Danielle speaks with Dr. Alison Arnold, the Director Interdisciplinary Center for Community Health & Wellness at Central Michigan University (CMU). In this episode we discuss CMU's Preventing Suicide in Michigan Men (PRiSMM) program and how we utilize telehealth to address mental health disparities and increase access to care.

Welcome to a Virtual View, a telehealth podcast, brought to you by the

Upper Midwest Telehealth Resource Center.

Today I'm joined by Dr.

Alison Arnold from Central Michigan University where she's the director

of the Interdisciplinary Center for Community Health and Wellness.

Thank you so much for joining us today.

Thank you, Danielle.

Pleasure to be here.

Yeah, of course.

And you're joining us all the way from Michigan today.

I am.

Yeah.

So tell me a little bit about yourself

In my role at Central Michigan University, I direct what you refer to

as an interdisciplinary center, which is a collaboration across multiple

academic colleges that all have to some extent a variety of different

health programs and health resources.

And the role of our center is to really connect CM U'S expertise in.

And wellness arenas to address community health priorities.

My director role has involved establishing and growing this center.

We provide a number of continuing education programs.

We've built a lot of capacity over the five years that we've now been growing

and glowing in trauma informed practice suicide prevention, and also in te.

So how did you specifically become involved in telehealth?

That's interesting.

I think part of the role of our center has, since its inception, has

really been to connect Continuing education opportunities to the field.

And so we did that in a lot of different varieties in the early

years of the center through conferences, webinars and the like.

But really and most significantly with a couple converging.

Kind of areas of need in our state.

We ma very rapidly shifted to providing most of our services through telehealth

at this point through our center.

And we are housed within the CMU College of Medicine and It's as part

of that mission within that college, it is focused on, really preparing

physicians to serve in rural and medically underserved communities.

And so we were supporting that mission.

And then along came global Pandemic.

And so while we were, really pleased with our ability to provide support for.

Medical students doing their clerkships and for community

educators in rural communities.

Then very suddenly all practice primary care as well as behavioral

healthcare really had to shift.

And consequently, there was a real need among providers to make this

transition in their own practices and become, Fluent in delivering their

patient care via a new modality.

And so we jumped into that water and kind developed these offerings, which

we'll be talking about today, including a toolkit for suicide prevention.

So it sounds like you guys were a little bit ahead of the

curve on the, the telehealth wave, cuz we saw everyone jumping onto

that during the the Covid pandemic.

But you guys had a bit of a head start with that.

Yeah, I think we were had been well on our way within the college of.

And because so many of the medical students are placed in remote areas

and so that was by way that they would do their didactics and provide

support to community educators.

So in the telemedicine mode, we were getting down the road, so to speak.

But then this.

Rapid shift to all medical practice or most primary care and behavioral

health was something that we really felt was really important.

We were part of that.

Right.

So can you explain a little bit about your preventing

suicide in Michigan Men Program?

Sure I'd be happy to.

The preventing suicide in Michigan Men or Prism is what we refer to the Initiative

is a program that is at the Michigan Department of Health and Human Services.

It's funded by the Center for Disease Controls Comprehensive Suicide

Prevention Program, and Michigan is one.

15 states that in includes two universities as well to receive

funds from the CDC Comprehensive Suicide Prevention Program.

So we're real excited.

It's part of a national network of initiatives and Michigan chose to

implement a its program to focus on males as our priority population.

Cuz the goal of this is to implement and evaluate a comprehensive public health

approach to suicide prevention with a special focus on Populations that are

disproportionately affected by suicide.

And of course in Michigan male men were chosen as the priority because

they have a higher than average rates of suicide in nationally.

Statistics suggest that men are three times more likely

to die by suicide than women.

And in Michigan in 2018, when a lot of this data lags a little bit.

But and that's part of our prism project.

We will be building our data as well across the state.

But in Michigan, two thirds of our suicide deaths were among the male population.

25.

And older and working age men 25 to 64 kind of made up three quarters

of that group of suicide death.

That's been really important for us to reach this population.

We'll talk about why telehealth is a way that we hope can improve access

as well as possibly reduce some of the other barriers to help seeking that

this population may embrace just because of traditional gender roles and norms.

some reluctancy at times to address emotional issues.

And we're really pleased to be part of this project.

There are other partners in the state that are participating in the PRISM Initiative

and the Prism Telehealth toolkit is just one component of the prison initiative.

I didn't realize how disproportionate those numbers

were with men being the ones who.

Committing suicide.

Wow.

Do you think that's a population that frequently gets overlooked when we talk

about suicide and suicide prevention?

Yeah, I think it has been.

And there's very importantly, there's a lot of focus and resources that have

and continue to flow into supporting maternal health, to supporting youth.

In suicide prevention and women.

But this particular population also carries a great deal of stigma

association associated with even help seeking behaviors to support

their mental health and wellness.

And I think it's important to break down the stigma surrounding

Mental health and normalized health seeking behaviors for men.

And in doing so we decided that it would be very helpful at this

time when so many providers were shifting their care to tele.

Consultation modalities that we would put together a resource hub and

strategies to support primary care, but also behavioral health clinicians and

providers with a set of strategies to really help them in the whole continuum

of suicide care and prevention.

Yeah, no.

It sounds like there's a lot of different aspects to why

telehealth is such a useful.

Modality for delivering this kind of care.

There's also another reason, and it's the professional workforce

shortage that we are all encountering, especially in behavioral health, we have

studies in our state that suggest that only 62% of Michiganders with a mental

health or substance abuse need actually receive the services they are in need of.

Telehealth is gonna increase access to healthcare and we also know that

the availability of professional mental health service providers are.

disproportionately located in our state.

80% of our highly professional psychiatric professional service providers are located

in the southeast, quadrant of Michigan.

And so it's really important that we are able to bring these much needed services

and referral programming to physicians who are practicing in rural communities.

And I feel like you see that pretty frequently in states and just

populations where you have a large amount of rural folks in the population.

Cause I know all of the states in the UMTRC service area.

That have a couple of larger cities and then a lot of rural, so you

see those specialty providers, including the behavioral health

providers, really concentrated in those cities and population centers.

So it gets really hard for folks to find the kind of care that they need if they're

not located within those specific places.

So I think another aspect of this that's so important is just general access from

the standpoint of stigma reduction, like you talked about earlier, because there

is something about making a behavioral health appointment and physically going

to an office that in some people's mind, I feel carries a different kind of stigma

than just sitting down at the computer in your workplace or your home and being able

to log on and talk to somebody like that.

Right?

I think you're onto something there.

We're just beginning to see some information that's suggesting

that patients really in many cases found the availability

of Telemental Health Services.

Found it something that they were quite receptive to during the pandemic

when there was the shutdown and when all services needed to be provided

in some sort of, virtual or you.

Telehealth kind of mode.

And what's being reported is that there was continuation of

staying in the the care plan.

It was convenient.

It was, as you suggested, somewhat private.

And so I think that there's, while.

People are still looking at the effectiveness of patient care

versus, access, they're still looking at these these questions.

But I, I think generally people are quite pleased with how

telemental Health has been a real.

Preferred and easy choice for those seeking help during the last few years.

And I'm hoping, and I think most behavioral health service providers are

seeing that these are continuing with their patients, that many patients are

wanting to continue in this in this vein.

Maybe not the case in other kinds of healthcare.

Primary care, physical healthcare, all that, but especially in

behavioral healthcare, mental health counseling services and so on.

This is a continued, continually accepted and in some cases

preferred way of receiving care.

Yeah, exactly.

I think you hit the nail on the head with that.

Like we've seen since we've hit this new normal that everybody keeps talking

about, that folks sometimes do want to go back to the doctor's office

for like a GP appointment, but for.

Telebehavioral Health.

There's just been not that same dropoff when it comes to like, going from being

a telehealth to an in-person appointment.

That has been in many of the other like disciplines, I suppose, I'd say . So

you mentioned your telehealth toolkit.

Can you tell me a little bit more about that and what that

Sure.

The Prism toolkit is really designed for providers, so it's

it was built and developed with.

Advisory panel that worked with lead from cmu, who's one of our

lead faculty in child and adolescent psychiatry, working with other

psychiatrists and behavioral health.

Specialists in the field.

We had representatives from the community mental health arena,

from the Veterans Administration.

And so she put together a panel.

They met probably for six to nine months to talk about what

do we mean by suicide care?

And really looked at the suicide prevention resource centers, continuum of

care, and all the various strategies that Clinicians and providers would want to be

aware of when they're treating patients along that continuum all the way from,

prevention to postvention and and and what would they look like in as delivered

in telehealth environments and settings.

And so we took these strategies from the s prc and we began to really

cultivate and curate like what shows.

Development of a safety plan.

For instance, in a telehealth consult with a a particular client or patient and how

is that, how does that look different?

And so of course, we're realizing you need different kinds of ways that

you can get patient agreement and all the different supports that have

to happen cuz they're not physically in your office as a provider.

And so a lot of care providers were in the first months of this transition

really grappling for just how do we administrate all of this over telehealth

and the agreement forms, the safety plans.

How do we get all this done?

And so there's a lot of resources like that in the toolkit.

But there's also resources that we're continuing to develop and we're.

Excited to work with you and your organization as a partner to make

these available video simulations that providers can watch to see these

kinds of consultations with patients.

And our population, again, is largely focused on our males

who are at risk and vulnerable.

So how do you have that conversation about.

When the consult is happening in the home, how do you have the

conversation about lethal means that may also be in that home?

And so trying to provide these kinds of ideas, strategies, suggestions,

and evidence based resources for providers to seek out as they prepare

for and conduct their consultations with their clients and patients.

That's awesome.

So when I see resources like this, usually they're focused on either the

people who are struggling or their family members or support groups.

Why do you think it's important for there to be resources that

are provided to be available to specifically providers as well?

Earlier we talked about the shortage of professionals in the field

right now, and we have beta tested this.

Toolkit with several cohorts of providers and and ask them how would

they would be using it primarily.

And they shared that this from their perspective, one of the

Uses of the toolkit, which we hadn't originally intended, was to

embed it with providers training.

And they've indicated that we are rapidly hiring and in a lot of cases we're

bringing in, new case managers new social workers that are pretty young in their

career as yet and may not have encountered a full range of experiences, especially

those in dealing with men 25 and older.

And so this toolkit is a way that providers are seeing that they can

more rapidly bring people up to speed who are coming in little bit or with a

little less actual career experience.

No, that's such a good point because you get people who come

in and you don't have the experience for this, so you substitute it with

a lot of really good resources,

So how does, I mean, you've talked a lot about how you've collaborated with

different folks to make this happen.

So how does collaboration impact a program like yours?

Quite honestly, I think you, you can't be successful unless you have it.

And and when I say successful, I mean you can't achieve the, your end goal

without working across different arenas of expertise and also, , different

arenas of resources that are available.

And I think that's one thing our center has really tried to practice and live

out is that we, when we step into this complex space of having to develop

a tool that's for a lot of different providers how do we do that and make

sure that it's relevant to the field.

We have to have the field.

Co-develop it with us and how do we make sure that it's gonna be useful?

We need the field to co test it with us.

So I think without that kind of collaboration, it, we just could

never hit the mark as far as trying to provide something that could be useful,

timely responsive to provider's needs.

And we're still fine tuning this toolkit.

We'll continue to do that.

And , anyone who visits the toolkit, there's opportunities to reach us

out and tell us what else needs to be included from their perspective.

We have this advisory panel that continues to vet those recommendations to make

sure that they are founded resources and certainly evidence based practices.

But we've gotten some great suggestions on resources that would be.

Really relevant to have in place for unique kinds of strategies for

working with men and also working with diverse populations within

within the entire population.

So even though this toolkit has been developed with a focus On that vulnerable

risk population of men, it's really transferable to care that would be for

suicide care across the population.

and I'm sure it cuts down on duplication of effort too because a lot

of these resources are already out there.

You don't wanna have to create something again if it already exists.

Just general suicide prevention.

But I do think.

Resources with a focus on reaching men, specifically men over 25.

There's not a lot of them, cuz after we initially met, I went through and

I was like, I had not heard that this was a specific push that was happening.

I wanna know more.

But there's just not the same amount of resources out there for

prevention among this particular group as there are just generally.

So that, as I mentioned earlier, our Prism initiative

in Michigan is multifaceted.

This toolkit for providers is one component, but there's also some

really Innovative work underway that is providing some resources directly

for men and the population themselves.

One of this one of these resources is called man therapy man therapy.org.

And that particular.

Online, you can seek that out.

Resource Hub is just full of great examples of resources.

Just chalk full of anti-stigma kinds of messages that are meant

for and developed by men for men.

And so it is another component where, you know, that.

Providing direct resources for men, there's opportunities to to actually

for men to take some screens in certain areas to assess their own sense of their

mental health and what their concerns are.

And those can also then be part of a referral within Michigan.

So desired for that individual to seek out help.

That direct resource is something we're really excited about and we like to

share as much as our prism toolkit.

Yeah, that's, that's amazing cuz you really cut down

the barrier for entry there.

All you need is a quick Google search instead of.

To find a provider yourself, which I know can be

Right mantherapy.org is the website on that for anyone that

wants to listen and check it out.

and I like the name too.

That cuts down on the stigma a little bit.

So are there any other resources from your program you wanna tell us about?

I think what I'd love to invite is that if you are a

provider in and you are working.

In Telemental Health telebehavioral Health environments and scenarios

to visit our Prism toolkit and let us know your thoughts about what

else we should be including in that.

We also are.

Interested in this idea of embedding it into providers existing training programs.

And so we are already meeting with selected organizations and agencies

to think about how this would enhance the work that's happening to equip

staff who work in that telehealth department or that virtual services

care area of the hospitals CMHS.

right.

So what does the future of your program look like in the short

term and in the long term?

This whole arena of telehealth expansion is really one that.

Pushing our boundaries a little bit.

Right now our Central Michigan University has a number of

pretty significant initiatives that our center is involved in.

Besides this Prism initiative.

One is just getting started in which we are, will be working through

some congressionally directed spending through HRSA to really

try to deploy more advanced te.

Equipment and also referral services, connections to our university

that's just getting underway and it will cover all of the northern

stretch of our state in Michigan.

And we're really excited to be leading that.

, that's one particular initiative in telehealth.

And then another one is some work that we have been piloting with TTAC that will

that brings us together with some states including Alaska, Texas West Virginia.

Wow,

Arkansas and we're all learning from each other as we try to get out and

understand what the broadband capacity is and how to measure that capacity to

inform our respective states as they try to ramp up and build for telehealth

Hm.

Yeah.

I know as TRCs collaboration with other states is really important to us too.

That's where we get so many of our, our good resources, good programs, good ideas.

It's all through collaboration.

It's such an important thing, and telehealth makes it easier.

And with the communications technology we have now, we don't just have to

be limited to one physical location.

I agree.

In fact another area where our center is.

Quite active is in developing trauma informed approaches across

schools and, community sectors and as well as healthcare.

And we're seeing that there's some really excellent models for

education that kind of our similar to somewhat of the echo model that

we may know of in healthcare that's transcending into these other areas.

And we're just seeing that, that te.

Platform, so to speak, is going to be just, something that is absolutely

not gonna go away, that we just need to keep strengthening and building

to deliver professional education as well as to promote collaboration

across partners who are working on some of these community issues.

Yeah, of course.

All right.

Is there anything else you wanted to touch on before we wrap?

I just wanna thank you for this opportunity to join it today and share a

little bit about some of the work that we have happening in our state of Michigan.

And we're really, grateful to be part of your multi-state

network that collaborates.

Yeah.

Thank you so much for joining us today.

I'm really happy we could have you on.

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