Some community-based mental health providers throughout New Jersey don’t have the funds necessary for the telehealth technology needed to reach patients or the personal protective equipment (PPE) required to protect its staff, according to a Rutgers survey.
The Rutgers School of Health Professions surveyed mental health providers – who work primarily in outpatient department day programs, through mobile outreach services or through face-to-face services in residences and settings inside and outside hospitals – from more than 40 community-based mental health organizations.
This is a sampling of the 140 provider organizations that serve more than 90,000 people with serious mental health conditions, most of whom are unemployed and impoverished and some whom are homeless or homebound.
Ken Gill, associate dean and chair in the Department of Psychiatric Rehabilitation and Counseling, who conducted the survey with Aaron Levitt, a faculty member in the Rutgers School of Health Professions, answers some questions about the findings:
What were the major challenges reported?
The organizations reported dozens of adaptations that they made or plan to make to deliver telehealth, with varying degrees of success due to limits in their organizational infrastructure, existing technology and an inability to move staff to more in-demand services due to lack of expertise in those areas.
However, they note they are ramping up as quickly as possible. Other adaptations include obtaining PPE from alternate sources, providing the necessary training to employees who are idle due to closures, connecting with consumers via emergency contacts and providing community resources for consumers who have lost their jobs, need food and help advocating with landlords to prevent homelessness. They also are using universal health screening protocols to serve consumers when possible if face-to-face services are still needed for psychiatric crises.
One major challenge to telehealth is that many people they serve do not have access to smartphones, computers or conventional phones, which means providers have to meet face-to-face. Since these organizations generally have minimal need for PPE during normal operations and did not have regular suppliers, there was a lack of and inability to acquire adequate personal protection at the start of the pandemic, which created a major barrier to delivering mental health services.
What staffing challenges do these organizations face?
Respondents reported staff members who were idle or under-used due to services that had been closed, like day programs, and a shortage of staff for services that needed to be increased. Although staff have been re-assigned where possible, a mismatch of experience of existing staff and expertise that is currently needed has made placements difficult.
Also, the increased, unforeseen expenses of staff overtime and from purchases of technology, software, apps and PPE were significant for organizations dependent on public support and revenue from Medicaid or other sources. Revenues have already declined as expenses are already increasing. Lack of clarity in regulations has further confounded what was permissible and reimbursable in regard to remote supports, such as ZOOM, Skype or Facetime for both one-on-one and group communication.
What are some solutions to problems confronting healthcare providers?
Mental health providers are feeling intense stress in trying to deliver effective services during the pandemic. For moral and social support of staff, supervisors and administrators should check in with Mental Health Technology Transfer Center, which is funded by the Substance Abuse and Mental Health Services Administration and is providing support sessions and resources. The Mental Health Association in New Jersey is also providing support.
Both the funding and regulatory environments are changing quickly. The federal government is making money available for telecommunications services, information services and devices necessary to provide critical connected care services.
Statewide advocacy organizations as the New Jersey Association of Mental Health and Addiction Agencies and the New Jersey Psychiatric Rehabilitation Association are monitoring regulatory changes and sharing new guidance that has been coming out. Centers for Medicare & Medicaid Services, Medicaid and the Division of Mental Health Services are providing regulatory flexibility and guidance that we called for in the report. Check these sources frequently as information continues to change.