With a lack of trained psychiatrists in rural areas, the care of patients with mental illness often falls to primary care doctors who may not be fully equipped to handle all cases. Doctors facing this issue in Northern Michigan will soon have more support when it comes to diagnosing and treating mental illnesses in children and pregnant and postpartum women. A $50,000, two-year grant from the Blue Cross Blue Shield of Michigan Foundation and the BCBSM Social Mission Department will expand phone-based consultations, educational programs, and telepsychiatry services to assist providers at three rural health clinics in Crawford and Roscommon counties. Improving mental health care is a critical need in rural counties, says Laurie Michael, Director of Operations for Mercy Physicians Network. There are only three child psychiatrists in all of nearby Grand Traverse county and none in the counties where access will be improved. The funding expands an existing Michigan Child Collaborative Care (MC3) program offered through the University of Michigan. The program is currently in place at the Mercy Physician Network – Grayling health clinic and will now be implemented at the Mercy Physician Network clinics in Roscommon and Prudenville. The MC3 program puts primary doctors in touch with psychiatric specialists from U-M. If a doctor at a clinic is having trouble diagnosing or treating a mental health condition, the program serves as a “phone-a-friend” option. In a larger urban setting, doctors would be able to more easily send their patients to local specialists. “In this case we can’t do that,” Michael said. “It’s a service that’s really needed for our patients in this area and helps to alleviate the problems of transportation and the financial worries of a patient or parent who would have to travel to see a specialist.” Doctors at the three clinics will be able to reach out to a behavioral health coordinator at Northern Lakes Community Mental Health Authority (NLCMHA), who then decides on a course of action. Patients will either be referred to appropriate local resources or doctors will be given access to U-M specialists who can offer guidance on diagnosis, medication options, and dosing. “The need is far greater than the ability to serve. This grant provides access to specialty care through same day consultation for the local provider with the specialty psychiatrist, with further assessment options if clinically indicated,” said Mary Hubbard, Chief Population Officer for Children and Families at NLCMHA. If a patient doesn’t make progress through an improved diagnosis or medication, telepsychiatry sessions can be set up at the NLCMHA offices. High-tech video equipment allows patients to be seen by psychiatrists at U-M over an encrypted system to ensure privacy and to comply with HIPPA requirements. “The data on telepsychiatric assessments suggest they are similar to in-person evaluations,” said Dr. Sheila Marcus, Primary Investigator for the MC3 program and Service Chief of Child and Adolescent Psychiatry at U of M. “We do the same kind of assessment we would do if we were seeing them live in the office.” Michael explains that greater local care is available if someone is in a crisis situation, such as a patient who is suicidal. For patients who are dealing with depression or a diagnosis such as autism or fetal alcohol syndrome, help is harder to come by. Doctors are often trying to provide intervention services so as to avoid a more urgent mental health crisis down the line. The support from NLCMHA and U-M is a lifeline. “For our providers to be able to consult with a colleague and focus on that one patient is huge,” she said. “That expert voice to assist them in providing care is just amazingly helpful.” Expanding services for pregnant women will further relieve some of the burden placed on primary care doctors who don’t feel adequately prepared to handle mental health issues. “It becomes really challenging for the providers to manage,” Michael said. “They are focused on managing the pregnancy, and a patient’s mental health issues impact that care.” Hubbard said having the support of trained psychiatric specialists gives primary care doctors a higher level of confidence to properly care for women and children with mental health issues. It also gives those patients treatment options earlier and closer to home, which will hopefully lead to better overall outcomes in their care. The expanded access made possible through the grant funding starts Dec. 1, 2014. While the initial pilot program focuses on kids and pregnant and postpartum women, there is hope that the telepsychiatric treatment option can eventually be expanded to the general population. The Blue Cross Blue Shield of Michigan Foundation supports research and programs to improve the health of Michigan residents. No grant money comes from the premium payments of Blue Cross Blue Shield of Michigan members. To learn more about BCBSM Foundation grant programs, visit bcbsm.com/foundation. Photo credit:David Mason
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