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Published on June 14, 2019

Why Behavioral Health is Important to Rural Communities

Behavioral health conditions are a pressing health need across our nation. Wherever people choose to live and raise their families, they deserve access to specialized care and treatment.

The Challenge

People in rural areas face these conditions just as their urban counterparts do. Yet for many, there is not a psychiatrist, psychologist or counselor available within an hour’s drive – or several hours drive – let alone inpatient psychiatric units or chemical dependency centers.

Dr. Matthew Stanley seeing patient using ecare telemedicineA 2018 study published in the American Journal of Preventive Medicine finds that a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.

“This is a problem that’s hitting right in the heart of America,” said Matthew Stanley, DO, Vice President of the Behavioral Health Service Line for Avera Health, based in Sioux Falls, S.D. “The Upper Midwest is home to several Indian reservations where people are at risk with limited access to behavioral health services. Farmers face year after year of low prices, erratic weather and trade turmoil. There are more elderly people in rural areas, who are often socially isolated and at risk for depression.”

When people in rural areas experience mental health conditions, they often try to go it alone. “There’s a ‘pull-yourself-up-by-the-bootstraps’ mentality that is so unfair to individuals who struggle,” Stanley said. Or, their care is left to a general practitioner who doesn’t have the specialty expertise to treat complex conditions such as bipolar disorder or severe depression.

“In small towns or out in the country, when an individual experiences a mental health crisis, the only option for the people around them is to call emergency services in the form of law enforcement, fire and rescue or emergency medical services,” Stanley said.

After the initial crisis is over, individuals often have to wait weeks until getting in to see a counselor or psychiatrist, and usually have to travel in order to access this care.

During this time of waiting, the person’s condition may deteriorate. “Sadly, people may become so desperate that they consider suicide or self-medication through alcohol or other substances,” Stanley added. Through its Zero Suicide initiative, Avera has instituted programs to identify and treat depression and suicidality earlier, for example, through depression screening tools used in primary care clinics and emergency rooms. “But if the professionals aren’t there to treat the need when it’s identified, we can’t complete the circle.”

A Solution

Avera eCARE® is developing a groundbreaking program to help address these challenges by building a 24-hour telemedicine behavioral health team.

This team will give patients access to timely, patient-centered, cost-effective, high quality behavioral health services via telemedicine. While Avera in the past has offered behavioral health assessments via telemedicine, this service can offer immediate treatment.

Avera received $7.8 million in grant funding through The Leona M. and Harry B. Helmsley Charitable Trust to launch this program. After the three-year grant ends in 2021, the program will move into a sustainable subscription program for hospitals, health systems and other organizations, similar to other eCARE services such as eCARE Emergency.

With an initial focus on services for people in crisis, Avera eCARE will provide virtual behavioral health assessments as well as treatment for patients in local emergency departments and inpatient psychiatric hospitals.

“Many of our inpatient psychiatric units are challenged with staffing, particularly overnight and on weekends. Avera eCARE will provide a psychiatric team to respond to off-hours needs from the hospital. This supports recruitment and retention of community psychiatrists and helps to preserve access to essential inpatient care for those in crisis,” said Deanna Larson, CEO of Avera eCARE.

In time, Avera eCARE will also provide mobile support to first responders encountering individuals in crisis.

“People in urban and rural areas alike need health services that address needs of the whole person. In the past, the Helmsley Charitable Trust has partnered with Avera eCARE to extend specialty care across vast rural areas, and now we are looking to extend behavioral health services via telemedicine as well,” said Walter Panzirer, a Trustee of The Leona M. and Harry B. Helmsley Charitable Trust.

Panzirer himself is a former rural paramedic and police officer, and knows first hand that people in mental health crisis can end up being held in a jail cell because there’s no other option. “No other medical diagnosis leaves you ending up in jail. We want to see medical problems – including behavioral health conditions – treated within the medical health care system. That’s what this grant program is designed to accomplish.”