Nebraska won’t erase its shortage of mental health care providers outside the state’s major cities by simply trying to attract them to rural communities.
The answer, said Dr. Thomas Magnuson, is telehealth, a secure videoconferencing technology that links patients and providers.
“I just think that there’s no other way that this could be solved,” said Magnuson, an associate professor at the University of Nebraska Medical Center who has used telehealth for 14 years to reach patients as far from Omaha as the Panhandle.
Nearly one-third of the state’s 93 counties have no mental health care providers, and 88 counties have a shortage, according to UNMC.
From Omaha, Magnuson can see geriatric psychiatry patients in almost all of those counties without providers. Many don’t need to leave their nursing or assisted living homes, he said.
A May 2018 University of Michigan study found telehealth’s use in mental health care across Nebraska is sparse. Their survey of Nebraska mental health care providers found only half of 42 respondents use the technology.
Some don’t provide the service because their clients live locally or have easy access to transportation. But others told the researchers they lacked training, the technology is too complex or clients hadn’t asked for it.
Telehealth advocates see reluctance among their peers to adopt the new technology and some organizations said they lack the needed support staff, the report found.
“Some providers or practices may be afraid of losing clients or patients to (telemental health) or have a fear of losing control of the practice or patients,” the researchers said.
Still, Magnuson and other care providers believe in telehealth’s power to reduce travel times and allow more people access to community-based mental health care as wait times grow.
Four years ago, the average wait for service at Blue Valley Behavioral Health in Southeast Nebraska stretched to three months, executive director Jon Day said.
His goal has been to expand service to clients across the 16 counties Blue Valley serves.
So Blue Valley turned to a telehealth network connecting its 12 offices, allowing clients in Falls City to see a counselor in Lincoln if need be, Day said.
After they implemented it in 2014, telehealth served 200 Blue Valley clients. This year, Day expects telehealth to serve 1,000 people.
That’s helped cut down waits for service to about a month, and the organization has seen 20 percent growth in the number of clients served.
Magnuson’s patients, who are 60 and older, have adapted to the technology.
“I have 90-year-old ladies who can do FaceTime,” the UNMC professor said.
And these telehealth sessions aren’t like the sometimes-interrupted FaceTime or Skype calls, Day said.
The calls are double encrypted to ensure security on both ends of the call, and Blue Valley’s offices are connected to high-speed internet to ensure strong signals and clear communication, he said.
Among clients who make an initial telehealth appointment, nearly all continue their treatment that way, Day said. Those who don’t like it can see someone in person.
The cost to install telehealth technology for mental health care has come down since the state first began outfitting various providers across Nebraska in 2008, the study said.
Researchers found the investment for the cameras and software can be less than $100.
It’s also used by law enforcement to connect with a trained behavioral health specialist who can identify what a person in mental health crisis needs to diffuse their situation, she said.
Jon Day, executive director of Blue Valley Behavioral Health in Southeast Nebraska believes telehealth in rural areas keeps patients from needing to be hospitalized at Bryan West’s mental health unit or taken to the Crisis Center in Lincoln.
“If you want to provide behavioral health services, there’s always going to be shortages,” said Day. “There’s always going to be not enough money. You have to be innovative.”