbh/pages/api/default.aspx

Western Interstate Commission for Higher Education: http://www.wiche.edu/

The Wall Street Journal: http://www.wsj.com/articles/where-are-the-mental-health-providers-1424145646?utm_campaign=KHN:+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=16079207&_hsenc=p2ANqtz–TKlI5-rvYxu0oFgrp6YkZ7TnjlyXuwn8yqq3EDyDjHhUT442lFRbTPjqemGUHeMhhzciFuY1CAXbPCNHwBMZEd1nLNuMaRZcE4GQ70-xcvNaW6XQ&_hsmi=16079207

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