More than 23% of all adults in the United States have some sort of mental illness, according to the National Institute of Mental Health.
Couple that with a study out of the University of Wisconsin that found the average county has only one mental service provider for every 320 registered residents, and you can understand why St. Elizabeth Healthcare is getting creative when it comes to removing barriers to mental healthcare in Northern Kentucky.
Placing social workers in primary care offices is just one way the hospital’s behavioral health arm is working to make sure social workers are able to meet people where they are.
“They capture patients that may be there for any reason to see primary care and need those services same day,” said Lisa Arrasmith, a psychiatric nurse practitioner with St. Elizabeth Health physicians.
The University of Wisconsin study, called Health Rankings and Roadmaps, ranks each county in the United States based on factors from healthcare to access to affordable housing to job opportunities, then explores how those factors work together to affect the overall health of a community.
Northern Kentucky’s statistics are stark compared to the number of providers per resident nationally: In Boone County, there is one mental health provider for every 710 people; in Campbell County, there is one for every 570 people; and in Kenton County, there is one mental health provider for every 460 people.
This mirrors what we found during our interviews for this issue. The two biggest barriers to mental healthcare in Northern Kentucky, according to the people we spoke to, are stigma and access to care.
But Arrasmith, who is also the clinical director of Behavioral Health and Addiction Medicine at St. E, said the hospital system is doing everything it can to change that.
“We don’t want to be part of the barrier,” Arrasmith said. “We are always trying to make progress in access.”
She said the number of providers in Northern Kentucky has increased significantly in the last 10 years.
“I would say for St. Elizabeth physicians it has skyrocketed,” Arrasmith said.
In 2016, she said, St. E had two nurse practitioners, a psychiatrist, a psychologist and a therapist or two.
Now, St. E has around 55 behavioral health providers and another 15 to 18 providers in addiction, Arrasmith said. That includes psychiatrists, nurse practitioners, physician assistants, psychologists, social workers and counselors.
“We decided we need to increase the number of providers and meet the needs of the community,” she said.
The services they provide range from therapy and testing to medication management to inpatient psychiatric and medical care to nursing home psychiatric consults and medication management, and more.
And while St. Elizabeth is working to provide more mental health resources to the community, Arrasmith said an important thing to consider is everything that goes on behind the scenes.
No-show rates are a big problem for mental health providers, she said, so St. E has implemented strategies to improve those rates.
“Through our efforts, we’ve been pretty successful,” she said. “Our no-shows for patients have dropped down from 17 to 18 percent to 7 and 8 percent.”
That also means there’s bodies in seats, Arrasmith told LINK, which means there aren’t a lot of openings for new patients.
Providers are also seeing more acute disorders since COVID-19 that require specialized, long-term care.
“That takes a lot of time and effort on both people’s parts where they end up staying with you,” Arrasmith said. “We have discovered that our turnover rate is about 15 percent of our current caseload. So if you’re keeping 85 percent of your caseload year after year, you’re not opening up a lot of access.”
It’s hard to graduate more than that, she said, because of the way St. E treats patients and the complexity of the care.
The other barrier mentioned at length in our interviews was stigma.
“Stigma and the time that it takes to do the hard work is one of the bigger barriers,” Arrasmith said. “It’s not necessarily the number of providers we have.”
Mental health, she said, is not easy, and it’s not easy to talk about.
“They’ve got to be ready to accept the help,” she said. “I do see that that is probably the biggest barrier. Getting the patient to come and do it.”
Whether it’s a generational stigma that older adults may face or a stigma associated with substance use disorder that stems from other mental health problems, NKU’s Brittany Smith agreed that it is a real factor for many.
“The biggest barrier for people is stigma,” said Smith, who is a researcher and assistant professor in the Department of Psychological Science. “Society as a whole and providers need to overcome that stigma.”
Even if they are able to find a provider, getting the appointment covered by insurance or getting to the appointment – especially if a person has physical disabilities or lives in a rural area – can create even more barriers.
But this LINK Reader Super Issue isn’t about barriers. It’s about the solutions that people and organizations in Northern Kentucky are finding and trying to help reduce the barriers keeping people from addressing their mental health needs.
These things can be as simple, NKU’s Smith said, as using people-centered language.
“Not calling people addicts, but people with substance use disorders” is one example, Smith told LINK.
It can also mean putting resources for people who are dealing with substance use disorders as a result of mental health diagnoses in one place.
“It’s like, here, go to this treatment center and get this medication that will help,” Smith said. “Great, but that treatment center is 20 minutes from my house and I can’t drive.”
Having a one-stop shop for people, or even centralized resources that don’t require the need to go to multiple places for treatment or medications, is another example.
And that, said Arrasmith, is exactly what St. E is trying to do.
“I think that what I’ve seen over the last 6 to 7 years is a collaborative approach to care,” Arrasmith said. “And it’s gone more than just inpatient. We’ve now looked from going from, OK they were inpatient, they stepped to outpatient, we keep them stable, hopefully we can keep them out of outpatient care.”
Now, St. Elizabeth has social workers in primary care offices so that patients who may need same day services can see someone right away.
The solutions that mental health professionals are trying in Northern Kentucky range from finding ways to pay for mental health care, finding a holistic way to care for seniors, hiring social workers into police departments, and more.
Keep reading to learn more about Northern Kentucky’s approaches to caring for its residents’ mental health.
