HJAR Jul/Aug 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2020 13 Editor What is your best mental health advice for healthcare workers during this time? Dr. Smith One of the things that happens here is that we get a daily briefing about COVID-19, and one of the things it reminds us to do is take some time for yourself, and to breathe and relax. It’s fine to be a hero, but even heroes need to rest and recover a bit. I think people need to realize that they’re human. I was with the governor at a press conference a few weeks ago, and I was try- ing to think of what I could do that would be helpful. I had the whole group just stop and take a deep breath. At that point, I think a lot of people were thinking this thing was going to be over with in a hurry, and it’s not. I think we’re going to be dealing with some element of this into the fall, and unfortu- nately, maybe even into next year. It’s fright- ening to people when they see the cases in Arkansas going up, and we’ve had a run of triple digit cases per day for the last five or six days? So, is this a new peak? I’m sure it’s a second wave, but how big is it going to be, and where else are the outbreaks going to come from? So, people need to be gen- tle with themselves and realize that they’re human, and everybody else is human too. I apologize to my family frequently for being short and irritable, and I apologize to my officemates, and colleagues for doing that too, because it’s just going to happen when people are working hard and under pressure. Editor What is your opinion overall on the status of mental healthcare in Arkan- sas, and what would you like to see in the future? Dr. Smith I think we don’t have enough providers, and we don’t have easy enough access. We have a rural state, and it’s hard to get mental health and substance abuse disorder providers to go to small towns. It’s hard for them to sustain their practices, so we need to be thinking of creative ways to make that happen, for example, what we and others are doing about digital health. But, what do you do when 25-30 percent of Arkansans don’t have internet, and you can’t easily do Zoom meetings with them? There is some technology where you can do things if somebody just has a smartphone, and we’re trying to rapidly transition to that, but there are still a lot of people who just don’t have the access, who are underserved and disadvantaged. Rural internet service is hard to come by sometimes, and then having enough band width is also hard to come by sometimes. Access is determined by a lot of things—not only whether or not you have third party coverage, but whether your social group or religious group frowns on getting mental health services. That hap- pens in some places. People ought to be allowed and encouraged to go for care and treatment, and to do things to keep them- selves healthy. It’s a pretty big chore to keep yourself and your family healthy. So, I think we need more providers, better access, and For more information about AR-Connect, e-mail us at arconnect@uams.edu . The AR-Connect call center is available 24 hours a day, seven days a week, at (501) 526-3563 or (800) 482-9921. The virtual clinic operates Monday through Friday, 8 a.m. to 5 p.m. a broader reach. We’re working with some rural primary care practices to see what we could do to enhance their providers, their ability to provide services in their practice, and how to back them up so those practices feel like they’re not left hanging and out there all by themselves with these problems. I think working together in a collaborative fashion, working with our sister organiza- tions to say, how can we do this together? If people in a certain part of the state need more referrals, we’re happy to do that, and if they need less referrals, we’re happy to help them out and take the load for a while. Editor Do you think the rules for telemedi- cine will stay relaxed after the COVID-19 pandemic ends? Dr. Smith I don’t think the rules will stay this relaxed, because right nowwe can treat people via telephone as well as televideo. But I think the country has been so hungry for the equivalent of telemedicine services that I believe, especially with mental health and substance abuse, we will be able to con- tinue that. As one of my colleagues told me the other day, I don’t think all the toothpaste is going to go back in the tube. I don’t think the feds or the private payers will allow us to use telephone long term, and frankly, that’s probably not adequate. It’s adequate during an emergency with established patients, but it’s not adequate for all patients long term. n