America’s Mental Health Is Worsening. Special Urgent-Care Clinics Step In.
Apr 11, 2024
Centers try to
ease a therapists shortage causing long waits for help
Bennington, Vt.—Amber Kelson said her 6-year-old daughter
Hadley had an outburst and other emotional problems at school in February.
The
local family-services department helped refer the girl to a new type of
urgent-care clinic, one that treats youths dealing with mental-health crises
rather than fevers, sprains and strep throats. A counselor was standing by to
see Hadley when she arrived.
“She worked with Hadley, she did an amazing job,” said Kelson, 42
years old, of Pownal, Vt. “She played, she loved it. They helped a child, and
she’s doing better.”
Mental-health
urgent-care sites are proliferating across the U.S. to treat the
spiraling numbers of children and adults who need mental-health care
and ease a shortage of therapists that has caused many people to wait months
for appointments or go to the nearest emergency room to find help.
The
sites are starting to change the face of mental-health treatment, offering a
much-needed alternative to emergency departments—long the first point of
contact for people in mental-health straits—that have become strained by an increase
in visits during the pandemic.
More
than 20 mental-health urgent-care centers have opened in the past year alone
from Colorado to Virginia. A letter published in
the journal Psychiatric Services in 2021 identified 77 of the clinics
across the U.S.
The sites can provide therapy and prescribe drugs or refer patients
to a higher level of care if needed, said Katherine Du, a University of
Pittsburgh School of Medicine student who was lead author on the letter. Some
are run by hospitals, while others were established by private-equity firms.
Many are in wealthy areas, but most accept Medicaid.
“We
want to get upstream to prevent the crisis,” said Dr. Aliya Jones,
executive medical director of behavioral health at the Luminis Health
Behavioral Health Urgent Walk-In Clinic in Lanham, Md., which opened in August
2022 and serves ages 4 and older.
Most visitors spend 90 minutes to three hours inside the
pastel-and-cream building. Staff, including mental-health clinicians, assess
the patients, and certain psychiatric nurses can prescribe medication. Anyone
deemed to be a danger to themselves or others is escorted in the safest way
possible to a nearby hospital.
Supporters
say the new clinics can provide better care than overwhelmed emergency
departments, while costing less. The sites also can see patients quickly, a big
difference from many psychologists’ offices, which have wait lists averaging
three months or even longer for appointments.
Yet even
backers harbor concerns such as whether the centers provide appropriate
follow-up care and whether they have enough expertise to correctly decide when
a patient should be referred for more intensive treatment.
“In concept, it’s a great idea,” said Dr. Robert Trestman,
chair of the American Psychiatric Association’s Council on Healthcare Systems
and Financing. “But it’s always in the details. What kind of follow-up is
there? Are they linked to primary care with support? That’s the real concern some
of us have.”
Demand
for mental-health treatment has surged since the onset of the
pandemic, especially among children and adolescents. Yet a shortage of
therapists means emergency departments don’t always have beds available, and
their care is expensive—$2,264
for a patient’s visit by one estimate.
Mental-health
urgent-care clinics, by contrast, promise to see visitors almost immediately. A
short visit can cost a few hundred dollars without insurance.
The Rochester Regional Health
Behavioral Health Access and Crisis Center welcomes adults ages 18 and older
without an appointment to walk in for mental-health concerns.
“It was quick and helped me with what I needed. It was very
supportive,” said Scharyta Wilkins, who is homeless and was diagnosed with
depression, anxiety and bipolar disorder. Wilkins, 31, was treated in February
at the center in upstate New York.
With a
pink kitchenette and mini trampoline, Psychiatric Urgent Care for Kids, or
PUCK, in Vermont is more like a fun recreation center than a sterile doctor’s
office. Instead of sitting at an exam table, patients can dangle in a hanging
swing. On a recent day, staff sought to engage children in activities aiding
relaxation: A clinician climbed into a life-size purple sensory sock that helps
relieve anxiety and excess energy, while a colleague stepped on liquid-filled
floor cards.
The
room is filled with sensory objects, including a weighted, buzzing bee that can
help soothe visitors.
The clinic is run by United Counseling Service of Bennington
County, a Vermont nonprofit that provides services such as outpatient
counseling and addiction treatment at its 15 facilities.
Some
of the young visitors arrive angry and upset, sometimes ripping down the window
blinds or charging at staff.
Clients
spend at least two hours while a team of clinicians provides a screening, and
also do therapeutic worksheets to help identify triggers for their emotional
challenges. They leave with discharge and safety planning and a follow-up
therapy appointment if needed. The cost varies based on length of time and
services provided, and the clinic also provides a sliding-fee scale and takes
Medicaid.
“We’ve
been asked by parents, ‘What are you doing up there, cause it’s working,’ ”
said Desiree Pechtel, the clinician who had climbed into the purple sock.
Source: Wall Street Journal