Expanding mental health services in Virginia through virtual care

The state of Virginia is facing a shortage of mental health professionals.

Many free and charitable clinics provide primary care to patients, but aren’t equipped to help those with behavioral health needs. But a partnership to offer mental health services through telehealth is expanding access to patients with lower incomes.

The Virginia Telemental Health Initiative is partnering with clinics across the state to offer free mental health services. Backed by some state funding, the initiative has expanded from 10 to 30 clinic partners over the past year.

Mara Servaites, executive director of the Virginia Telemental Health Initiative, says there are pressing needs for mental health services in all areas of Virginia.

“There are just not enough providers to serve all of the patients who are in need of services,” Servaites tells Chief Healthcare Executive®.

“There are patients across the Commonwealth, and particularly those who may or may not have insurance, who may be in a lower income bracket, may or may not have access to mental health services in their communities or be able to afford them. There's quite a few barriers that exist,” she says.

The telehealth initiative has partnered with clinics in northern Virginia, including Arlington and other communities near Washington, D.C., Richmond and central Virginia, the Tidewater region, and down into southwest Virginia.

“Patients are coming from all over the commonwealth,” Servaites says.

(See more about the telehealth initiative in this video. The story continues below.)

Training providers

The initiative also aims to help develop more mental health professionals.

The program utilizes a host of mental health providers as volunteers, including those who are working to gain professional licensure but need to acquire more hours working with patients.

The volunteers are paired with clinical supervisors and patients with more pressing needs are directed to appropriate services, says Robin Cummings, deputy advisor for strategy and quality of the Virginia Telemental Health Initiative.

“Our folks are managing patients that have pretty complex mental health and emotional health needs,” Cummings tells Chief Healthcare Executive®. “I think they're really well supported by our cohort of clinical supervisors. And then we've also been able to add in some licensed providers to support those folks that really have that highest level of need.”

Some of the patients seeking assistance are dealing with more serious conditions than officials initially predicted, Cummings says.

“We discovered the acuity of our patients was higher than we had expected,” Cummings says. “So in our early conversations with folks, we were expecting the worried well to be those who came to us. We knew that our patients would likely also have a lot of other social challenges or financial sustainability challenges. So we had anticipated that piece, but our folks are managing patients that have pretty complex mental health and emotional health needs.”

The telemental health effort also encountered other unexpected challenges, including a number of areas where broadband coverage couldn’t support video visits. Servaites said those issues are found in “pretty significant pockets of the state.”

“We were expecting it in the rural areas, but we weren't expecting it quite as much in some of the more suburban areas,” she says. “So that was definitely a learning curve for us.”

The initiative has recruited bilingual volunteers, since one out of five patients who have needed services use a language other than English.

“Having an interpreter come into a 60-minute appointment is not only financially expensive, but also can create a dynamic with the patient, where it's a third party in the room when they're disclosing traumatic events and things that have happened to them that they may not want another person to know about,” Cummings says. “So we have been really intentional about recruiting bilingual volunteers.”

Read more: Telehealth providers say virtual care must evolve, but it’s not going away

Patients with many needs

Many patients are managing the stress of poverty, and some are dealing with domestic violence.

Some are also dealing with the intersection of physical health and mental health. The clinics draw patients who are dealing with chronic issues such as diabetes and hypertension, but some are also battling cancer and other life-threatening diagnoses.

Many of the patients using the telehealth service are working shift work or multiple jobs, and they simply aren’t available during typical office hours.

Some volunteers are holding virtual visits on evenings and on weekends.

“They have very limited availability to actually make it into an office,” Cummings says. “Some of our volunteers provide therapy at 10 p.m. at night or 7 in the morning, or on a Sunday afternoon, because that's when the patients have their only free time.”

Some also don’t have reliable transportation to get to an office, so they’re using the option of telehealth. Many residents in smaller communities have also welcomed the chance to talk about their mental health with a professional who doesn’t work in their hometown.

“We heard a lot in our focus groups that folks didn't want to run into their therapist at the grocery store in their small town,” Cummings says. “They wanted to have a little bit of that separation from a physical perspective.”

Many patients nationwide prefer accessing mental health services via virtual care. About 60% of all telehealth visits involve appointments for mental health needs, according to data from Trilliant Health.

Keys to success

The Virginia Telemental Health Initiative has found success by focusing on each of its three customer bases, Servaites says: its clinics, its mental health volunteers, and the patients.

“Each one of them is really critical in terms of making this model work,” she says.

Cummings also says that providers offered valuable guidance in designing the program, and they’re gathering feedback from patients.

“We listen to our patients about what kind of care they need, what kind of specialty they need,” Cummings says. “And so I think it's kind of been almost like an organic growth from each of those groups about what's important to them, what works well for them.”

For others that may look to launch similar telehealth efforts to expand mental health access, Servaites stresses patience.

“We've tried a lot of things, and we continue to try things, and sometimes they succeed and sometimes they don't. And so I think patience and flexibility are really critical,” she says.

She also points to staying true to the mission.

“What we really want to do is be able to break down the barriers that are keeping patients from being able to access mental health care,” Servaites says. “And then we want to accelerate getting mental health professionals into full licensure so that they can be serving more patients themselves. So I think it's important to stay true to what drives you because it can be a really rocky road.”

Cummings also points to the need to have strong connections with partnering clinics and communities to help patients.

“When you work with a patient population like ours, it's really important to have that community connection, so that you know what services are available to your patients. You know that there's somebody who can refer them if they're in need of additional care, or if they're in need of social support,” Cummings says.

“Without that community connection, I don't know that we could serve our patients as well as we're able to right now,” she adds. “It's really a terrific partnership.”