Providence's behavioral CMO on bridging the 'huge gap' in mental healthcare

Becker's recently connected with the CEO of Providence's Well Being Trust, Arpan Waghray, MD, who also serves as chief medical officer of behavioral medicine at the Renton, Wash.-based health system.

A geriatric psychiatrist by training, Dr. Waghray oversees Providence's telebehavioral health network that delivers mental health services across 36 Providence hospitals, including many rural and critical access hospitals.

Question: How would you describe Providence's mission when it comes to mental health?

Dr. Arpan Waghray: Mental health concerns are among the No. 1 health concerns for most healthcare employees, so how are you creating a comprehensive way to make sure everyone in your workforce has access to mental healthcare support? This is foundational; it's one of the most basic things that need to happen. That is one major bucket of our work, the caregivers, and doing this in partnership with community hospitals and so on.

The second is the patients we serve. How do we ensure that if anyone trusts us with their care, that we're always showing up for them as a whole person — to care for their needs in their mind, body, spirit. This is a core part of who we are as a health system. We talk about telehealth, we talk about changes here and there. Those are smaller pieces, but the larger thing cannot be lost. If someone is reaching out to us, they're receiving primary care, how do we support and early identify? If they're in a crisis, how do we meet them wherever they are on their journey? That is across all the care settings. That's a huge part of what we're building and trying to do. Access by and in itself is insufficient. How does that translate to alleviating the most common causes of human suffering and saving lives? 

That's a huge gap in the mental health field. We talk about access, we talk about one or two problems and then we get distracted. Are we making people's lives better? If depression is the leading cause of disability worldwide, how do we ensure that access being provided is actually translating into improving lives. 

Q: What role does preventive care play in Providence's goal of treating patients with mental health needs?

AW: If you do 3,000 mammograms, you're able to identify one patient and save potentially one life from breast cancer. For patients who present after an opioid overdose, if you identify and start 30 of those patients on medication assisted treatment, you will save one life in the next year. There are few interventions that actually have the greatest potential of saving lives, so how do you bring access, when you do bring access, how are you making sure that it translates into improving lives and how do you really do that?

Every single community, through the community health needs assessment that every hospital does, across the country, it's the same. It's mental health, substance use, homelessness. These are always what every community health needs assessment is saying. That's where our focus has been on youth mental health and partnering with schools and sports teams, trying to destigmatize mental illness, normalizing looking after your physical and mental health. We're going into schools to start doing this so we prevent people from getting sick and coming in to use our services. That's what healthcare needs to do, and every one of us needs to rise to the occasion.

Q: How did the telebehavioral health network at Providence first come to be?

AW: Providence is a fairly large system; we have 52 hospitals and span across seven states. Some of our hospitals are in very small communities, or they're critical access hospitals in rural communities. About six years ago when we polled our caregivers to understand what their greatest opportunities were, we heard loud and clear that in these small hospitals when a patient is brought into the emergency department, there was limited to no access to psychiatric support. Across the country, anywhere from 6% to 12% of all emergency visits are related to a primary psychiatric concern. There is a need, and yet there were no resources.

What we did is we built a telehealth network, starting off with a few small sites in rural Washington, and then continued to grow and expand and build a care team. We have a group of trained social workers and psychiatrists who work as a team and they're available 24/7, now supporting 42 of our hospital's emergency departments to provide access on demand for any patient who has been brought in in a mental health crisis.

To contrast what used to happen if you didn't have these resources and telehealth to take advantage of, you could not staff for these kinds of resources. What might have taken several days to get access, if you are able to get access to a psychiatrist, now all of these sites within 30 minutes, any emergency room physician who has a patient that wants help can be on a call within 30 minutes with one of the psychiatrists or social workers on our team and we can arrange for a virtual visit and then other recommendations.

Q: The system was established pre-pandemic, but how did the pandemic affect its operations?

AW: All of this was way before the pandemic, and we continued to build on that. Once the pandemic came in, being a highly cognitive discipline, a vast majority of what we do in psychiatry and mental health support can be done virtually. I'm not saying it's for everyone, but it naturally lends itself to this modality of care, so it has only since then exponentially expanded.

Q: Does Providence just connect patients with short-term behavioral healthcare, or are there options for long-term care?

AW: It's both depending on the care needs and the care setting. In the emergency department case, those are patients coming in in a crisis, they might need an assessment, intervention treatment or some short-term support until they're connected to a different resource — long-term care, inpatient unit, whatever it might be. Then on the primary side, that's part of their ongoing care. It varies. Schools and other areas also are providing more immediate support, but also when needed, we're trying to ensure that the longer-term support is there. It's a combination depending on where we're at.

Q: What's next for Providence's behavioral health services?

AW: We're also looking at supporting primary care, having resources available across multiple clinics, having more on-demand support, in-home support. We're partnering with telehealth in schools to have kiosks available in schools where we're partnering and also have the ability for children to get telehealth support through the school. We're really trying to think about this more comprehensively as a core part of care.

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