Tackling Montana’s Mental Health Crisis with Telepsychiatry

I’m a child and adolescent psychiatrist.

When I arrived in Montana in 2013, I couldn’t believe that some of my patients drove 300 miles for a 30-minute appointment with me.

When I try to describe the geographic barriers to getting care in Montana, I have a go-to statistic that still amazes me.

The distance from one corner of the state to the opposite corner (704 miles from Troy, MT to Hammond, MT) is equivalent to the distance between Chicago and Washington, DC (696 miles).

There are just 1.1 million people in Montana.

There are 40 million people living the Montana-sized land mass between Chicago and DC.

I moved here 11 years ago with wife and two daughters - I was starting my first job as a newly minted psychiatrist.

After my 14-year journey from Wall Street bond trader to child and adolescent psychiatrist, I had decided to make the move to Big Sky Country to escape the hubbub of the Northeastern US. I wanted to introduce our then 7-year old girls to the beauty of the Intermountain West.

I didn’t realize I had chosen to practice psychiatry in what is ground zero of our country’s mental health crisis.

Montana and Wyoming post suicide rates that consistently rank among the country’s worst. According to the Kaiser Family Foundation, Montana and Idaho have the fewest psychiatrists per capita.

Depression in a city and depression in a small town are diagnosed the same way.

There are, however, rural health disparities that tend to make outcomes worse for individuals suffering from mental illness or substance use disorders in more isolated communities.

Here are some of the factors that contribute to health disparities among rural and frontier communities:

1. Geographic isolation
2. Higher rates of health risk behaviors
3. Limited access to healthcare specialists
4. Less access to employer-provided health insurance

Montana has long been a telehealth-friendly state. In fact, several state and regional stakeholders formed the Eastern Montana Telemedicine Network in the early 1990’s. I started doing telehealth visits as soon as I started practicing here.

But patients couldn’t access care from home. Webcams and Zoom hadn’t been widely adopted yet, so they had to drive to a satellite clinic equipped with the right technology and a robust broadband connection.

My partner, Reza Hosseini Ghomi, MD, MSE and I launched Frontier Psychiatry in March 2020, an all-telehealth provider of psychiatry and addiction care.

We’ve managed to deliver care into all 56 counties statewide and our data shows we’ve been able to reduce the need for ER visits for patients in crisis.

A lot of work remains to be done if we are to move the needle on the worrisome suicide rates in this part of the country.

Telemedicine can’t solve all problems, but it’s giving me some hope that we can use it to tackle at least one.

Photo Credit: Jack Bell Photography