Support for Providers Caring for Patients with Mental Health Needs

Recent data estimates 22% of the state population or 1,269,000 Washingtonians have a diagnosable mental, behavioral, or emotional disorder. The problem is that for far too many, access to behavioral health care is not just limited, it is nonexistent. Some Washington counties have no practicing psychiatrists and for those that do, wait times for appointments are not measured in days or weeks, but months. Couple that with an increase in the number of people who have seriously considered suicide and that the highest risk of suicide due to the pandemic is expected to occur between October and December 2020 and put simply, we are facing a mental health crisis. Some mental health experts call it a perfect storm.

But this isn’t news. Limited mental health resources and the mental health workforce shortage is well-documented. Between 2017 and 2030, the expected number of new entrants into the field of psychiatry is woefully short of the number retiring. In ten years, the supply of psychiatrists, nurse practitioners and psychiatric physician assistants may help blunt the shortfall, but it will not offset it. In Washington state, there are several efforts to help improve available mental health resources.

To increase our infrastructure, there are new facilities in the works. In November, King County voters approved a $1.74 billion bond to support improvements over the next 20 years at Harborview Medical Center. Of that funding, $79 million is designated to expand capacity for Harborview’s behavioral health services and programs. In 2023, UW Medicine will open a new behavioral health facility to offer more treatment beds. For those interested in the field, there is an effort to create a Behavioral Health Support Specialist bachelor-level credential, and additional psychiatry residency and fellowship positions have been added to the UW School of Medicine. But these are long-term solutions. Given the importance of mental health access and its effect on better treatment adherence and patient outcomes, what we really need is to help health care providers who are de facto mental health practitioners now.

  • The Psychiatry Consultation Line (PCL) is available seven days a week, 24 hours a day and helps prescribing providers with patients who are 18 and older. Started in July 2019, callers from primary care clinics, community hospitals and emergency departments, substance use treatment programs, county and municipal correctional facilities, and other settings, can get help with their patients’ assessment, diagnosis, and treatment planning, including medication management, from faculty of the UW Medicine Department of Psychiatry and Behavioral Sciences. Within 24 hours of the consultation, the provider requesting assistance receives a written summary of the recommendations. There are no restrictions on the number of times a provider may call the PCL at 877-WA-PSYCH (877-927-7924) and follow-up calls regarding a particular patient’s progress or changing needs are welcome.
  • The Perinatal Mental Health Consultation Line for Providers (PAL for Moms) provides support for any provider caring for pregnant or postpartum patients (that includes midwives and doulas). By improving mental health for this population, experts believe more serious mental illness can be avoided. Started in January 2019, the consultation line is available weekdays from 9 am to 5 pm. Common topics of consultation include anxiety, depression, substance use disorders, or other psychiatric disorders, such as bipolar disorder or post-traumatic stress disorder. Callers to PAL for Moms at 877-725-4666 (877-PAL4MOM) will consult with faculty members with perinatal mental health expertise at the UW Medicine Department of Psychiatry and Behavioral Sciences and will receive written recommendations following the consultation.
  • The Partnership Access Line (PAL) was the first psychiatric consultation line established in Washington state, started back in 2008. Now it provides mental health support for primary care providers caring for pediatric and adolescent patients regardless of insurance type in Alaska, Washington, and Wyoming. In Washington, in addition to providing psychiatric consultation, a master’s level social worker is available to assist doctors, nurse practitioners, and physician assistants with finding mental health resources to help patients under 18 years old, weekdays from 8 am to 5 pm at 866-599-7257. Based out of Seattle Children’s and staffed by psychiatrists with expertise in child and adolescent psychiatry at Seattle Children’s and the UW Medicine Department of Psychiatry and Behavioral Sciences, assistance was provided to 3,218 calls to PAL in the 2019 to 2020 fiscal year.

While these consultation lines cannot address our state’s mental health crisis in totality, they are critical to helping caregivers provide patients with important mental health treatment support now. “These psychiatric services help ensure children and adults with behavioral health needs receive high-quality services at the right time and in the right setting,” said MaryAnne Lindeblad, State Medicaid Director at the Health Care Authority. “We hear regularly from providers how important these services are to helping them with complex medication, diagnosis and treatment situations. These services also help to keep the care with local community providers, which is good for the patient, their families and the system.”

Feedback to the program has been overwhelmingly positive, with comments from providers such as “amazing,” “fantastic,” and “wonderful.” One captured the downstream effects perfectly, “It makes me feel so much more confident to know that I have an expert available for tricky questions, and then I can apply that knowledge to my next patient in a similar circumstance.”

You can help spread the word about these valuable resources, by passing them along to an individual or organization that can help get the word out to providers.