Collaborative research demonstrates ways to overcome barriers to rural mental healthcare access

Access to mental health services can be a struggle for residents of rural areas. A recent study conducted by the University of Washington with help from Washington State University demonstrated that telepsychiatry can be beneficial for patients with bi-polar disorder and PTSD.

A man in a blue jean shirt stands in a green field with a silver laptop and mountains in the distance.
Specialized healthcare can be hard to come by in Washington’s remote rural communities, but telepsychiatry can be an option.

Outcomes of a five-year Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) were published August 25, 2021 in  JAMA Psychiatry.  Dr. Danna L. Moore, associate research Professor in WSU’s School of Economic Sciences was a co-author. University of Washington’s lead investigator John Fortney ask Dr. Moore to join his research to help develop high quality data collections using cutting-edge survey methodologies.

Funded by the Patient Centered Outcome Research Institute (PCORI), the project used a randomized control trial to compare Telepsychiatry Collaborative Care treatment with Telepsychiatry Enhanced Referral. More than 1,000 people from 12 federally qualified health centers and 19 clinics took part and received services for a year.

The WSU team helped develop and implement mixed web, telephone, and mail data collection using  incentives for participation. The team also coordinated with UW researchers and clinics to monitor and document outcomes for specialty mental health services and to establish efficacy of treatments.

Dr. Nick Ponomarev, scientist at WSU’s Social and Economic Sciences Research Center (SESRC), collaborated with Moore and UW researchers to design a tailored research portal which collected participant status in recruitment, enrollment, randomization, treatment assignment, surveys, and customized reports. Dan Vakoch, also an SESRC scientist, was the survey data manager.

Through the portal, messages could be automated in real time in case a safety intervention was needed. “This worked to help keep patients safe,” said Moore.

Two interactive video approaches for remote specialty mental health services were studied at participating clinics, including one-on-one referral services with a psychiatrist or licensed clinical psychologist, and collaborative services with a tele-psychiatrist and care manager who supported visits with a primary care provider. The model was pioneered at the UW School of Medicine to allow a psychiatrist to manage more patients than a traditional referral model.

The study found patients who screened positive for PTSD and bi-polar disorders were treated successfully with both types of telepsychiatry treatments in rural, federally qualified health centers.

Patients in both groups of the study reported substantial improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life. The positive outcomes were the same across age, gender, and ethnic demographics.

Results are important for federally qualified health centers, which receive funds from the Health Resources & Services Administration Health Center Program to provide primary care services in underserved areas.