How a Health Center Eliminated the Waiting List for Psychiatric Services

Going Beyond Waitlists in Mental Healthcare

Managing waitlists for outpatient mental health services particularly in community health settings is difficult to standardize, poses an administrative burden, and are barriers rather than gateways to access to care particularly for low-income communities. While telehealth has initially expanded access to mental healthcare at the onset of the COVID-19 pandemic, it has not resolved the challenges associated with the increasing demand for services and the shortage of available providers. This commentary explores the intricate interconnections between wait times, readiness for and appropriateness of therapy, and engagement in treatment. Drawing on insights from waiting line theory to question the attachment to and utility of waitlists for non-emergency, outpatient mental healthcare, this commentary questions the utility and efficacy of waitlists. Alternative solutions that capitalize on community resources and collaboration and harness patients' agency for change are discussed.

Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic

Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.

Using a tele-behavioral health rapid intake model to address high demand for psychotherapy at an academic medical center during COVID-19

BACKGROUND

Long wait times for mental health appointments have been a chronic dilemma for academic medical centers. This problem intensified worldwide with the onset of the COVID-19 pandemic. Approximately 70% of mental health services experienced pandemic-related disruption in care provision, while simultaneously experiencing a substantial increase in patient demand. Wait times for mental health appointments also increased, varying across populations from 3 to 18 months. As prolonged wait time is positively associated with severity of psychiatric symptoms and negative outcomes, the authors implemented a novel rapid intake telemedicine clinic model to shorten wait time and increase patient access to psychological care at an academic medical center.

METHODS

To address an overwhelming influx of mental health referrals and a growing wait-time-until-first appointment at an academic medical center serving as a lone safety net hospital during the COVID-19 pandemic, a 5-provider Psychology Rapid Intake Team was established using a hybrid of telehealth and in-person appointments based on patient preference. Data on new patient volumes, wait time for 1st appointment, and wait time to begin therapeutic intervention were compared during the same calendar 3-month period immediately prior to and following implementation of the rapid intake clinic.

RESULTS

A paired-samples t-test was conducted to compare new patient volumes pre- vs. post- intervention. Results revealed a significant increase in the number of new patients the providers were able to accommodate in the post-implementation (M = 62.00, SD = 7.21) compared to the pre-implementation (M = 31.00, SD = 2.61) condition; t(2) = -8.60, p < 0.05. There was a significant decrease in the average wait times for 1st appointment post-implementation (M = 24.99, SD = 2.38) compared to the pre-implementation (M = 37.32, SD = 1.47) condition; t(2) = 5.56, p < 0.05. In addition, days to begin therapeutic intervention decreased dramatically (394%) from the pre- (M = 142.50) to post-implementation (M = 28.84) period.

CONCLUSION

The COVID-19 pandemic strained a mental healthcare system which led to increasingly long wait times for intake appointments and delayed psychotherapy interventions. The Psychology Rapid Intake Team initiative served to improve access, reduce patient risk related to prolonged wait times, and accelerated patient engagement with psychotherapy services. The model can serve as a unique, sustainable infrastructure for behavioral health delivery for low acuity mental health problems in large health care systems.

Consultative Approaches to Leveraging the Psychiatric Workforce for Larger Populations in Need of Psychiatric Expertise

Efforts are underway to leverage the expertise of the limited psychiatric workforce by utilizing psychiatrists as consultants to primary care providers (PCPs). These approaches have demonstrated the potential to increase access to care by having PCPs manage patients with common, less complex behavioral health conditions earlier and more effectively, thereby reducing demand for specialty psychiatric evaluation. Multiple approaches to indirect psychiatric consultation have been developed with varying levels of evidence and success. These ongoing efforts will require modifications in workforce training to prepare psychiatrists and PCPs for this new role and in reimbursement approaches that cover the cost of the psychiatric consultants' work.