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Billings Clinic Launches Pilot to Increase Access to Mental Health Services

Jackie Yamanaka

Billings Clinic launched a pilot project to help rural primary care providers deliver mental or behavioral health care to their patients.

“Montana is at the epicenter of a mental health crisis,” says Dr. Eric Arzubi, chair of the Psychiatry Department at Billings Clinic.

He says there aren’t enough psychiatrists, so it falls upon primary care providers in rural areas to help their patients who are struggling with mental and behavioral health issues.

“It’s important to remember about 80% of all psychiatric medications are prescribed by primary care doctors not psychiatrists,” says Dr. Arzubi. “We can hopefully help that primary care clinician get more comfortable prescribing and handle some very difficult cases.”

To do that, his team at Billings Clinic will collaborate with rural based clinicians on individual patient cases and provide feedback and guidance using Project ECHO.

Credit Jackie Yamanaka
A mock consultation using Project ECHO. Clinicians can use slides and interactive video technology to discuss individual cases, provide feedback and guidance on patient care.

Dr. Arzubi hopes this peer-to-peer interaction will give his rural colleagues the confidence to treat their patients in their home communities.

Matt Kuntz, the executive director of the National Alliance on Mental Illness for Montana (NAMI Montana), calls Project ECHO a dream come true. He says it breaks down many barriers to delivering mental health care in rural states.

“Often the reality is is there’s a waiting time or there’s a waiting time and you have to drive 90 miles down the road,” Kuntz says.

A combination, he says, that often leads to a Montanan committing suicide.

Kuntz is excited this pilot project launch comes as communities are working to put into effect a directive from the 2015 Montana Legislature to establish community based, mental health crisis intervention and jail diversion services.

“ECHO has the ability to reduce hospitalizations through people who need treatment but typically couldn’t access it. So this kind of care can reduce long-term hospitalizations so I think it fits in really well with that desire to improve community services. It’s not going to eliminate the need for long term hospitalizations for some folks,” Kuntz says.

Governor Steve Bullock says the state of Montana has pledged $100,000 toward the pilot project, pending approval from the federal CMS.

Two insurers also immediately announced donations to help cover the costs of this pilot project.

Blue Cross Blue Shield Montana pledged $50,000/year for two years and PacificSource said it would donate a minimum $15,000/year for two years.

Dr. Monica Berner, the chief medical officer for BCBS Montana, says using Project ECHO to deliver mental health care makes financial sense.

“Anytime that you can manage a chronic condition before it escalates, anytime you can care for a condition in a local clinical setting so that that patient doesn’t escalate with their condition such that they have to receive care in an acute setting that’s certainly more cost effective,” says Dr. Berner.

Under the pilot project, up to 10 doctor’s offices and health clinics in rural communities throughout the state will participate in weekly tele-health clinics.