Dr. Chad Koyanagi appears on a video screen from the Queen's Medical Center while counseling a Maui mental health patient.
Rural islanders get mental help via video
Patients on Maui and Molokai who do not qualify for state mental health services are getting help from a unique program.
Dr. Chad Koyanagi, University of Hawaii assistant professor of psychiatry, is working with the Community Clinic of Maui and Molokai General Hospital to assist patients needing psychiatric services.
He sees them in person the first time and follows up with teleconferencing from the psychiatry department in the Queen's Medical Center.
"He's really championing this model here," said Stacey Krenelha, behavioral health director at the Community Clinic of Maui. "A lot of places in this country could use something like this. They don't have a prayer of getting psychiatrists to come."
Many people go to the clinic without the proper diagnosis to qualify for services, she said.
They include those with severe, persistent mental illness, schizophrenia, bipolar disorder and chronic depression, as well as some substance abusers with mental health problems.
Also, she pointed out, many patients do not have any health insurance, or they have Medicaid or Medicare and private psychiatrists will not take them because of large caseloads and low reimbursements.
The community clinic's doctors were providing psychotherapy and brief intervention, but many people needed medicine and some cases were too complex, Krenelha said.
"There was a real hole that we had here that we really needed to get help on."
A federal mental health expansion grant a few years ago allowed the clinic to hire a psychiatrist, and Koyanagi volunteered, she said. He was then at the Kalihi-Palama Health Center.
He began flying to Maui once or twice a month to see patients and consult with physicians, Krenelha said. "More often than not, he'd be the one to treat and prescribe."
They initiated telepsychiatry consultations last year. Some patients really like it, Krenelha said. "They like to be on the cutting-edge kind of thing." They also "really, really need help" and cannot get it any other way, she said.
"There are always more than we can fit into the schedule."
Koyanagi said he thought it was a great opportunity when he began providing service to Maui patients, and he continued when he left the Kalihi-Palama center to join the University of Hawaii medical school.
"It's just a tool we use to help with our rural-access issue," he said. "It allows us to see more patients and cut down on flying over there every time."
He also started providing service out of Molokai General Hospital's rural outpatient clinic, he said, with the goal to collaborate with health care providers on the island.
He goes to each island for a full day once a month and spends one or two afternoons per month seeing patients via video.
His youngest patient is 17.
Most responses were positive in a patient survey on Maui, Koyanagi said. "Some people say the way the faces show up on video, they feel the doctor's attention is much more focused on them."
Finding funding to support the program is a big challenge, Koyanagi said, but he hopes to expand it to other sites around the state.