Sign up for The Brief, the Texas Tribune’s daily newsletter that provides readers with the most important Texas news.
For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administration’s toll-free helpline at 800-662-4357. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.
Rural hospitals across the state are facing a shortage of mental health care providers, with more than 60% of rural counties designated as provider shortage areas by the Health Resources and Services Administration.
At the same time, the number of people experiencing mental health crises is increasing, and these patients are often forced to seek treatment in local hospital emergency rooms, where they face long wait times for treatment. in the face of serious illness and accessing the resources that critically ill patients need. conditions.
Terry Scoggin, CEO of Titus Regional Medical Center (TRMC), said that even though ER doctors are not trained to treat mental health conditions, he and other rural He said hospital ERs are primarily where mental health patients are transported.
“Emergency departments are very busy, chaotic, and life-or-death areas. It’s not the best environment for people with mental health or drug overdoses,” Scoggin said.
Emergency rooms are the last resort for rural mental health
Located in rural northeast Texas near the Arkansas border, Titus County has one psychiatrist and four licensed clinical social workers serving 33,000 people in Titus and surrounding counties. serving people. Considering population, there are about two-thirds fewer health care providers than the rest of the state, according to the Texas Department of State Health Services.
Titus mental health providers also care for patients in surrounding counties with even fewer resources.
“There’s one psychiatrist in every five counties we serve, so you can see there’s a lack of opportunity,” Scoggin said.
Without preventive care, people facing mental health crises in rural counties like Titus end up in the ER. Some are brought there after public disturbances. Some were brought in by relatives.
Patients who enter the ER may spend days or even weeks waiting to be evaluated by local mental health officials before being discharged or transferred. For patients at Titus Hospital, which doesn’t have a psychiatrist on staff, it’s the Mount Pleasant Mental Health Clinic, which serves four counties but is struggling to keep testing patients.
In Titus, patients with mental health needs are typically taken to Terrell State Hospital, where wait times are also long.
“Terrell remains full. That’s what it is. It’s not us, it’s Terrell,” said Rachel Sills, director of the Mount Pleasant Mental Health Clinic. Sills said her team calls Terrell daily when transporting patients, and she sometimes waits as long as 14 days for an opening.
Kathy Griffith is vice president of clinical operations and chief nursing officer at Titus Regional Medical Center. She worries not only about patients with mental illness, but also about the staff who sometimes deal with violent patients during long ER stays.
Brittany Bakaku, a licensed clinical social worker, said the isolation mental health patients experience while waiting in the ER can worsen symptoms and lead to violence against staff.
“When you put a client in a room and they have to stay in that room and they can’t leave the room for days on end, people get excited, right?” says Bakaku, an instructor at the school. Prior to earning her doctorate in social work and teaching at Texas State University, she spent eight years working in Texas emergency rooms at rural and urban hospitals in Bastrop, San Marcos, and Austin.
Telemedicine in the ER could reduce violence and provide more timely care for patients
Concerned about the long wait times experienced by mental health patients in local ERs and the associated danger to staff, Griffith worked with colleagues at Baylor University Medical Center and St. Luke’s Health in Lake Jackson to help ER physicians We explored the use of telemedicine to help treat mental health patients. Eventually you will be assigned to your own department.
A year later, the state Legislature appropriated $7.4 million over two years to fund telepsychiatry services for local hospitals, based on Griffith et al.’s research.
The pilot program began in March in Titus and Knox counties. Texas Tech University psychiatrists contracted with the Texas Department of Health and Human Services are available to local hospitals 10 hours a day, seven days a week, and ER physicians treat mental health patients in the ER within the first 24 hours. can be started.
“Now you can at least get a diagnosis and a prescription and maybe even be discharged into the community instead of being discharged to another hospital,” Scoggin said.
Sills, of the Mount Pleasant Mental Health Clinic, welcomes the program because it reduces workload and helps move patients to more appropriate care settings in less time.
“This is a very high-risk, high-volume clinic, so local psychiatrists (via telemedicine) and paramedics will probably be able to move some people faster, whatever that means. I think it’s really helpful to advise them on whether it’s letting them go, getting them somewhere else, or allowing them to get treatment,” Sills said.
Griffiths hopes to demonstrate the program’s effectiveness and secure future funding, but the challenges of providing mental health care in rural areas extend beyond the ER. A shortage of health care providers makes it difficult to access ongoing mental health care in rural areas, even for those with private health insurance.
“I think we need to look at our community mental health infrastructure,” Scoggins said.
Liza Kalinina is a graduate student at Texas State University and an intern with Texas Community Health News, a joint venture of the School of Journalism and Mass Communication and the university’s Center for Translational Health Research. TCHN’s stories, reports and data visualizations are free to Texas newsrooms.
Disclosure: Baylor University has financially supported the Texas Tribune, a nonprofit, nonpartisan news organization funded in part by contributions from members, foundations, and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. See the complete list of them here.
Big things are in store for the Texas Tribune Festival, which takes place September 5-7 in downtown Austin. Join him for three days of big, bold conversations about politics, public policy, and the news of the day.
