How to Decrease Wait Times for Mental Health Services

M Health Fairview has multiple sites of care for mental health services, with most services provided on a same-day basis or within 48 hours.

Editor’s note: This article appears in the July-September 2023 edition of HealthLeaders magazine.

Minneapolis-based M Health Fairview has succeeded in achieving short wait times for mental health services.

With a national shortage of mental health professionals including psychiatrists, many health systems, hospitals, and physician practices have struggled to provide timely access to mental health services. In addition, there has been increased demand for mental health services across the country.

M Health Fairview is a partnership between the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. M Health Fairview's mental health and addiction service line employs 200 physicians, about 50 advanced practice registered nurses, about 60 PhD-level psychologists, and about 120 masters-prepared mental health-licensed clinicians.

There are two primary reasons why demand for mental health services has increased, says Lewis Zeidner, vice president of the mental health and addiction service line at M Health Fairview. "One significant reason is that there is reduced stigma and people are more receptive to accepting care. A second factor is that during the pandemic there was a drop in access to care—many people isolated and they did not receive care, so we are seeing a rebound in terms of demand that goes along with that decrease in access, increased symptomology during the time they were unable to get care, and more crisis levels of need for care."

M Health Fairview offers multiple settings for mental health services, including the following:

• Hub sites: M Health Fairview has five hub sites in the Twin Cities region. Within a hub site, there is a suite of services that include psychotherapy, psychological testing, psychiatry, and addiction medicine. Some of the hub sites offer intensive outpatient programs.
   
• Behavioral health integration: M Health Fairview offers mental health services at 16 primary care and specialty clinic locations. The organization has embedded masters- and doctoral-level psychotherapists in the primary care and specialty care clinics. They function to provide same-day access for mental health services. These are brief visits, brief interventions, and brief assessments with referrals to higher levels of care. They can help bridge patients until they get into a specialty referral.
   
• Assessment center: M Health Fairview has an assessment center, which is used when a provider refers a patient and does not know what the patient needs or a patient does not know where to start. A patient can go to the assessment center and be seen by a masters-level mental health professional. Then the patient is directed to the right level of care. Access times for the assessment center are typically 24 to 48 hours.
   
• Transition clinic: The transition clinic is designed specifically for people who have a need when there is a delay in access. The transition clinic can see patients on a same-day basis, and the clinic can see patients through the period when they are waiting to get into the care that they need. It is not a substitute for care, but it is a bridge for patients waiting for psychiatric care, medication management, as well as counseling and therapies.
   
• Emergency Psychiatric Assessment, Treatment, and Healing unit: The EmPATH unit is relatively rare—there are about a dozen units across the country. The EmPath unit is designed to provide emergency mental health services without the drawbacks of a traditional emergency department, Zeidner says. "If you think about traditional emergency rooms, they are loud and structured with a lot of rules, and none of that is desirable for someone in a mental health crisis. The space we have created for the EmPATH unit is much more calming with appropriate lighting. Some people have equated the noise level to a library effect. In addition, the staff in the EmPATH unit are mental health professionals, as opposed to a traditional emergency department, where there are more generalists."

Rising to the staffing challenge

One of the reasons why M Health Fairview can achieve timely access to mental health services is through effective management of its mental health staff, says Chris Beamish, vice president of integrated and outpatient mental health and addiction services at M Health Fairview.

"We have a pipeline of trainees right out of graduate school and into our services. At any given time, we have about 45 openings across our service line, and we went from an average lead time of about 145 days to fill a position down to 60 days recently. Being able to hire learners and develop the next members of our workforce has helped us to create better access," he says.

In addition to the learner pipeline, M Health Fairview triages patients to clinicians with an appropriate level of license to ease the workload burden on psychiatrists, Zeidner says. "Historically, the model has been to send all patients to psychiatry; but, like everyone else, we have fewer psychiatrists than we wish we had. Not all of the work needs to be done by psychiatrists. So, we have begun to triage the work to the appropriate level of care, with an interdisciplinary team that allows us to use all levels of clinicians."

Embracing telehealth has boosted clinician retention, Beamish says. "There are a lot of employees who enjoy working from home and there is a high demand for telehealth. So, for many of our outpatient services, we have about an 80-20 mix of telehealth and onsite work. Staff may work one day onsite and four days working remotely from home."

Acknowledging the challenges mental health professionals face is also helpful for retention, Zeidner says. "The important piece to this is that the work is hard. If you do not acknowledge that the work is hard, then you wear people out. We do not have the level of burnout that other organizations have."