Free clinic now offers psychiatry online

YORK — A screen on Rob Bradley's desk at Lackey Free Clinic turned on and the words "incoming call" appeared.

With the touch of a button, Dr. Avtar Dhillon, a psychiatrist in an office seven miles away, showed up on the screen.

This is telepsychiatry — a way that Colonial Behavioral Health psychiatrists can consult with patients at free and reduced-fee clinics.

"It's like sitting and talking to somebody in a doctor's office," said Dhillon, Colonial's medical services director.

Telepsychiatry is one of the new features of the Chronic Care Collaborative, made up of four health clinics, Colonial Behavioral Health and Rx Partnership, which provides free medicine to the uninsured. Colonial is the community services board that assists people affected by mental illness, intellectual disabilities and substance abuse in Williamsburg and Poquoson, and in James City and York counties.

The idea is to create a patient-centered medical home for patients of free and reduced-fee clinics. The patient-centered medical home is a concept that gained traction in the wake of health-care reform. The concept is that a patient's primary-care physician would work with other health-care providers to see to a person's comprehensive health. The link between patients and specialists was already in place through Project CARE. Now, the collaboration is linking patients to behavioral health services.

"There's a high proportion of the safety net patients who have mental health isuses that have not been addressed. And the recession has further exacerbated this. Stress is up," said Paulette Parker, senior program officer at the Williamsburg Community Health Foundation.

"Mental health services were identified from the outset as a critical component of health care," she continued. "We're a proponent of integration of primary care with behavioral health. It promotes the health of the whole person going forward."

A 2006 study showed that the life expectancy of people with a serious mental illness is on average 25 years shorter than general population. That shows they don't seek care for their primary-care problems.

"They may not be in the position of having the skills and the mindset to take care of themselves," Coe said.

The Chronic Care Collaborative started a few years ago with training of clinicians by a psychiatrist to spot signs of behavioral health conditions and refer them to appropriate services and treatment. The project also brings Olde Towne's primary-care van to Colonial Behavioral Health's campus once a week. Total funding this year for the collaborative is $766,000.

The collaboration also includes A New Lease on Life, provided by a Virginia Health Care Foundation grant. It provides face-to-face psychiatrist time with patients at Olde Towne Medical Center and Lackey Free Clinic, as well as individual and group therapy with licensed clinical social workers, said David Coe, executive director of Colonial Behavioral Health.

The latest offering is telepsychiatry.

"It's a lot more efficient than having the psychiatrist get on the road all the time to try to see patients in other locations," Parker said.

It's also more efficient for nurse practioners, who were being bombarded with questions about depression. Once the patients are connected to Colonial services, the practitioners are freed up to focus on medicine, Bradley said.

It also helps people get help faster because they don't have to schedule an appointment at Colonial, Dhillon said. Plus, they're seen in an environment they're already comfortable in. For some, the stigma of having a mental health problem might hinder them from going to Colonial, he said.

At Lackey, telepsychiatry consultations happen in Bradley's office. He's clinic's executive director and a licensed clinical social worker.

Depression, stress and anxiety are some of the more common behavioral health problems they see, Bradley said. Depression will affect your numbers if you're diabetic, he said.

"You're going to get better outcomes" if you address behavioral health and medical problems, Bradley said.

One woman enrolled in the program who suffered from anxiety recently gave a presentation during a tour at Lackey.

"Before, she couldn't even get in her car to drive," Bradley said. "It's been a huge gain for us."

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