Mind Matters

Todd Price: America is experiencing a mental health care crisis. The country does not have enough providers. And in rural states like Arkansas, patients often live far away from the mental health care services they need.

For the past 50 years, the Psychology Clinic, run by the University of Arkansas’ Department of Psychology, has worked to address mental health care needs, with low-cost therapy for the university community, residents of Northwest Arkansas, and the entire state.

With the support of psychology students and faculty, the Psychology Clinic turns every dollar in its budget, into the equivalent of $7.50 worth of mental health care to Arkansas.

I’m Todd Price, a research and economic impact writer at the University of Arkansas.

Today on Short Talks from the Hill, Clinic Director, Doctor Jessica Fugitt, joins us to talk about the mental health care needs of Arkansas and the work of the Psychology Clinic. Jessica Fugitt, Welcome to Short Talks.

Jessica Fugitt, welcome to Short Talks.

Jessica Fugitt: Hey, thanks for having me.

TP: Can people in Arkansas who need mental health care get those services today?

JF: Some yes, and some no. About 40% of Arkansans that need or want mental health care are not able to access it.

TP: What are the main barriers that are limiting their access to this care?

JF: There are a lot. Cost is a big one. Access, so just having a provider near you. Beyond that, there’s access to high-quality care, which is even harder to get. There are also barriers around language, transportation — even knowing how to get plugged in to the system can be difficult. All of those things keep people from getting the care they need.

TP: And how many of these issues are unique to Arkansas, or are unique to states like Arkansas that are largely rural and not urban? Or are these the same problems we see playing out nationally across the country and other states?

JF: Yes, they are the same problems we see playing out nationally, but they’re more exaggerated in rural states like Arkansas. It’s much harder for people to get to providers. We have fewer providers in the state as well. So it’s exacerbated just by access to someone that can provide the care, much less that we do have a lot of poverty in the state. We don’t have a lot of people that have health insurance. All of those things are bigger barriers here in Arkansas.

TP: The Psychology Clinic, which is run by the University of Arkansas Psychology Department and turns 50 this year — which is amazing — works to address these needs for mental health care in the state. What services can the clinic provide?

JF: I’m so excited to tell you all about the Psychological Clinic. We have three missions, a tripartite mission. One, we’re training the next generation of psychologists. And we are supporting applied research. But most importantly, like you were talking about, we’re providing direct mental health care in therapy, intervention and diagnostic evaluation to the community at a really low cost compared to community providers.

TP: Who are the clients that the Psychology Clinic sees?

JF: Anybody and everybody. So anybody is welcome to come call us up and get on our waitlist for services. We do see students. We do see faculty and staff. But then over half of our clients are just people from the community, fully unaffiliated with the University of Arkansas.

TP: And are these people primarily in Northwest Arkansas? Are you able to reach patients across the state?

JF: They are primarily in Northwest Arkansas, but in some cases we can offer telehealth services or virtual services across the state for families, individuals, kids, anybody.

TP: And I was curious about that because telehealth is able to reach people and overcome some of these barriers of distance. Do you think, in general, telehealth could be an answer to some of the mental health issues in America, or is it already working that way?

JF: It is already pretty widespread. The VA has been doing it for some decades, and Covid really pushed it to everyone. The early research on it says that it works as well as therapy in the room. Some people like it better, some people like it less. There is a difference in preference, but as far as how well it works, it works well.

TP: And you talked about how one of the barriers is cost, because often people don’t have insurance, or these services can just be expensive. And that is something that your clinic is able to overcome with an income based sliding scale. My question is, in concrete terms, what does that mean?

JF: We would determine what your fee for a session is based on the pay stubs or the tax returns that you would bring in, and then how many dependents that you have. So really, it’s just a function of that information. We have a chart. We find your fee that fits you best.

TP: And what is the range of fees that people pay for these services at the clinic?

JF: For our clinic, it’s $20 to $100 a session. Most of our sessions are $30 or under. For university staff and students and faculty, it’s $15 a session, so it’s a little bit reduced. We also offer diagnostic evaluation, which can be very expensive in the community and isn’t always covered by insurance at all. And those range from about $400 to $600.

TP: And what would those be specifically? What kind of diagnostic tests would people come to you for?

JF: This could be anything that’s happening that you’re not sure what’s going on, right. We can help take stock of your symptoms, understand that and offer you diagnostic clarity so that you know what’s going on. That could be depression, anxiety, bipolar disorder. But it could also be things like ADHD or autism. The whole gamut we’re able to do. Personality disorders, we can do that and give you those answers in the clinic.

TP: Do most university psychology departments run programs like the Psychology Clinic?

JF: If they have a PhD training program, many of them do, yes. Because, like I mentioned before, it is a joint mission for training and serving the community.

TP: The lack of mental health care providers, as you said, is really part of the problem here in Arkansas and across the country. Obviously, one of the missions of a university psychology department is to train new providers. What is the advantage to having a clinic and what do your students get out of that experience of being part of the clinic?

JF: Absolutely. That means that in addition to just the theory learning, the intel, the diagnostic understanding, they get real-world, hands-on experience and working with patients. They see how to not only learn about the therapy, but really then how to do it with a person, who is always going to be different. There’s always going to be unique challenges in every individual. And this teaches them how to apply what they’ve learned and meet the client where they are, no matter where the client presents.

TP: The clinic turns 50 this year, which is a huge milestone, which is amazing. And I’m sure you guys are thinking about the future as well. So how would you like to see the clinic evolve and grow going forward?

JF: We would love to just get bigger, right. Some of the limitations on us getting bigger, is our physical space. We’ve been in the same space for that whole 50 years in the ground floor of Memorial Hall. And the number of clients that we can see is limited by the faculty that we have to supervise, right. Because any client that comes to the clinic, their care is being supervised really closely by a licensed clinical psychologist. So we need more faculty. And that would allow us then to take more students as well. All of our students are on fellowships or financial support as well. And so before we bring more students in, we want to have that in place to be able to support them. The clientele is there, the patients are there. We just need more people to serve them better.

TP: The Psychology Clinic provides what you describe as evidence based mental health care. What does that mean exactly? And what would non-evidence based mental health care be?

JF: So, not only do we have a problem with people accessing any mental health care, in particular we want to make sure that they can access high-quality mental health care. Another way to say that is evidence-based care. Evidence based is kind of just a fancy way of saying that this is therapy or intervention or diagnostics that is research backed. We’ve done the work to make sure that these procedures, these strategies, when applied correctly, work to address whatever mental health concern they’re paired with.

TP: Then I guess that it implies there are non-evidence-based providers. What are they providing? Is that still useful care? And are there certain conditions or issues that really need to be addressed by people who are coming from an evidence-based background?

JF: Yes, there is definitely a place for non-evidence-based care. This would be great if you need support maybe navigating difficult decisions, you want to have someone to kind of run through your week with, do talk therapy that’s more maybe just focused on finding solutions or getting advice. That is really helpful for some people.

Evidence-based care is more applied to specific mechanisms or the things that are contributing to the mental health concern that you’re presented with. So rather than just going maybe week by week, because therapy is often weekly, and kind of addressing what’s happening that week these evidence-based therapies go in and try to correct the maintaining mechanisms. Or we say in medical care the root cause sometimes, right. And so sometimes you need a root cause treatment, sometimes you don’t.

TP: And is this ongoing treatment or is this treatment where you’re really trying to solve something and then let the patient move on their own?

JF: One really special thing about evidence-based care is that it is designed to be time limited. So something funny about psychologists is that when we’re doing therapy, we’re trying to work ourselves out of a job. We’re trying to help your symptoms improve so much that you really don’t need us anymore.

TP: And so obviously, this is part of what you’re training your students on. Students are getting doctorates here from the University of Arkansas. But is the Psychology Department also working to improve evidence-based care and train practitioners in the state as well?

JF: Absolutely. In the clinic we have some applied research running, which basically means we’re doing the research to see does this strategy of intervention work? Is it evidence based for this thing? One thing we’re doing right now is to see if we can augment or change something about it and establish evidence-based therapy to better fit kids with autism.

As far as training practitioners, we have about 30 students active in the clinic at any time that are then practicing in the community also. We have a lot of community partnerships where they’re in the clinic some days of the week, and then they’re out in school districts, or the CAC, or Peace at Home, or New Beginnings, working with clients there. And then over time, we’re hopeful that they will stick around and work here. And we’re also working on programs to do more education for existing psychologists in the area.

TP: Jessica, it’s been a great conversation. Thanks for coming on Short Talks.

JF: Thanks so much for having me.

TP: Short Talks from the Hill is now available wherever you get your podcasts. For more information and additional podcasts, visit ArkansasResearch.UARK.Edu, the home of research and economic impact news here at the University of Arkansas.

Music for Short Talks from the Hill was written and performed by local musician Ben Harris.