Fauquier Free Clinic increases the availability of mental health services by tele-linking patients with providers.
By Aimee O’Grady
It began with a nine-question form. Used by mental health practitioners, the Patient Health Questionnaire, or PHQ-9, asks the patient concrete questions about their sleep habits, interest in activities, appetite, and concentration, among other things. In the mental health field, the PHQ-9 is a multipurpose instrument for screening patients who may be suffering from depression. The form has been given to every patient who comes through the Fauquier Free Clinic for the past year. The findings have added fuel to the fire for advocates of mental health services.
“We always knew there was a problem, but with the shortage of resources, there was little we were able to do about it,” says Rob Marino, MSW, who has been executive director of Fauquier Free Clinic for the past 17 years. “Once we started collecting the forms and reviewing the answers, we knew the problem needed to be addressed.”
Thus began the pursuit of a solution to a problem that had grown for too long. The process began with a six-month planning grant from the PATH Foundation to the Fauquier Free Clinic and the Mental Health Association of Fauquier County. They worked with a 22-member planning team, including representatives from Fauquier Health, the Community Services Board, 13 primary care physicians, and other health professionals to develop a plan to increase access to behavioral health care through integrated and coordinated services using telehealth technology.
This group agreed that timely access to mental health care is a community-wide problem, and the best place to start would be forming a collaborative care model linking mental and medical health care at the Fauquier Free Clinic. Thanks to a $370,000 grant from the PATH Foundation, the group could do just that. “The patients who come to us are the most vulnerable in the community. If we cannot help them, they are unlikely to get help anywhere else. We have many people in our area who are right on the edge of being successful if they could get the help they need,” Marino says. “Most of the primary care physicians in the county also volunteer at the clinic and would have a chance to experience the program.”
“Although the simplest answer was to hire 17 more mental health professionals to meet with the people in the community who needed the help,” surmised Marino, “it wasn’t that easy.” After several brainstorming sessions, the group arrived at the solution—tele-psychiatry. Telehealth, a program already used at Fauquier Health in various departments, was already well-known and proven to be effective. But to consider using the same technology to address mental health, members of the group needed more information.
Marino recalls meeting several companies that provide this mental health technology, but wasn’t ready to approve them until he experienced it himself. Marino says, “So, I came into the clinic, logged on to the system (which uses a secure video connection) in one of our telehealth rooms using our computer and our internet. I wanted to experience it exactly as a patient would. And within a matter of minutes, I had forgotten that I was having a conversation through a computer screen, it faded away and I was just having a conversation.” In the clinic, every patient also has the option to meet with a counselor face-to-face. To date, only one person has made that choice after trying the telemedicine option.
The clinic now makes tele-psychiatry and telemental health counseling available to every patient who comes through the doors and presents with issues. With this added service, the Fauquier Free Clinic is now helping members of the community improve their overall health. “It is widely known that by addressing mental health, physical health can be improved,” says Sallie Morgan, executive director of the Mental Health Association of Fauquier County. “And in some cases, the treatment of physical ailments can be accomplished by addressing the symptoms of the mental health issue.”
This initiative created a new position, mental health coordinator, to help run the program. Shannon Raybuck, LPC, joined the clinic in October to fill this role. The magic, according to Marino, is the interaction and collaboration of the mental health coordinator with the doctors, patients, and counselors. “In a traditional setting, a patient will see their primary care physician who may recommend mental health therapy. Assuming the patient even follows up with a mental health professional, the primary care physician rarely receives feedback about the session, and if they do, it is from the patient themselves,” Marino explains. “We all know the stigma of mental health problems. If a patient is asked how they are feeling or if they are unhappy, they are likely to tell you they are just fine. It is not an easy question to answer,” says Morgan. Often, patients prefer to keep their records confidential with the mental health care professional, and it legally requires written permission from the patient for their records to be shared, even with their primary care physician.
The pilot program facilitates a more comprehensive system. With the patient’s permission, doctors receive feedback on every mental health session that occurs with their patients. This feedback comes from other practitioners in the field, and from the patient directly. “In the clinic, the coordinator assesses the patient, receives a report from the counselor which is read, and a doctor signs off on the chart before putting it back on the shelf,” adds Marino. With this system, doctors are not relying solely on patient feedback.
Raybuck could not be a more perfect fit for the position. Her experience, enthusiasm, and drive to help has moved her to attend court with patients, help them be admitted to substance abuse facilities, and connect individuals with countless county services, all in addition to her daily interaction with people at the clinic.
“The program has created breathing room among the doctors,” Marino explains. “Before, physicians were hesitant to even ask about mental health because they knew the resources to address the problems were scarce. Today, we have a successful model that is addressing these needs and helping people to feel better.” Marino shares the story of one patient who after several sessions confided in him that she didn’t know she could feel so good. “She just didn’t know it was even possible,” he says.
Perhaps most troublesome, is the statistic that most patients will wait ten years from the onset of symptoms before seeking treatment. “Mental health patients suffer for an entire decade before getting help,” Marino ponders, “that is simply not acceptable.”
The success of the collaborative care model and tele-mental health program is looking to move the group to phase II. “In this next phase, we are looking at ways to make the model program available through primary care practices within the broader community. We are considering a number of different scenarios, including a Wellness Center where local doctors could refer patients for evaluations and to be linked with local mental health providers or tele mental health providers,” says Morgan. Once patients are set up for care, they would even be able to link with tele-psychiatry or tele-mental health counseling from their homes.
The sky is the limit when it comes to the potential of this program. “We are working towards breaking down the stigma surrounding mental health. Asking patients on a simple form when they come to the clinic—for anything, even just a fall or a cold—is the first step. It’s a matter of conversation,” concludes Morgan.
The message from this group of experts is simple. They were not okay with the shortage of resources for mental health issues and are now committed to adding resources until needs are met. “We have an amazing community of doctors and members-at-large helping with this effort,” remarks Marino. Every patient who remarks on their new-found wellbeing reinforces that what the group is doing is not only needed, but effective.
The Fauquier Free Clinic accepts volunteers with a wide-range of experience, both medical and nonmedical. Visit the PATH volunteer portal at letsvolunteer.org. Visit fauquierfreeclinic.org for more information about the Fauquier Free Clinic.