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Minute-clinics for mental health care pioneer in giving quick relief to patients

October 13, 2014


MINNEAPOLIS ó Even on her worst days, Shirley Thompson used to have to wait weeks to see her psychiatrist to get help with her bipolar disorder.

"You canít put a date on your depression," she said.

Itís a problem shared by millions of mental health patients across the country. In Minnesota alone, nearly 168,000 adults live with a serious mental illness and one in four experiences a mental illness of some kind in a given year. Acute shortages of mental health professionals fuel growing delays for appointments.

But now, Thompson finally has a way to get help. Fast.

Instead of waiting weeks for her next scheduled appointment, she can stop in at a momentís notice to see her psychiatrist at the Hennepin County Mental Health Center.

The center is on the cutting edge of a movement to deliver mental health care quickly and conveniently ó mirroring the minute-clinic model for flu and colds.

Hennepin County officials say its drop-in program at the center, located on the outskirts of downtown Minneapolis, is the only one of its kind in the Twin Cities. For now, it only sees patients already connected to a doctor there ó the service is not open to walk-ins off the street. Nationally, clinics are experimenting with other quick delivery methods, from mobile apps to iPad kiosks. A grocery store in Philadelphia recently began offering online screenings for mental health to its customers.

"Thereís a shortage of psychiatrists and prescribing nurses all over the place," said Sally Kratz, manager for the countyís Mental Health Center.

Almost 91 million adults live in areas where a small number of mental-health professionals makes finding treatment difficult, according to the U.S. Department of Health and Human Services. Nationwide, the problem is getting worse as more psychiatrists retire without enough graduates in the pipeline. During a recent five-year span, as the U.S. population grew nearly 5 percent, the number of psychiatrists hardly budged, according to the Association of American Medical Colleges. So experiments with delivering care in new ways are sprouting.

"The wave of the future is really more along the lines of having integrated care where a provider or group of providers can really treat the whole body at the same time and know how things will interact," said Alyson Ferguson of the Scattergood Foundation, which funded the Philadelphia kiosks.

Hennepinís program recently was honored as a "model practice" by the National Association of County and City Health Officials.

The Hennepin County program aims to reach patients who have had trouble keeping appointments ó a factor that is crucial to their care.

Often, depression contributes to missing appointments, county officials said, as some patients get confused easily and have trouble keeping track of dates.

"Previously, if you missed an appointment, it could take months before you came back in," Kratz said.

The center treats about 3,800 people a year ó mostly those with serious or chronic mental illnesses, many of whom also are battling chemical addictions. It offers all patients diagnostic tests, individual and group therapy and medication management.

But on drop-in days at the center, patients can receive an instant 20-minute consultation with a therapist and also have their medications adjusted. To make room for drop-ins, each therapist at the Hennepin County center reserves several hours a week for patients who donít have an appointment.

The county is seeing results. In the past two years, the number of patients participating in mental health consultations with their therapist has gone up threefold, from 110 to 375, according to county officials. There also have been fewer costly visits to the emergency room for psychiatric care since the drop-in hours started.

"Being able to get in quickly and get responsive care has made a difference," Kratz said.

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Mental health advocates elsewhere are pushing the envelope in different ways. A Shop Rite grocery store in Philadelphia allows shoppers to take an online mental health assessment at an iPad kiosk.

"Itís right next to the blood pressure cuff and the pharmacy," Ferguson said. "We made it a whole wellness corner and rebranded the area."

The iPad screening tool doesnít issue a diagnosis, but it does provide a list of resources in the area. While there are no mental health professionals available on site, the staff at the in-store primary care clinic has been trained in "mental health first aid," the Scattergood Foundationís Ferguson said.

"The kiosk is a great step in elevating the conversation that mental health really needs to be an integral part of your overall wellness," she said. "Itís a great way to push against the mental health stigma and everything that goes along with it."

The minute-clinic model for mental health services is an idea with promise, says Ed Eide, executive director of the Mental Health Association of Minnesota.

"Any way we can make any health services more accessible to people, we all will be healthier," he said.

But he cautioned that the retail setting could be problematic. For one thing, itís not discreet, he said. Another concern is there are no mental health professionals on site.

"When youíre working on the brain, itís a little bit different than if youíre working on my ankle," Eide said. "It takes special training and it takes a better understanding."

At the Hennepin Mental Health Center, Dr. Ngozi Wamuo says the drop-in hours have helped her see her patients more often, and that has led to better outcomes.

"Usually we see people once in three months," she said. "For people like (Thompson), the drop-in really has helped. Itís allowed us to see her on a weekly basis and also on her own time, so we can meet her where she is at."

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For Thompson, who has myriad issues, quick access to her psychiatrist on days when she needs it most has helped her stay on track.

Sheís survived drug addiction and prostitution, and says she is now focused on staying healthy and being a good mother to her toddler son, Zantrell. Her psychiatrist proudly noted that Thompson had recently graduated from a parenting class.

"Iím happy that Iím able to walk in that door and see people saying that Iím a good mom," Thompson said. "Thatís the best feeling."

Her 1-year-old is often by her side at the drop-in visits.

"Iíve been through a lot," she said, wiping tears from her face, and sometimes that has made it difficult for her to get to appointments and continue her treatment. "I basically was about to give up. With this walk-in clinic, there is no giving up. I can walk in here, guaranteed to be seen. Itís like a security blanket."

 

 


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