The therapist is online
When the idea of mental health counseling via video was first suggested to her, Mary Carpenter wasn't exactly enthusiastic.
"I was absolutely going: 'What!? No way!' " recalled Carpenter, a psychologist who is CEO of the Range Mental Health Center in Virginia and Hibbing.
Three years in — but only two years in terms of regular use — Carpenter is a convert.
"I had to be pulled along kicking and screaming, but as I've seen the results ... I'm absolutely a believer," she said.
Connecting health professionals with patients in remote areas or health professionals with other health professionals via what's often described as telemedicine or telehealth has become increasingly more common in recent years. Advocates see it as a way for specialists to help patients in rural areas without transportation barriers.
That includes use of telemedicine as a tool for treating mental health conditions. Nationally, the number of "telemental health visits" grew an average of just over 45 percent annually from 2004-14, the journal Health Affairs reported last week. The study used an analysis of Medicare fee-for-service claims as its data source.
In Northeastern Minnesota, mental health is one of the specialties for which the technology is being adapted. Both St. Luke's hospital and Essentia offer psychiatric services from Duluth to clinics in other communities via video links.
Three years ago, a Northeastern Minnesota coalition and the state Department of Human Services pioneered a partnership that has brought the technology to schools, hospital emergency rooms and jails from Cloquet to Floodwood to Grand Marais and elsewhere.
The coalition is the Arrowhead Health Alliance, which serves and is funded by Carlton, Cook Lake, Koochiching and St. Louis counties, said Ric Schaefer, who directs it. Additionally, it coordinates the Region 3 Adult Mental Health Initiative, which serves those five counties plus Itasca County as well as the Bois Forte, Fond du Lac and Grand Portage bands. That group now goes under the title Arrowhead Telepresence Coalition, said Savanah Thompson, who coordinates it.
It's a region that lends itself to telehealth, said Dave Lee, director of the Carlton County Public Health and Human Services.
"We've got 23 percent of the state geographically," Lee said. "You've got 6 percent of the population. We have broadband, we have the fiber optic, we have the connections."
It's a large region, sparsely populated, and it doesn't have enough mental health professionals to go around, Lee said. That's backed up by the U.S. Health Resources and Services Administration, which identifies all of Northeastern and north central Minnesota as a shortage area for mental health care.
FIRST IN THE STATE
The idea of helping to fill the need via video connections goes back as far as 2011, Schaefer said, when Bridge House still existed in Duluth to address mental health crises.
"We started to hear from some of our very rural, remote hospitals, especially emergency departments, looking for ways to connect with mental health professionals," he said. "And so we had this idea of trying to connect staff from Bridge House, who were there anyway because they were providing that 24/7 service to some of those locations."
After a couple of early attempts, the coalition connected with DHS, which already had the secure video technology available, Schaefer said.
"Essentially they gave us access to their video network," Thompson said. "What we provide to them is just basically our currency, which is knowledge. ... We're just providing feedback to DHS on how our region is operating."
The Arrowhead coalition was the first in the state to take advantage of the DHS technology for regional purposes, said Roger Root, whose job title is person-centered telepresence integrator for Minnesota IT Services, a state agency.
"It's opening ... a whole new set of possibilities to get the right service to the right person in the right place at the right time," Root said.
USED IN JAILS, SCHOOLS
In its third year, the regional telepresence network is being used in a variety of ways, among them:
• The Northeast Regional Correctional Center connects with the Human Development Center in Duluth to provide psychiatric care for inmates. It's also connected to the Center for Alcohol and Drug Treatment for chemical dependency evaluations.
• Likewise, the Carlton County Jail is connected to HDC for psychiatric care and chemical dependency evaluations.
• Range Mental Health Center is connected with 10 schools in the region, allowing students to stay in their school while meeting with a therapist.
• The emergency room at Cook Hospital also is connected with Range Mental Health Center, making a therapist available via video if a patient in a mental health crisis is seen at the ER.
The initiative has won notice. Last year, it was named winner of a Minnesota Local Government Innovation Award in the "county" category. Word is spreading, Root said.
"Over in the Brainerd region there's now a project started up very similar to the Arrowhead project, where they're trying to hook up their jails and schools," he said.
People involved with the video connections say it makes better use of a limited resource: the mental health professionals themselves. The beneficiaries are their clients.
"We're able to have our therapists meet with students during the day rather than have them leave school and usually not come back," Carpenter said. "Parents don't have to take off work in order to do the transport."
The Carlton County Jail is connected with a psychiatrist at the HDC two days a month, said Holly Compo, a county public health nurse who spends all of her work time at the jail.
Sometimes when a scheduled appointment at HDC is canceled, that time also is made available for jail inmates, said Sheriff Kelly Lake.
Correctional facilities are required to provide inmates with the same standard of care as the community gets, Compo said, and the number of people who enter the system with mental health issues seems to be increasing.
For the jail, the arrangement "has some cost benefits as well as safety and security benefits," Lake said. "We're not paying a deputy's time for transport. We're not taking a deputy off of other duties to do the transport."
TEENS LIKE IT
Cecilia Bloomquist, an HDC therapist who formerly worked out of Cook County, was separated geographically from her patients when she was promoted and transferred to Lake County as program manager. But some clients stayed with her — doable because of a video link between the two offices.
Bloomquist, who joined a discussion on telepresence at the Birch Tree Center in Duluth from her office in Two Harbors, said that otherwise her clients would have to drive 1½ hours for a 45- minute session.
"It's kind of sad that people have to do that," she said.
Birch Tree Center, which filled the gap left when Bridge House closed, so far has been using the technology primarily for conferences and administrative purposes, Thompson said. But the hope is to connect the center's mobile crisis team with various hospital emergency departments for mental health assessments.
Both Bloomquist and Carpenter said clients tend to be wary of meeting via video at first, but generally adapt. One group takes to it particularly quickly.
"We're finding teenagers actually prefer telepresence," Carpenter said. "It really is their mode of communication, so their defenses are down more so than in an office face to face."
Lee said there's anecdotal evidence about how people respond via telepresence compared with old-fashioned face-to-face therapy, but as of yet no hard and fast data.
But whatever the outcomes, telepresence is clearly better than nothing, Bloomquist said.
"I would have a hard time thinking that it would be better than face to face because I'm a therapist and I'm used to face to face," she said. "But I think if you compare between that and not getting service, I would say, 'Yes, for sure it's better.' "