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Building a Dedicated, Sustainable Behavioral Health Workforce

A strong workforce binds every complex network or system that supports human well-being. This is especially true in healthcare, where everyone from emergency responders to surgeons to pharmacists collaborate to protect and save lives. In rural communities, however, the healthcare workforce faces a severe shortage, compounding the impact of other barriers to accessing quality care created by geographic isolation. The situation is particularly acute for behavioral health care, where demand for trained professionals is increasing rapidly. As part of overarching efforts to ensure that where you live doesn’t limit the quality of care you receive, Helmsley’s Rural Health Care Program is taking steps to shore up the behavioral healthcare workforce in the region it serves, reflected in $12.6 million in awards made since 2013.

These awards – spread across nine grants – reflect a commitment to first understanding community needs through research. Helmsley’s initial behavioral health investment led to a partnership with the Oregon Health & Science University Center for Health Systems Effectiveness to conduct a comprehensive population-wide health needs assessment in South Dakota. OHSU’s assessment resulted in unprecedented availability of data about behavioral health in SD.

Building on this, in 2015 a grant to the South Dakota Department of Health supported a task force that examined the intersection of mental health and the South Dakota criminal justice system. South Dakota had a backlog of competency assessment evaluations—leading to long wait times in jails and delays in court proceedings. With Helmsley support, the Task Force on Community Justice and Mental Illness Early Intervention – led by the South Dakota Supreme Court Chief Justice – was formed to study how individuals with mental illness encounter law enforcement and move through the court system, jails, and probation. The taskforce identified a need to help law enforcement better identify mental illness, safely address crisis situations, and understand their options. Ultimately, more resources were allocated by the state for training law enforcement officers, jail personnel, and courts, enabling more effective responses to supporting those with mental health needs within the criminal justice system.

Primary care physicians who work in rural areas may struggle to meet the behavioral health needs of their patients. Adapting novel approaches to supplement the behavioral health workforce is one solution to this challenge. In 2014, Helmsley granted to Montana’s Bighorn Valley Health Center in Hardin to implement the innovative Improving Mood – Promoting Access to Collaborative Treatment (IMPACT) Depression Care Model, an integrated approach to care that increased access to effective depression treatment for low-income patients. IMPACT provides a team approach, keeping the primary care physician and patient in the center with support from a care manager, therapists, and as needed, a psychiatrist. Across the state in Butte, the Southwest Montana Community Health Center – a healthcare center serving the frontier region – also implemented IMPACT’s collaborative approach to depression treatment the same year. Both IMPACT grants allowed the model – already proven effective in urban settings – to be expanded to rural settings.

Similarly, the Billings Clinic Psychiatric Stabilization Unit, funded in 2017, is a standout for being the first rural hospital to adopt the Alameda model – originally developed in the Bay Area as an approach to meeting the unique needs of patients in psychiatric crisis who present in emergency rooms. To date, Billings reports improved outcomes for patients since implementing the Alameda model, including reduced emergency department wait times and fewer patients in psychiatric crisis needing to be admitted as inpatients.

Around the same time that the Billings Clinic decided to test the Alameda model, data indicating the low prevalence of psychiatrists in Montana spurred a plan to address a statewide psychiatric workforce shortage. Montana was one of three states without a psychiatric residency program – in other words, no direct pipeline for trained doctors to support its people over the long-term.  With Helmsley support, the Montana Psychiatry Residency Program launched in 2018, led by the Billings Clinic in partnership with the University of Washington, with a goal of increasing the number of practicing psychiatrists serving rural communities. Beginning with its first cohort of residents in 2019 (the residents will spend two years at the University of Washington before completing their program at Billings Clinic), the program provides training, leadership opportunities, and reinforces the value of committing to work in rural states.

Each community should determine how to best meet its needs – and a first step is often understanding what those are. That’s why in 2018, Helmsley made a grant to Pennington County Health and Human Services. Pennington County, which includes Rapid City, is southwestern South Dakota’s hub for healthcare services. This grant enabled a range of 32 stakeholders who comprise the region’s West River Behavioral Health Alliance to meet and align regarding priorities for improving behavioral care through a partnership with The National Council for Behavioral Health, which is conducting research. The findings will be used to develop a concrete plan of action for a more effective rural behavioral health system.

A new option for counties like Pennington is to expand behavioral health care using telemedicine, which leverages technology to extend the capabilities of the workforce. Helmsley is a long-time investor in Avera’s telemedicine offerings, including its newest program eCARE Behavioral Health. Through a $7.8 million grant, Avera has built a team focused on providing psychiatric services to hospitals and inpatient units. This allows these sites to continue to provide services locally without interruptions or delays for patients if a staff psychiatrist is not available. Helmsley is also funding the development of a psychiatric telemedicine certification program by Avera. This program will set the standard of quality for psychiatric telemedicine services, which will be an important complement to other efforts to enhance and grow the workforce.

Behavioral health programs are a challenge to staff and fund in rural areas. Dedicated, trained professionals that offer care that responds to local needs are key to sustainability. Helmsley’s Rural Healthcare Program is committed to supporting efforts that ensure that no matter where you live, behavioral care is within reach.