TelePsychiatry delivers rapid care to vulnerable patients

[6 MIN READ] 

In this article:

• About 169 million people in the U.S. live in areas with not enough mental health providers.

• TelePsychiatry at Providence bridges gaps by providing vulnerable patients access to board-certified psychiatrists and licensed social workers at hospitals experiencing mental health provider shortages. 

• The TelePsychiatry team includes 13 psychiatrists and 13 social workers who serve 42 hospitals.

• Learn how TelePsychiatry turns wait times that used to be counted in days to as little as seven minutes.

Some people who experience an acute psychiatric or mental health crisis must wait days or drive hours to see a psychiatrist or licensed social worker. With Providence TelePsychiatry, the average wait time is seven minutes.

Providence TelePsychiatry provides rapid, specialized care to patients experiencing acute psychiatric and mental health crises. It supports in-person health care providers managing an increased number of patients requiring help. Within the TelePsychiatry team, 13 psychiatrists and 13 social workers cover 42 hospitals in five Western states, from busy urban emergency departments to small critical access hospitals.

Telehealth allows for rapid crisis intervention

According to the National Center for Health Workforce Analysis, as of December 2023, 169 million people in the U.S. live in areas with a shortage of mental health professionals. Emergency departments and hospitals located within these shortage areas often rely on community mental health services and organizations to do mental health assessments at their facilities.

However, people who come to the emergency department in a mental health crisis are frequently suicidal and require immediate psychiatric and medical care. When there is no one available to complete a mental health assessment for several days, patients end up boarding in emergency rooms, which is not an ideal situation.

“If you wanted to staff an emergency department with a psychiatrist full time, 365 days a year, you would need 4.2 of us,” says Providence Medical Director of TelePsychiatry Joshua Jones, M.D. “You can’t get 4.2 of us in, say, Seward, Alaska. TelePsychiatry allows us to take a concentrated resource of psychiatrists and social workers and spread it out over a large geographic area.”

Telehealth, also called telecare, telemedicine or e-health, allows for high-quality rapid crisis intervention, especially for underserved and vulnerable populations.

How TelePsychiatry works

When an emergency room physician or hospitalist recognizes that their patient could benefit from a consultation with a mental health professional, they reach out to the TelePsychiatry team via a request through an online portal. 

“Our first step is a phone call to the attending provider because we want to have a provider-to-provider discussion to better understand some of the dynamics at play or some of the symptoms they’re seeing,” says Providence Director of TelePsychiatry Stacia Fisher, MSW, LICSW, ACM.

The TelePsychiatry team also has access to the patient’s medical history and records, including provider notes, medications and test results.

“We can get a really good picture, but some things you just better understand through a conversation with the provider,” Fisher says. “That helps us narrow down the goals of a consult.”

After the pre-consult call, hospital staff schedules a time for the mental health consultation, just like any other intervention in the hospital that a patient might need (for example, a CT scan at noon).

Consultations commonly discuss:

• Capacity assessment
• Confusion/delirium/altered mental status
• Depression or anxiety treatment
• Detainment
• General behavioral care plan
• Medication recommendations
• Safety planning
• Substance abuse
• Suicide risk assessment 

“These are the kinds of things our team provides, always in collaboration with the attending provider who is there on-site caring for the patient,” Fisher says.

Psychiatrists and social workers communicate with the patient via what clinicians and staff call a cart, which looks like a tablet on wheels.

Some people call this videoconferencing. Jones says it’s like “FaceTiming with the doc”. 

“The carts are very high-tech,” Fisher says. “They have a lot of bells and whistles. There’s a lot of zoom capability. The audio is really good. The microphones are good at filtering out background noise. They’re really built for this type of work, which is doing an assessment as similar to face-to-face as possible.”

Emergency rooms are often loud and busy environments without much private space.

“We encourage hospitals to place patients in a private area if they can, just to limit the noise and help patients feel comfortable sharing how they’re feeling,” Fisher says.

During the video assessment, which is HIPAA compliant, encrypted and never recorded or stored, a psychiatrist or social worker gathers the patient’s history to better understand their needs. Together, they discuss possible interventions as well.

Some patients prefer video visits over in-person visits. Fisher remembers asking a patient if it was OK to do a video consultation to shorten her wait time. The patient said she preferred it, knowing she would be less anxious if Fisher wasn’t in the room. 

“For some people, it gives them a little breathing room and is hopefully a little less stressful,” Fisher says.

After the assessment, the patient’s medical record is updated, and there’s often a follow-up with the attending provider to confirm recommendations and answer questions.

Reducing barriers to treatment

People who don’t have primary care or who live in a community without established mental and behavioral health providers often rely on the emergency room to be seen, Fisher says.

“We’re bringing the care to patients, “ Fisher says. “We’re not making them move around in a system where things are very siloed and you have a cardiac specialist over here, you have a neuro specialist over there. We’re bringing the care to them where they presented, where they’re comfortable, nearest their home, nearest their family support system. I think there’s a lot to be said about that model.” 

TelePsychiatry is particularly beneficial in areas without large health care facilities. For example, some hospitals that TelePsychiatry serves are close to residential chemical dependency treatment facilities, but not large health care facilities.

“We’ve had many patients who’ve had a psychiatric emergency while they’re at a facility,” Jones says.

When a psychiatric emergency occurs, the patient is transported from the chemical dependency treatment facility to a local hospital.

“We see them and are able to adjust their medications or start medication,” Jones says. “After a couple days, they’re able to go back to the residential substance abuse treatment program.”

Before TelePsychiatry, Jones says many of these patients would have been flown to a larger health care facility, delaying treatment and recovery. Telehealth visits increase patient satisfaction.

Specialized psychiatry care

A team of 26 psychiatrists and licensed social workers allows for more diversified and specialized psychiatric and mental health care.

For example, Jones says the TelePsychiatry team has experts in a particular psychiatric condition called catatonia, a condition in which the brain stops reacting to the outside world. These patients often stop eating, drinking and moving.

“It’s relatively difficult to detect, relatively easy to treat, but it is also a life-threatening condition that can come from a lot of psychiatric conditions or from a lot of psychiatric medications,” Jones says. “So whereas I used to see one or two of these a year, I will now see one or two of these per shift.” 

Some of the sites TelePsychiatry serves are in rural areas, such as the high desert region of California, with limited resources and perhaps mental health professionals who aren’t familiar with some psychiatric emergencies. With virtual care, hospitals have access to a larger pool of professionals.

Jones and his team can quickly recognize and reverse catatonia, saving lives by accelerating treatment.

TelePsychiatry is for everyone

TelePsychiatry gives more people access to acute psychiatric care from specialists with diverse backgrounds. 

“As a team, we don’t exclude anyone,” Fisher says. “We see everyone despite where they live or their health insurance status. If we’re serving that hospital and they present and need care, we’re going to see them.”

A diversified team also allows providers to bring their perspectives to team meetings.

“They talk about things that they know are issues in particular communities,” Jones says. “And that’s been really great. That’s probably not something you get in a small community where you might have just one or two psychiatrists.”

Jones knows this firsthand. Before this position, he was the lone psychiatrist for about 14 years for a population of around 100,000 people.

“It’s been really nice to be able to present a diverse selection of psychiatrists and social workers to folks in rural communities,” Jones says.

Every day, Jones says he’s grateful to give people access to evidence-based psychiatrists and social workers who have helpful attitudes and model good psychiatric care in emergency settings, which results in a better patient experience.

“It makes a difference when you’re able to interact with colleagues who are calm about this stuff, who are not thrown by someone’s dramatic, manic episode or intense delusions or hallucinations or just aberrant behavior,” Jones says. “That has a broad, calming effect that allows folks to treat patients with mental health conditions like any other medical illness in the emergency department and on the inpatient unit. And that’s intensely gratifying.”

Contributing caregivers

Joshua Jones, M.D., is the medical director of TelePsychiatry at Providence Virtual Care and Digital Health.  

Stacia Fisher, MSW, LICSW, ACM, is director of TelePsychiatry at Providence Virtual Care and Digital Health. 

Find a doctor

The TelePsychiatry providers at Providence provide rapid, specialized patient care for people with acute psychiatric or mental health needs. If you need to find a doctor, you can use our provider directory. 

Download the Providence app

It’s all in the app: easily stay connected with Providence and your health. With the Providence app, you can schedule appointments, have virtual visits from the comfort of your own home, get health recommendations personalized for you, access your health records and so much more. Learn more and download the app.

Related resources

Fostering equity in mental health

How to prioritize your mental health

Your physical and mental health go hand in hand

This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.