Unmet Needs: Look onscreen, the doctor will see you now

April 11, 2014

Harry Wolin manages Mason District Hospital in Havana, Illinois, one of many clinics in Illinois that provide care to medically underserved areas. The hospital has been treating patients via telepsychiatry, when a patient meets with a doctor via a computer screen, for about four years now. Wolin says they started offering appointments that way after the county mental health center shut down due to lack of funding.

“If we wouldn’t have started offering this service, many of our patients would have had to travel an hour or more to see somebody,” he explains.

In an evolving health care system where cost control and efficiency are key, some are looking to telepsychiatry as a solution; some are more skeptical. Could the technology a way to offer more patients quicker access to a doctor? Is that really the best solution? 

Deborah Medlin knows all too well the shortage of psychiatrists in central Illinois. Her son Zach had to wait six months to see a doctor and he wound up in the emergency room instead. If he’d seen the doctor earlier when I first called it when escalated to the point of him being hospitalized to meet the growing demand for psychiatric care a number of providers like Jan ating with the Douglas County Mental Health Center are looking to the Internet to reach patients.

It’s probably inevitable. That eventually we will have to get to the tele psychiatry.

I’m Scott Cameron. The benefits and the drawbacks of tele psychiatry. That’s coming up on focus. After this news.

Good morning I’m Scott Cameron this is focus from Illinois Public Media. Well this week on MORNING EDITION we’ve heard about the shortages of psychiatrists in central Illinois and the lengths some will go to to find care if they can find it at all. It’s all part of our series unmet needs. Living with mental illness in central Illinois the series runs all this month as hospitals and other mental health care providers look for ways to better serve their patients. Many are taking a second look at the practice of tele psychiatry. If you work in mental health or if you’re a patient have you try to tell a psychiatry would you if it was offered to you give us a call eight hundred two two two nine four five five e-mail will dash talk at Illinois dot edu You can also find us on Twitter at Focus five eighty. We’ll talk with a doctor an administrator offering tele psychiatry here in a few minutes but first what’s driving the need for services like tele psychiatry. Donna Mayer joins us in Studio C. Thanks for coming in.

Thank you for airing about it is that you are an illness that needs to be brought to the fore in pushing away at an important topic or you know you live in Coles County.

Yes your son diagnosed with a mental illness you’ve jumped through all sorts of hoops. From what I see here to get him the care that he needs. Let’s go back over what happened when you first realize that something wasn’t quite right.

Well he was hospitalized and it was just like a nightmare you hear you are in a hospital and your son see in trees movin in the yard and cameras than any nail hole in the wall. Watch name and think people was going to get a game and you think what’s going on I’ve never been around anything like this. And it’s just devastating what am I going to do you know I’m the only person going through this that’s that’s exactly what I thought. Very alone and I did not know it was going to be such a long journey. Whenever it started. He seemed to I was telling earlier that whenever he had had his first in hospital birth they told my husband and I that they never thought he would get any better than what he was now the doctor said about you that he’s never going to know that they didn’t know whether he would he didn’t know and they wanted us to be prepared. But they were willing to work with him. O’Connor and and Steph and which I’m really thankful for because at that time he had good insurance. Because he had been working and they did work with him and we got to see the Dr in Decatur and in fact John would not take his medicine and somehow they got a court order that he had to take his medicine. John is your son. Yes John is my son. And so he started taking the medicine and he felt like he could go back to work. They weren’t real they didn’t really want him to go back to work because I think they felt like the pressure would be too much for the doctors or the doctors they just did not want him to and the John insisted and the psychologist said well he had some connection to where my son worked and he said let me see if I can get a job where the pressure won’t be there so they did it. But it didn’t last it didn’t last he just could not he started thinking that people were after a game and all the paranoia and also my son was dual diagnosed with alcohol alcoholism. So which is really another thing which it is hard to get a dual diagnosis care to and it’s a common thing where the evils of maybe to try to self medicate. Yes yes it is but you know at the time I was new to all this and so that’s what he’d do whenever he’d go off his medication because he’d think it was better that he would self medicate and the whole process would start all over and I was working at a job where I was working ten to twelve hours a day trying to drive to Decatur Illinois to get him to his appointments it was just it was too much. So we knew that the doctor in our area which we had very few at the time was as he was in his network.

And I should have probably never changed doctors but I did and that’s a mistake. But you learn as you go along with you you are going to make mistakes and you are going to learn that who is a good doctor for somebody else and this may not be the right one for your loved one until you meet that person and have that experience you’re not going to know you’re not going to know that I am facing a shortage of doctors it sounds like are already there and I’m going to use from your trying to find the best doctor to fit your son and what happens and what happens is is after he started going there. Well his insurance because at the time he got sick your insurance you had a spin down on mental health and now you know drugs substance abuse so it is spend on me for a while they say you can only spend it. Yeah and it was gone. His coverage was gone there was used to working of a point you know he had been off again. Point Yeah and it was it was kind of a bad deal because we went on and paid his Cobra a couple of months before to keep him on that he was still on the medical part but as far as anything to do with mental illness and substance abuse they would pay no more. They were OK That was all. So we had to find a place to take him which is really hard because we were trying to get away from this doctor we had went to kohls County to get we were trying to get him away from there so. Well no because if you don’t have insurance you don’t have a medical card or anything and they kept on refusing him a medical card or the Medicaid for they wouldn’t want to know if using remote to cure for well for what I feel like it was because he was still living with my husband and I.

So they were counting. Yes During your income as his income he wouldn’t qualify.

Yes and at the hospital they wanted John and my husband and I to be responsible. I felt like for his medical bill because we filled out the financial thing there and hold your son at the time. At the time he was twenty eight years old eight years old. Yeah he was not.

But where else was he going to live with them for them to view him as a toy as your astute friend of yours.

That’s a complicated thing and the only way we finally I don’t know whether this is what did it because I’m going to be perfectly honest with you what the deal was my husband talked to the person in finance at our hospital because we were arguing with them because he was responsible for his own bills we were not we were just giving food and shelter. And my husband finally told him he said Well do you want us to give him an address under the foot bridge by the railroad tracks. So this to the hospital. Yes my husband said that to the hospital. Is that what you want to do. Well I piped in and told him what I had heard about some of their practices about some people get them. He got his financial you know good.

So you took an advocate to say this is not right something needs to change .

And it worked and it worked. So we got him. But then it was still he had to see that doctor there and it was working my son was getting worse instead of better.

So still seeing a doctor but not improving or not improving.

And so I knew I had to get him somewhere and he had seen that doctor for over two years where we were fighting all these issues.

And somebody told me about a great place up here in Champaign which you guys are very fortunate that you have doctors that volunteer to do this at the Chris champagne County Christian health center. And he got to see a psychiatrist there because he had no insurance and they’ll only they see people without insurance. And that was the greatest turning point for us because it was a doctor my son clicked with. Plus he had gotten a counsellor at our mental health center that was good and it all started kind of fallen into place. And she finally talked him into moving into a group home which we finally got him qualified for a medical card so we could get those minutes because before that I was having to fill out papers and give him to the doctor to fill out to go to the drug companies which the drug companies are good about furnishing medicine for people in need. You just have to find out where to go and how to do it through the paperwork. But the problem with that champagne County Christian house center was it’s not that’s not a full time job . So whenever those medicines came in the mail if nobody was there they sent him back to the

drug. Company so we we’ve been talking quite a bit this week about access issues and from you I mean I’m hearing that there one there was a shortage in calls county of just mental health professionals to begin with the insurance issues being able to afford to care and certainly that’s that’s an access issue and then finding a place that will take your son to a place that will do it without insurance. And yet they’re struggling with their own financial issues I’m sure you know limiting the service they can provide the amount of time they can dedicate to this. I mean that’s that’s quite You’ve been through a lot to get to that it have been a heck of an advocate it sounds like how is he doing now.

He’s done a lot better he went from group home to like a semi group setting where there was just an apartment manager there like for four hours and now he’s in an apartment by himself. But they’re through our mental health center and he still has his times but he is so much better than what we ever thought he would be. When this started out because I’m just thankful I can hear the relief in your voice as you say that oh I am and I just you know I tell everybody whenever this first started I felt kind of like maybe a person whenever they find out their loved one has cancer you can even let that cancer be you. Where you can try to beat that cancer. You said no way no way am I going to because we have been through a lot of things like before my son so it’s hard to find an attorney that will take somebody for disability whenever they’re dual diagnosed and I feel like this is something that should be brought up because alcoholism does not qualify for disability. So we had a battle because this doctor that my son did not have a good rapport with. He had wrote in the records that it was all due to alcoholism all due to alcohol. Well he felt like he would quit drinking and that he would get rid of the psychotic stuff but he would do the psychotic stuff and then start drinking. So state and we were getting nowhere on that . That’s what I’d say and it’s just really hard to get all of us. Yes and we had an attorney for him who said no I’m not going to take the case. Well it’s this is the attorney that was probably well known he was supposed to be but we found an attorney up here who I want her to know if she hears this that we think she’s great because she said I’m not afraid of one doctor. And she took care of it. Well it took her a long time.

She took care of it right down the mayor is with us. It will remain with us here we’re talking about the challenges of finding mental health care in central Illinois. As you’re hearing in too few psychiatrists to meet a growing demand in many cases among other issues and the promise and problems related to telemedicine as one potential solution. Donna mayor with us talking about her experience getting help for her son. And joining us now is Harry wall and he’s C.E.O. of the Mason District Hospital in Havana Illinois. They’re treating patients right now with Tele psychiatry Harry Warren joins me on the line from the hospital there walk into focus. Hi Thank you for having me. Sure thanks for joining us here is Don’s experience here Representative in terms of access issues and having a shortage of doctors to go to reflect some of what you’re seeing their patients in and around Havana .

Yeah it it it’s not unheard of it’s a very complex issues with many medical issues many financial issues. Oftentimes individuals who are suffering from mental illness as an add on to that the dual diagnosis of alcoholism or in other cases other forms of addiction find it very difficult to maintain employment and with that hurt her situation with her son’s challenges in getting coverage under the state Medicaid program those financing issues are not uncommon. The challenge that she. Didn’t talk about that is also a problem that we face is lack of public transportation for individuals to you know when they can get access to a provider how do they get to their point and there’s no bus service and then you’re all areas and that adds up to in many cases the challenges that people experience who are suffering from mental illnesses and other behavioral conditions.

So it’s a number of very real challenges obviously not for everybody but her situation that she really did is is not at all uncommon with that kind of context and background.

There’s a shortage of issues of access transportation. You wanted to hire a psychiatrist to work with patients one on one there at a van what happened .

Just became cowed we couldn’t find anybody. The simple answer we. The problems that we face are a financial to which we are in a rural somewhat isolated part of the state.

And given the shortage of physicians finding someone who is interested in relocating their family their practice their career to other than a full time basis was something that we were unsuccessful in accomplishing.

So there are many doctors who they’re attracted I suppose to big cities to bright lights or opportunities when you’re in a shortage situation and can pick where you would like to live where you’d like to raise your family. Oh a lot of things go into people’s decision making process as to where they would like to live when there are numerous opportunities that they have .

They choose what for them is the best match and fit for their family and in their professional desires and we didn’t make the check mark on that when you’re in that process of trying to find someone.

Then we began looking to see if there was someone on a part time basis who would hear from some of the neighboring community or share their resources with another willing or interested in coming over here and a part time basis and and again we were unsuccessful in that regard again so you there’s a clear need you’re not able to bring somebody in.

In house anyway on a full time or part time basis what brought you to tell us a country that well I was.

We’re attending some conferences X. was a conference being put on by the Illinois Rural Health Association they have an annual meeting each year in the focus of their discussion. That year was on psychiatric services and so our presentation presented talked about some of the advantages of tele psychiatry that were being used in other parts of the country presenting some scientific evidence showing the success factors of the strengths of the program the weaknesses of the program and as we began our evaluation considering the fact that we had absolutely no services at all so that the advantages that such a program brings to the population would be providing value to the residents of our community.

As in the full time psychiatrist probably not that far better than having no access to psychiatric services at all.

So in terms of what we really start doing the research on this I wasn’t even aware that this was happening in many places right now. Can you walk us through the what what happens in tele psychiatry and how does it work what’s the process what does it look like.

Well we in our services been in place for several years now so we’ve worked out some of the learning process that goes along with this but in our counseling office in the office that we use where the patients come in they check and it’s it’s staffed by either a counsellor or a nurse depending on scheduling on our side and who the providers are and who the patients are.

So the patient comes into your offices were there with that that person in front of in front of a video screen.

Exactly and it’s just a high definition T.V. screen that is high speed video conferencing It’s no different than sitting across the room from an individual. The quality of the T.V. screen is very high quality the audio quality is very strong. There’s no delays. We’re using high speed broadband for connectivity and so the two individuals can sit and have a discussion there’s a camera mounted there so that the position on the remote side can see the patient as clearly as the patient can see the the psychiatrist in your case where were the doctors in Springfield Illinois about sixty miles away. A couple of the physicians can do part of an organization that’s based out of Chicago but their physicians and cells are based in Springfield we also work with the S.R.U. School of Medicine Department of Behavioral Health and they’re located in Springfield and in the other patients are doing.

Oh we have been less. That goes for several months to even get an appointment. We have two different programs one with adults and one with the children and adolescents.

So the response has been has been pretty robust and it has been been viewed by many of our patients as a very positive opportunity experience giving them the help that they need the contact and evaluation discussions with their physician as needed. For everybody all of the patients have found it helpful we have a number of folks who don’t show up for their appointments that challenging for us because people on a waiting list where if they knew they weren’t coming we could have gotten somebody else then. But it’s still those sorts of challenges that take place. We provide the program on a weekly basis for adults and or one of two programs are running every week and been very well supported by the folks in the community cannot for everybody all the patients. They haven’t found it to to meet their needs. Some of those folks go without care and some of those folks that borrow or find a way to get to the psychiatrist in a community an hour away or so or further and we were even talking here was it was sort of a showdown a mayor her son diagnosed multiple times doses of mental illness.

Don’t you bring him back in the conversation or you were presented with the option of tell psychiatry for your son. What did you say.

I said no because I wanted him to have more of every pore with a doctor because we had seen how that had worked in the past with a previous doctor I feel like if they don’t have a report that after listening to the doctor explain some of the things I would if that was the only care I could get my son I’d be in line. Beg borrow and steal and get in line. You’re an actor and I admire you for finding out for people who could make those trips because I think that the public is unaware of how many people with mental illness do not have families at all anymore or for some reason there’s not anybody there and they have to worry about getting somewhere to get the help they need to get the. Since for the meds they need because I’ve seen these people without meds and I admire you for doing that for your area very well and do you find that people are skeptical at first and once they hear in the information they hear what you describe just like Donna just said it starts to click.

Yeah I think some people are skeptical. Some people have been reassured I mean a lot of these patients are seeing primary care physicians in the community who when there isn’t a psychiatrist available they are the only physicians able to assist these individuals with their care. Recognizing the need for psychiatric services is not the problem it’s getting those patients a referral in to see a psychiatrist is the challenge and where that isn’t available those primary care physicians are able to explain the process introduced into the counsellors introduce them to the nurses who are the staff people on the local side of the conversation and that has helped in some cases to allay those apprehensions that nervousness that comes from. Being and certain other people find it very helpful not to have that reporter if you would that one on one contact. But still able to have that conversation over the television screen the fact that there is a counsellor or a nurse in the room so some of those non audios sorts of nervousness or questions that might arise because there isn’t face to face contact can be communicated and shared. Recent histories and things or records are available to the psychiatrists in the case of sie you we’re also have the benefit in working with their program with your teaching program to expose some of our new psychiatry or psychiatrist in training I guess might be the the better way the folks who are in a couple of years going to be psychiatrists out in the field that get that exposure to the tele psychiatry and get to participate in that process of part of their education and training and they are just briefly here you had mentioned that they’re thinking about meeting that face to face contact or as I think you need that face to face kind of your standard I suppose I should say you referenced that there had been some issues that that led you to think that what what happened.

Well what happened was this we had lost our psychiatrist. At the mental health center there in Coles County she was leaving and so they couldn’t find anybody because we had the same issue who once you know we live in a small area you know and people usually want their kids where there’s a good school curriculum which you don’t have. They’ve got good school curriculum I’m not saying that but they don’t have a lot of the sports and other stuff you can. The extras. Yeah that they do like offer in Champaign Urbana Even so when your son was trying to see a doctor and things what we’re with that face to face contact make make a real difference do you think for me as my son is such a manipulator but after listening to him I don’t know if they could have seen him on the screen it might have been better because he probably would acted out more or think what you mean by manipulator and anything to make them think that nothing’s going on because he does not still like taking his medicine he would like them to think that he doesn’t need it and he said earlier that somebody will not acknowledge that he has a mental illness. Yeah sometimes that is really hard for him to do and then other times he accepts that he knows. You know that there’s things that he used to be able to do that he cannot do anymore.

We are talking about the lack of access to good mental health care in central Illinois and one potential solution tele psychiatry next year in just a moment to hear from a doctor who treats patients by video link actually helped set up the program here in Havana and other telemedicine programs all part of our month long series on unmet needs. Living with mental illness and central Illinois and join us also online or a Twitter chat we’re talking about mental illness there and some of the stigma that exists in central Illinois if this is something that you’ve experienced. Join that conversation as well on Twitter using the hash tag we’ll chat. Stay with us it’s focus from Illinois Public Media . This is focus from Illinois Public Media Welcome back. I’m Scott Cameron. Federal data show that downstate Illinois suffers from widespread gaps in mental health care. There just aren’t enough psychiatrists to meet the growing demand especially in many rural areas. For years V.A. hospitals among others have offered tele psychiatry to improve access to care and to keep costs down. In some cases some hospitals are experimenting with Tele psychiatry for faster consultations with patients in the emergency room as well. We’re talking today about the promise and some of the limits of telemedicine. Now if you work in mental health if you’re a patient Have you tried to tell a psychiatry would you try it if it was offered you give us a call eight hundred two two two nine four five five. You can e-mail us. We’ll dash talk at Illinois dot edu Also the conversation going on Twitter that I just mentioned at Focus five eighty largesse or Harry Wallen C.E.O. of mace and District Hospital in Havana Illinois hospital offers tele psychiatry Donna Mayer she cares for her son who has a mental illness and chose not to do so tele psychiatry at least in part because she felt that her son could manipulate the doctor without face to face contact and joining us now is Dr Jeffrey Bennett he served as acting chief of the adult psychiatry division at Southern Illinois University School of Medicine in Springfield he treats patients by tele psychiatry teaches others do the same and he worked with Harry wants hospital set up their program joins us now by phone from his office Dr welcome to focus. Thank you very much for having me .

So let’s back up a little bit here how long has tele psych been around Oh it’s been around for well over twenty to thirty years. As soon as Tower monitors were around people have tried to do various kinds of treatment and in fact some of the first treatments that were done were forms of group therapy that the resolution of the audio was very different back then and over the time that we’ve been doing tele psychiatry that over the past four or five years there’s just incessant presses increased inequality. Of both the auditory and visual resolution of the way the video conferencing or that we still find that the technology is already tense of the administration the legal aspects of it.

So so the technology has progressed to high speed Internet has expanded at other places. It’s allowed this type of service to reach out to places that were underserved already and now have a capability to reach using this kind of technology.

Yeah and there’s an important Cabinet you know escaping it’s been around for a long time in a very successful communication one of the difficulties is maintaining the security of the connection if you want to be sure that if you’re speaking with a patient about confidential issues that it’s compatible with the confidentiality that patients need to HIPAA.

So how do you overcome that or how do you ensure that like we have a specifically dedicated T. line connecting to the different places that we serve and we also have several firewalls the connectivity is very carefully in line like a direct Internet connection right.

Bridging you from the locations you’re after then firewalls and software to further protect a great deal in terms of we’ve talked a bit about you know the reasons people use tele psychiatry. Then a couple of studies are primarily done from what I can tell for the V.A. that showed improved outcomes of tele psychiatry when compared to receiving no care at all on the since the limited research in terms of whether tele psychiatry works as well as face to face meetings with a doctor do we know what do we know about how this works and how well it works.

We know a lot about the quality diagnostics using tell a psychiatrist we know a lot about how patients perceive it in terms of their satisfaction we know a lot about the satisfaction of primary care physicians who receive this is as a service by participating psychiatrists and generally very very favorable. The ability for a tele psychiatrist to diagnose depression is almost identical with what they can do say an office based on face to face and or interchange I think the areas that are still undergoing research are things like How do patients feel over time talking.

Somebody on the T.V.. Do they divulge as much information do they .

Is it easier for them to not tell the truth and I think that that’s an interesting area where we’re working on that that we’re actually doing research to understand more about the doctor patient interaction here and say you certainly are areas of developing research but by and large the quality of a complicated diagnostic is very very accurate.

Do you find your does research show that some people tend to be more helped by tele psychiatry than others.

Well that’s a harder thing to quantify.

Yeah. If you have access to a psychiatrist then it’s harder to get in .

Why would you go see a top psychiatrist that’s doing that kind of comparison and I think it’s very difficult. There is data. I think about the show rates have an interesting anecdotal statement and that is somebody who practices tele psychiatry keenly sees patients in person at a mental health center but also has a tele psychiatry clinic at a different mental health center and sometimes at the same mental health center when they’re not able to make it at a distance and what he finds is that the show rate for the top of the Kaiser clinic is better than the show rate for his in person treatment. So sure remaining who shows up. Yeah so does that suggest that the patients are more comfortable speaking to somebody through a video conference rather than face to face.

It’s a hard thing to quantify but that that’s a possibility that the mascot will differ with who are there certain types people who are best helped by tele psychiatry and what we’ve talked about a rural area so there are other folks who tend to benefit specifically from Tel psychiatry as an option.

People who don’t have psychiatric care I think benefit from having the option for seeing a psychiatrist to tell psychiatry I’m not sure that . Let me sort of back up because one of the things that I’m doing is I’m still learning and the way I got into tele psychiatry was that I was asked by the person running our tele health service if I was interested in developing a training clinic though so I got into this as an educator and somebody that’s interested in training future psychiatrists visions on how to how to work with patients.

Yeah getting it was seen something where people who are deaf in some cases it really helps some because some of the issues or transportation things that Harry wanted talked about earlier not having enough interpreters to go around to tell psychiatry give them an opportunity with in a single location to treat many people. Veterans we mentioned the V.A. hospital children with some schools in some cases it sounds like they just it open some doors.

If access is a problem then it’s been remarkable how helpful it’s been I think a great example would be say the prison population where transportation transporting a patient from an inpatient from a prison setting to a psychiatrist many miles away as the only option for obtaining secondary care is very expensive it’s potentially dangerous but it’s a care that very often is extremely important very beneficial for the prisoner.

And if you can decode psychiatry into the prison then it saves tremendous amounts of administrative and financial effort so sinking in there to have you help set up the system there what do you have to think about what kind of factors do you take into consideration when you look at a community and its needs and start setting up a service like that.

That’s a great question. I think one of the important things is that we practice here in a city where there are lots of resources that are not available in rural areas . The transportation issue is very very prominent. But we also don’t know what kind of therapists are available we don’t know whether they have the same kinds of diagnostic equipment and so the process of evaluating somebody to tell psychiatry I think is sort of a stepwise process. And if we decide that somebody needs to get an M.R.I. because we’re not sure whether they’ve got a brain tumor that’s causing their symptoms versus having some kind of psychological stress or is that kind of resource available. So in advance of having meetings with the organization or working with the plan out those kinds of resources what’s available it’s not available and then planning with a specific patient. If we make recommendations for therapy can they make it to that therapist on a regular basis and they make it through the two hour drive to the nearest substance abuse treatment facility and on the planning resources is really important thing is learning to get just getting to the people who are making the referral. Understanding what their needs are well in advance of actually seeing patients. We spent some time setting up this clinic and having several meetings with the staff at Mission District Hospital as well as our own coordinating staff as well as our information technology they have to really work out the details of how that time on would be most efficiently and how are complicated recommendations can be most beneficial and we actually routinely would have our medical students in our residence.

Oh trip and visit Mission district hospital so they got to know the doctors they were working with and who are referring patients and Harry walland had a Mason just your house but there have been a reference to that that partnership between the tell psychiatrists and the doctors in Springfield and I suppose they could be used anywhere and in this case they are in Springfield and their primary care doctors the assistants and things back in the van. Harry come back to you for a moment here in thinking about that partnership and that relationship. Things like medication how is that handled who prescribes medications.

Well it it is either one of two ways it’s either the psychiatrist or the psychiatrist. When a conversation and refer one to the patient’s primary care physician.

There are different ways it works but it clearly is based on the professional recommendations of the psychiatrist either by prescribing the drugs directly or by having that conversation referral discussion with the primary care physician who can then coordinate the medications to make sure that there aren’t other drugs that are in play to get those drugs ordered. It’s complicated with some of the very dangerous psychotropic drugs . Where is the communication. Long distance communication in getting those prescriptions written to the pet and to the patient to the pharmacy so that drugs and prescription to be filled. Because it’s they’re not the type of groups that allow just anybody to pick up the phone and call a pharmacy and sad like daughter such and such a drug they are the Controlled Substances that require the actual prescription document to be taken to the pharmacy so it’s a little more complicated but something that through planning logistics can be addressed. It’s also a communication also would be key in this I mean what what do you have in place and what sort of systems are there to make sure that you know the doctors in Springfield know and understand what’s happening in the primary care physicians on the end there and then you know know what what has gone on and have access to records and those things as well but just that I mean this question of making sure that the records are available in a timely manner down in Springfield so that they know the other activities are going on the drugs a patient or on the other medical conditions and how those treatments are going and then similarly getting copies of those reports back after the session is completed. It’s one of the advantages of having the counselor present. While this is going on because many of these patients in addition to their visit with the psychiatrist. Have visits with a counselor who’s helping them through some of the other challenges that they’re dealing with or in some cases a nurse who would be in the room to address some of the medical issues and to make sure that communication and that the transfer of records is up to date and current.

And what’s the word I’m looking for ultimate responsibility I guess for the patient’s care with all these different sort of elements there who’s kind of the final say.

Well it’s always a challenge.

We are very strong and very active proponent of that patient’s primary care physician. It’s in the best position to overall have responsibility for managing their care we have a medical home concept within our practice that kind of thrives within that concept. To recognize the importance of the specialist has been uniquely qualified to deal with some of those unique medical problems that the patients are dealing with. So it is very much a communication at the end of the day the patient has is the person they are the ones who are in charge of what medical care they will receive. It’s why having an advocate who is going to you know as we heard earlier in the show an advocate who is going to take that personal interest to make sure that the care that is being provided is the best care for that individual. We have some personal responsibility we have to take for our care. It becomes very challenging when we’re being told perhaps different things by different physicians which is why again we have fallen back and set up our processes based on the medical home model that says that the patient’s primary care physician is in the best position to help the

patient. Sort those sometimes conflicting but usually not always complicated issues out in helping the patient and in some of these ability complexities and think this is not all you need to tell of psych I mean the same things need to be worked out between primary care physicians and even if if I were to go see a psychiatrist you know right down the street you know those same issues come up so it’s you know we should be fair there as well and sometimes because we are far away we focus on it a little more and therefore it becomes a little more cognizant force than if it was just somebody around the corner where out of sight out of mind but we know we’ve got those challenges.

So we we tend to focus on them a little more and build in those systems.

We’re talking today about the promise the limits of telemedicine tele psychiatry. If you work in mental health if you’re a patient you know somebody who is have you tried tele psychiatry. Tell us your story would you if it was offered to you. Give us a call eight hundred two two two nine four five five can also reach us by e-mail. A will dash talk and Illinois dot edu and join the conversation on Twitter. Producer Lindsey Moon over there right now at Focus. Five eighty. Hash tag. We’ll chat. We’re talking with a Harry wall and C.E.O. You just heard his voice Mason district hospital have an Illinois mayor with us here in the studio. I care for her son with a mental illness also Dr Jeffrey Bennett assistant professor of psychiatry at Southern Illinois University School of Medicine in Springfield and acting chief of the adult psychiatry division at the S.R.U. School of Medicine there as well.

Now I’m coming back to you Dr Bennett here for a moment on the business side of this there has been some movement lately but the fact remains right now insurance coverage is not always there for tele psychiatry what it what it where does that stand right now as a member of the Illinois I think Tkachuk society’s general counsel I’m working with our executive director to develop and pass legislation which would enable third party payers to pay for psychiatric services through tele psychiatry just like they would pay for them if they were face to face and that’s an ongoing effort. It’s happened in many states so far but I think working it through here in Illinois is one of our next steps.

And it sounds like to the industry to some degree is involved too and I’m not opposing this is untrue.

There’s a great deal of support from the industry I think that they recognize that this is a way to prevent hospitalizations that maybe are necessary to prevent a co-morbidity. So for instance somebody that has a psychiatric disorder may not take as good health care and if there are psychiatric disorder can be treated then it lowers the amount of supervision and excessive amounts of the health care burden that may be required. So there’s really a win win situation at stake here I think the problem is rolling out such services in a way that is cost savings and doesn’t require a tremendous amount of expenditure and so developing a system and passing up legislation and getting the rules in place is really kind of a long long process.

And Harry will end it for you there in Mason district hospital. Is there a business model here is this affordable is it sustainable.

He not yet. QUESTION It is not a goal I mean maybe that’s the end that may not be the goal to be a goal.

The challenge becomes if it is not something that is adequately paid for by somebody and it will not be able to be sustained on a long term basis . We use this program as clearly the community service that we provide for as part of our mission to our community and our efforts to meet the health needs of the community. But it nowhere near it is even close to something that is self-sustaining. When we look at our other operations and the cost that we would be incurring if not for this patient to help us understand the need for it. You know there’s no question as to the need for the service. Patients But when we look at where we expend our resources and which community needs we can afford to support and underwrite it becomes part of that strategic. There’s only so much resources we have and how is the best way for us to spend them for the needs in our community and there are a lot of needs. All of which you can make a very compelling case as to why help is needed to eradicate this problem that problem a long list of medical and social ills that impact people’s health. You sound like you faced tough decisions our internal discussions but if it doesn’t become self-sustaining.

The real question becomes is how long can we continue to provide the service and then what happens if you can’t you know I have we’ve talked about some of these acquisitions already you know where does that go it is or do you see any support coming in. I mean we have the insurance companies and the state pushing and that is their grant funding as are federal funding and there are other options for to push this through the U.S.D.A. recently committed fifty million dollars to specifically rural mental health issues.

Yeah I mean there are grants I mean our original equipment that we purchased for the program was obtained through a grant and so it’s not that there aren’t some.

Reports for it but the going costs of the program significantly out of the core of the revenues that we generate for it. And so yeah it becomes a very real budgetary question that we deal with on an ongoing basis. There’s no question as to the need the need is is very compelling . Term basis though the question is can always be worth those other needs because there are other needs that are gone unmet because we’ve chosen to meet this health need. There is a bill in the Illinois assembly as we speak that made it out of committee and as it is in the process of making coverage for medicine services a requirement of third party payers to Kate pays but many of the and and some insurance companies do pay but many others do not and the bill that has some technical pieces in terms of making the logistics of tele medicine a little easier . But on the financial side would make coverage for telemedicine it a requirement of insurance companies at this point just looking at the budget.

How long you can keep this going at this rate.

Well no I mean it’s a tough question.

It’s the broader question of health care financing which is not a simple question to to address. We serve a rural part of the state with a very high level of poverty high level of folks without insurance are doing it in a very compelling way to try and do it in a high quality state of the art mechanism using technology where we see fit. But the challenges are very real that go beyond just a discussion of mental illness although mental illness is a very high challenge on the issues of problems facing rural communities and their health unmet health needs.

Dr Bennett we just have a couple minutes left here but you. It makes me think you know you teach students you work with future psychiatrists that these issues of shortages and access to care come up to talk about practicing in rural communities. Absolutely what are those.

Well there are several challenges One is that primary care physicians deliver most of the mental health care. As far as prescription medications right now and one of the goals I think of tell if a country is to enable psychiatric consultation to take place for those tri care physicians who are really holding the front line and enable them to prescribe medications in a safe way and to be sure that a proper differential diagnosis is made her patients are present primarily with psychiatric psychiatric complaints I think the other thing is that there are interactions between the psychiatric medications as Terry mentioned and many medical conditions and so have the psychiatrists who are experts and working with patients that have medical conditions and working with patients that might have medical conditions that give rise to the psychiatric situation. So those kinds of services I think are needed and the patient centered medical home and this collaborative care model is one way that services can be provided but still localized where patients come.

So it’s we know the challenges. There’s agreement on the challenges this is an option to be able to reach some of those places are still figuring out in many ways the business model the financial aspects the insurance aspects which is true of health care in so many different ways right now. Donna mayor from Coles County cares for her son with a mental illness. I thank you for joining us Harry wall and serves as C.E.O. of Mason District Hospital in Havana Illinois Hospital is offering tele psychiatry and the voice you just heard Dr Jeffrey Bennett he served as acting chief of the adult psychiatry division at Southern Illinois University School of Medicine in Springfield thank thank you all for your time today.

Thank you.

Even though we’re out of time here on the air we’re continuing this conversation on Twitter .

It’s all part of our series unmet needs living with mental illness and central Illinois Lindsey Moon and Shawn powers hosting a Twitter chat today right now the next hour to talk about mental illness and stigma in the community. What has been your experience. Tweet us use the hash tag we’ll chat. I’m Scott Cameron this is focus from Illinois Public Media.