Does Setting Matter When Treating Behavioral Health?

The complex and inefficient systems by which health care is delivered in the United States are a study disparities. Two of most perennial these disparities difference delivery behavioral versus nonbehavioral one that divides rural settings from found suburban urban settings. How do we deliver settings, what key differences? With practice innovations, some born coronavirus disease 2019 (COVID-19) pandemic others intended to optimize resources, it seems can look forward continued changes healthcare landscape coming years. Hopefully, will lead greater equity delivery. This month, as Journal for Nurse Practitioners focuses on care, 2 nurse practitioners (NPs) who specialize different explore similarities differences their practices. –Donald Gardenier Yes Lili CargillLili Cargill, PMHNP, ANP-BC, GNP-BC, director integrated at Ammonoosuc Community Health Services, Inc Woodsville, NH. She also sees patients Grafton County Nursing Home North Haverhill, NH, Becket Family provider youth family services Pike, Originally New York City, Ms Cargill graduate Columbia University School Stony Brook State York. lives northern Vermont. “It 5 miles country makes danger,” said Holmes Dr. Watson when client left London metropolis accept job dubious merit.1Doyle A.C. adventure Copper Beeches.in: Adventures Sherlock Holmes. George Newnes Ltd, London, UK1892Google Scholar Access chief obstacle many sites. COVID-19 pandemic, there has been more freedom use new via telehealth, underused be lifeline. We now see telehealth expanding rapidly primary psychiatric realms. However, availability broadband, or any Internet all, remarkably lacking A twist down dirt road, not mention affordability, make connectivity with computer smartphone video capability while nearby neighbor only landline telephone. When your distress seeks advice consulting clinician countryside, chronic professional shortage areas mean limited system capacity decreased access even expanded telehealth. Rural workers older than national average, themselves trend older; Vermont Maine regularly compete title oldest population. Older adults frailty identify being lonely socially isolated have higher mortality risks. poverty rates, lower educational attainment, high rates alcohol substance disorders. Through my local newspaper, I learned child used those life-giving hands die hanging. emergency room small hospital named after beloved practitioner committed suicide. Burnout, alcoholism, ubiquitous guns mix poorly despair. Stigma discourages people seeking help places where everyone knows everyone. Recently, burgeoning interest leaving city centers because COVID-19, but remains seen if an influx well off enough houses really translates into diverse workforce communities. Twenty-two mostly states allow NPs full potential, corresponding increases quality outcomes. Knowing setting fraught unique dangers informs how care. Mental illness does offer pass bucolic stretch out between us lie host problems talents address. may dodge occasional moose commute, am hamstrung able fully knowledge skills, admittedly far less storied Holmes, dream. No Gary CarlisleGary Carlisle, MSN, PMHNP-BC, mental NP. He currently serves coordinator electroconvulsive therapy service NYU Langone City. maintains private midtown Manhattan, providing medication management psychotherapy. Mr. Carlisle’s previous roles include consultation-liaison advanced manager patient geriatric psychiatry Mount Sinai Beth Israel received his bachelor science nursing City Hunter-Bellevue College master Rory Meyers Nursing. One things we’ve providers consumers adapt provided. My went remote literally overnight result subsequent quarantine lockdown. became epicenter last spring, city, least temporarily, other parts state country, suddenly urban-based population essentially one. Because much work involves talking, listening, observing, particularly suited done across distances, making practicing significant. curriculum, training, evidence base another aspect same Generally speaking, need infrastructure such laboratories diagnostic imaging important interventions frequently receiving treatment. Although obviously difficult telecommunications technology continue mitigate this future. In fact, NP programs focus facilitating underserved populations, effective practice. addition, easing regulatory restrictions around reimbursement relaxation privacy guidelines helped telepsychiatry move forefront during resulted improved populations. Being home location definite plus both populations might otherwise unable unwilling travel clinic office. terms available providers, positioned fill gap. combination prescriptive authority psychopharmacologic expertise physical treatment skills ideal generalists Donald Gardenier, DNP, FNP-BC, FAANP, FAAN, Department Editor “Point Counterpoint”. contacted [email protected] .