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Jesse Higgins, PMH-NP, RN, Acadia Hospital

Charles A. Dean Memorial Hospital (CA Dean) in Greenville sits along the scenic shores of Moosehead Lake, one of Maine’s most treasured natural resources. It’s a peaceful, idyllic spot that draws tourists from far and away who are eager to get away from the hustle and bustle of their daily grind. But beneath the hum of motorboats cruising along Moosehead Lake in the summer, or the snowmobiles skirting across its icy surface in winter; beneath the laughter of kids splashing in the water on a hot August day or pulling a trophy trout through the ice on a frigid February morning, there is a rural health problem that those visitors do not see. To be fair, it affects communities throughout Maine but has been more problematic in those towns and hamlets tucked far away from urban centers.

“There is very little rural mental health period,” explains Joseph Babbitt, MD, an Emergency Room physician and hospitalist at CA Dean. Historically, people in rural communities have had to travel hours to access psychiatric services. If they showed up at any rural hospital emergency room with a mental health crisis, they had to wait hours for an evaluation. “You’ve got an emotionally unstable patient who is in a very disruptive emergency waiting room environment, waiting 18 hours to have a mental health professional come assess them. That doesn’t help anyone.” Dr. Babbitt said.
 
But technology is bridging the gap and allowing those who live in rural communities to have the same access to psychiatric services as their urban counterparts. “Telemedicine is a medium that connects a patient with a practitioner via a screen,” explained Gavin Ducker, MD, chief medical officer at Inland Hospital in Waterville. 

Inland Hospital and CA Dean use telemedicine to provide psychiatric services to patients through Acadia Hospital, which offers telepsychiatry services to 15 rural emergency departments and 12 rural primary care practices across the state. CA Dean uses telemedicine for behavioral health in its emergency department. Inland does, too, but also offers the service through its primary care practices. “Our goal has been to deliver the care on site, in a place they’re familiar with, comfortable with, and would feel more relaxed, and hopefully in a more timely manner. Telemedicine has allowed us to do just that,” Dr. Ducker said. 
 
In addition to providing patients with access to services closer to home, the technology is also a valuable recruitment tool to attract mental health providers. “There’s a combination in my department of folks practicing on site in these practices and telemedicine from afar,” Jesse Higgins, PMH-NP, RN, the director of integrated behavioral health at Acadia Hospital explained. “Recruiting’s been a challenge in Maine. It’s a rural state. There are parts of the state that have struggled to get providers to move. Now we can recruit and explain to providers that they can stay in their home and work as fulltime staff at Acadia Hospital.”

“Recruiting has been a challenge in Maine. It’s a rural state. There are parts of the state that have struggled to get providers to move. Now we can recruit and explain to providers that they can stay in their home and work as full-time staff at Acadia Hospital.”
- Jesse Higgins, PMH-NP, RN 

Michael Workman, PMH-NP, is one of those providers who works for Acadia but lives in Indiana. He is a psychiatric mental health nurse practitioner who sees patients in Maine via telemedicine. He works from a laptop in his home office. “It’s actually no different than you sitting across the table from me in my office. We’re just using the technology available to help people living in areas where we don’t have as many psychiatric providers,” Workman explained.  He says initially he thought the technology would make it harder to do his job and make a personal connection with a patient—to pat them on the shoulder reassuringly as they’re leaving his office or to shake their hand as they arrive. He says sometimes he’ll shake their hand through the screen, which he demonstrated. “It lends some humor to the visit and makes a connection with the patient,” he said, adding that even some reluctant patients came around quickly. “I had one gentleman who came into the office and said ‘I’m not doing this’ and by the end of the session, I had a hard time getting him out of the room because he was so comfortable talking to me.”

“Mike is eminently qualified and is great with patients,” Dr. Ducker noted, adding that he is pleased with the telemedicine services and the benefit it has offered to patients. And even though Mike is several hundred miles away, he’s a full-time employee at Acadia. He attends staff meetings, has supervision, and help is just a phone call or computer screen away. “They really are a part of our team at Acadia and Inland, whether they live in Indiana, Arizona, or anywhere.”

The result of this technology is that people living in rural Maine, who choose to live far from the noise or chaos of a larger community, can still have access to quality care and enjoy their beautiful corner of the world that tourists only see on short visits.