The Georgia Health Policy Center recently spoke to Sy Saeed, M.D., director of NC-STeP, and Kalyan Muppavarapu, M.D., NC-STeP’s medical director, about their participation in the Telehealth Network Grant Program.
The N.C. Statewide Telepsychiatry Program (NC-STeP), hosted by East Carolina University, anticipates connecting 80+ hospital emergency departments across the state to psychiatrists in order to provide timely psychiatric assessment and rapid initiation of treatment for patients experiencing an acute mental health or substance abuse crisis.
What has been an early win in your telehealth program?
Dr. Saeed: Our number one early win was to bring a very large group of stakeholders to the table. Since this is a statewide problem, we wanted to bring a statewide perspective — not just one university or system — and were able to really bring in people from the four major universities in the state, all the major health care systems in the state, the North Carolina Hospital Association, the College of Emergency Physicians, the North Carolina Psychiatric Association, and so on. About a dozen people met regularly to come up with a plan. So, the first win was to come to a consensus and understanding about how to solve the problem.
The biggest win, of course, was presenting the problem and the proposed solution to the state legislature. When the bill was introduced in the North Carolina House, literally within the first week of that, we had 32 sponsors from both sides of the aisle. Running that bill through the legislature was a clear win for that, and we were funded and written into the statutes.
What is a tip or early learning that you would share with an organization launching a similar telepsychiatry services program?
Dr. Saeed: It is common, especially in the early stages of a telehealth program, to think of technology as driving these efforts. Start with the question about what problems you are trying to solve, as opposed to ‘I have some equipment who can I help?’ We were approached by the Department of Health and Human Services to help solve a problem — patients were showing up in emergency departments in mental health crises and ending up staying there for a very long length of time. Part of that problem is that the patient needs to see a psychiatrist, and a psychiatrist is not available. We can certainly help to solve that by using telehealth.
At the heart of the problem solving is relationships — building a team and bringing people together —and letting the relationships drive the effort rather than the technology driving it.
Dr. Muppavarapu: Telehealth is not done by one person or one entity, it should be done by a team of people. The team includes many stakeholders — more than psychiatrists — but the originating sites, the nurses, the social worker, the mental health or psych tech, and psychologists. So, bring them all to the table, help them understand why it is important and how they can help, and come up with a good plan. Further, it is important that the plan is sustainable and that the team remains aware of the changing policy landscape.
How do you see participation in the Telehealth Network Grant Program impacting your broader telehealth efforts?
Dr. Saeed: The focus is basically making care accessible to those who otherwise may not have access to it. When I have an opportunity to talk with people who have an influence on policy, I like to say that the best thing is that we live in times when care of mental illness has never been more effective. People get well. We can truly talk about recovery. But unfortunately, a large number of people, in just about every state, still don’t have access to what science has promised, evidence-based treatments. A program like this can get to places where access is an issue. * In areas where population density is such that you can’t really put face-to-face clinics in that area, then the next best option is to provide that care via telehealth. For example, in Eastern North Carolina, we have large number of counties in which people would have to travel about two to four hours to get to a place for care. In North Carolina, 31 out of 100 counties have no psychiatrist and 90 of 100 counties are considered a mental health shortage area by federal definitions.
*For more information of where NC-STeP is currently operating, see this map.
How has COVID-19 impacted NC-STeP?
Dr. Muppavarapu: We have had a significant increase in consultations for our psychiatric telehealth program, even during COVID. In the very beginning of the pandemic, because of the fear associated with it, many people stopped coming in at all. But within a short period of time, the consultations for psychiatric conditions are consistently going up, including at hospitals in rural areas with no other resources. At many times in the COVID pandemic, the outpatient clinics have been closed, and access has been limited. Additionally, many patients may stop taking their medications, or they are not getting medications on time, leading to worsening of their symptoms. That could be contributing to the increase of emergency department visits for psychiatric reasons.