Meeting the moment in mental healthcare
Outpatient mental health services have expanded significantly to meet the surge in demand, putting therapy within reach for more people.
Depression and other mental health disorders are creating an ever-growing need for treatment, and more people have severe and potentially dangerous conditions.
Getting care can be tough. Psychologist Kristen Carpenter, PhD, has found an avenue to meet that demand – and shorten the wait to start treatment.
While hospital care is important for many, most people get mental health treatment in an outpatient setting. Dr. Carpenter is expanding outpatient options for getting both therapy and medication. She’s recruited significantly more mental health clinicians since she came to the Ohio State Wexner Medical Center in 2013. She’s also helped launch new services for people with complex needs, including those at risk of suicide, trauma survivors, adults experiencing psychiatric emergencies and new parents facing postpartum depression.
The results are significant. Outpatient mental health visits to Ohio State Wexner Medical Center have nearly tripled in the past decade. And many more people can meet with a therapist within two weeks of seeking help.
“It’s easier now to get an appointment with a counselor than it used to be, and we need to continue to push to do more and better,” says Dr. Carpenter, who directs all outpatient mental healthcare at the Ohio State Wexner Medical Center.
She’s always pushed for more. Dr. Carpenter is now leading efforts to reduce the wait time to see a therapist at Ohio State, and she’s added measures to ensure each person is directed to the therapy that’s best for them.
“Ten years ago, the goal was to help people just be able to get an appointment,” she says. “Now we don’t want somebody to just get an appointment. We want people to get an appointment for the right issue with the right person from the start.”
Meeting mental health needs across Ohio
When she began her career at Ohio State, Dr. Carpenter specialized in treating women cancer survivors whose sexual health was hindered by cancer or its treatments. That focus on women’s health made her a natural fit to lead the Women’s Behavioral Health program a year after she came to Ohio State.
At the time, anyone who needed outpatient mental health therapy came to Ohio State Harding Hospital on the Wexner Medical Center campus. Now, many locations make it easier for people to see a clinician.
In 2016, the medical center opened its first outpatient site in Upper Arlington that offered different medical specialties in one place. Since then, a network of outpatient centers has been available across central Ohio. In person and online mental healthcare now reach people in every county in the state.
“With Dr. Carpenter leading the department, our programs have grown from treating individual concerns to preventing mood and anxiety issues before they start and providing group therapy to expand our reach,” says Nicole Hollingshead, PhD, a psychologist with the Women’s Behavioral Health program.
At the same time, Wexner Medical Center researchers are generating and testing new treatments for some of the hardest-to-treat conditions, including treatment-resistant depression and disorders that come with psychosis.
New ways to satisfy the mental healthcare demand
Depression is the most common reason people seek mental health treatment at Ohio State. Anxiety is the second.
When someone calls for their first appointment, instead of automatically pairing them with a therapist for one-on-one counseling, people with mild to moderate symptoms are now being offered the chance to be in group therapy. The group teaches skills to help them better understand and cope with their disorder.
Many find they’re encouraged by the support of a group, Dr. Carpenter says.
“When you do group therapy, there’s this really lovely benefit, this thread that connects people,” she says. “To hear similar stories and experiences, to find community in that way, is really powerful. It helps our patients to not feel so alone.”
If someone comes in with more serious depression, or they prefer one-on-one therapy, they can get that and also meet with medical staff who can prescribe medicine and help manage it over time.
Anyone who’s struggled with depression and tried multiple treatments with little effect can be assessed to see if they’re a good fit for treatments such as brain stimulation or psychedelics taken under close supervision.
And mindfulness classes offered online and in person can help people deal with depression and, once it’s gone, keep it from returning.
Matching people to the right mental healthcare from the start
Getting someone in to see a therapist rapidly matters, but so does getting them connected with the right provider or program from the beginning.
To make that happen, Dr. Carpenter will be adding patient navigators to the process. These individuals have a background in social work, psychology or related fields and help place people with the best treatment option for them. And if their needs change − for example, if someone starts with one-on-one therapy and later needs medication − a patient navigator can help direct them to another clinician.
“People call in and they need to be seen as quickly as possible,” says K. Luan Phan, MD, professor and chair of the Department of Psychiatry and Behavioral Health at The Ohio State University College of Medicine.
“Access is a really important issue that Kristen is working on. She’s relentless in thinking about how we serve patients as fully and as quickly as we possibly can,” says Dr. Phan.
More often since the COVID-19 pandemic, people are arriving in crisis or with one or more disorders that can be hard to treat, says Dr. Phan, the Jeffrey Schottenstein Endowed Chair in Psychiatry and Resilience.
“As an academic medical center, we try to take care of everyone who seeks care. We often treat patients with chronic, severe and hard-to-treat conditions such as treatment-resistant depression, psychosis, addiction, trauma and suicidal thoughts.”
Turning possibility into practice
Every new mental health service at Ohio State started with an ambition to take the results of what worked in research studies and offer those treatments to the wider public.
Colleagues of Dr. Carpenter credit her with having a knack for doing that – taking a promising idea and turning it into a service and helping others on her staff do the same.
“There are lots of people who are efficient at getting work done. And there are lots of people who have good social-emotional skills to get people excited about projects. She can do both,” says Nick Breitborde, PhD, director of the Early Psychosis Intervention Center (EPICENTER). “There are not many people who can do both.”
Dr. Carpenter played a key role in the launch of EPICENTER in 2015, a program for young adults who’ve begun experiencing psychosis or are at high risk of a psychotic disorder, says Dr. Breitborde, the Charles F. Sinsabaugh Chair in Psychiatry.
Every year, EPICENTER treats between 500 and 600 young people, leading many of them back to work or school with new skills and support to lean on during tough times.
“Dr. Carpenter took something that was a hope and helped us to make it a reality and deal with the complexities that you have to manage to make these things work,” Dr. Breitborde says.
Solving puzzles
Even as she manages all outpatient therapy, hires and mentors staff, serves as the point person – the first call – when issues come up and provides one-on-one therapy once a week, Dr. Carpenter is clear about her top role.
“Being a mom is the first thing I am in the morning and the last thing I am when I go to bed,” she says.
She thinks about work a lot, but she doesn’t have trouble disconnecting from it at the end of the day and tuning in to baseball practice, guitar lessons, homework help, planning dinner and, if she has time, a book or puzzle.
Dr. Carpenter has always been drawn to puzzles: jigsaws, word games, math. Sitting down to a puzzle at home is like meditation for her, a way to unwind.
And when the sun comes up, she trades those puzzles for the tougher ones awaiting her at work.
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