I could not ever hire enough psychiatrists to meet the need here. — A psychiatrist in rural Georgia

For many years, video-based telepsychiatry sessions have been talked about as the savior for us all, removing barriers to access quality care for all patients in need of mental health services. Today, it’s clear that video session are but a part of a more complete solution. Allowing patients to see their psychiatrist remotely remove problems with transportation and scheduling. This also addressed the uneven geographic distribution of psychiatrists, especially in rural areas. However, as we implemented video sessions the nation over, it became clear that video sessions alone do not address all of the issues pertaining to access to psychiatric care. More definitely needs to be done.

As of May 2015 (the most recent data available), there are 24,060 psychiatrists in the U.S.- that is, one psychiatrist for every 13,304 Americans. The US Department of Health reports that over 2,500 more psychiatrists are needed nationwide, and that 44% of all Americans live in one of almost 4,000 counties with severe shortages of psychiatrists, where there are more than 30,000 people per psychiatrist. The U.S. not only suffers from uneven geographical distribution of psychiatrists, but it suffers from a nationwide shortage, as well.

See if your area is experiencing a health professional shortage HERE

For those of us in the healthcare industry, this shortage of providers is the scary daily reality. There are long waits for a diagnosis, long waits between visits, long distances to find the nearest psychiatrists; all of these negatively impact patients’ access to needed care. Furthermore, with swelling caseloads, many psychiatrists are overworked, burned out, and pressed for time with each patient.

This is where telepsychiatry visits are an incomplete solution — video visits remove some inefficiencies, but still require one-to-one time between psychiatrist and their patients. As a result, telepsychiatry visits Many health systems extend their psychiatrists through psychiatric nurse practitioners, and masters-level providers, such as social workers and counselors. However, this is not enough. Many clinical issues cannot be sufficiently handled by staff working under the psychiatrist. Again, more is definitely needed.

So what can we do to help meet the need for psychiatric services? Here are three steps that will help us move the needle further.

1. Improve the screening process and screen every patient at every medical encounter.

This may sound counterintuitive — why screen more patients when we have too few providers? In short, the quicker we detect emerging mental illness, the easier it is to correct it and handle it with social workers, counselors or nurse practitioners. Patients in the U.S. are reluctant to share mental health issues — we all still struggle with stigma attached to needing a shrink. Fighting this stigma is important, but it represents a long and uphill battle. In the short term, computerized screening has shown remarkable results as it reduces the stigma and the shame related to sharing the symptoms of a mental illness or a substance abuse problem.

We had never heard about our patients’ mental issues until we began screening each one of them on a tablet. Even paper-based screening reduced the number of issues reported. — A director of a women’s health clinic in Texas

2. Provide better care at non-psych settings and refer only severe patients

Half of patients with mental illness choose to share their concerns in non-mental health environments, such as family practices, women’s health clinics or the post-acute care setting. Many of these practices struggle to care properly for these patients, relying heavily on first-line medications, rather than comprehensive therapy. Other practices work hard to refer these patients out to the care of unknown colleagues.

We need to ensure that we can provide lower-severity patients with care in the non-mental health setting, making proper referrals for consultation. Primary care settings need additional support and guidance to provide the best possible care before the situation becomes more severe.

Without early detection and care, we are needlessly letting patients’ conditions escalate to the point of needing psychiatric care… psychiatric care that is in short supply.

3. Help patients to successfully manage their illness between visits

A patient seeing a psychiatrist will need to come back repeatedly for future sessions — it’s the nature of the gradual recovery from mental illness. The frequency of these visits depends on many factors, but in general, the more severe and unstable patients require more frequent visits. If we can help patients remain stable at a lower-severity state, we can give the patients and their physicians the freedom to extend the time between visits. Self-management is key, but so is the physician’s ability to monitor for emergent crisis, managing the patient remotely. We find ourselves seeking a product that should exist but rarely does — a way to administer self-guided interventions, assigned by the clinic, and one allowing remote monitoring of the patient’s changing status.

With more patients becoming more stable, and the clinic knowing this from afar, the psychiatrist can see more patients in need of a one-on-one visit, whether in person or over video.