Brooke Kempf on How LAIs Improve Mental Health Care in Rural Communities

In rural areas like Indiana, access to mental health care is a persistent challenge. Brooke Kempf, PMHNP, from Indiana University Indianapolis, draws from her career as a psychiatric mental health nurse practitioner (PMHNP) to shed light on the barriers faced by patients with schizophrenia. Despite efforts to close the gap in care by training advanced practice providers, a severe shortage of mental health professionals remains. This shortage leads to significant delays in posthospitalization care, contributing to high rates of rehospitalization and medication nonadherence among patients. In this interview, Kempf discusses her journey to becoming a provider, the importance of timely outpatient care, and how innovative approaches like long-acting injectables are helping to bridge the gap in mental health services.

This transcript has been lightly edited for clarity.

Transcript

In terms of access to care for schizophrenia, how do long-acting injectables factor in?

If we think about access to care, there are not many providers out there. I know one of the reasons that I went back to school, or my community mental health center asked me to return to school, was because we live in a rural Indiana area—there are not many psychiatrists coming to our area. They knew we were going to need advanced practice providers to fill that gap, so they thankfully sent me back to school. And even with having advanced practice providers now, we still have a huge shortage of providers out there. There's a long gap of trying to get patients seen by providers. Working most recently as a hospitalist, upon discharge, we want patients to be seen within 30 days of discharge within our own community mental health center, where we have access to case managers, therapists, nurses. We still don't have that access sometimes to get patients in as soon as we'd like to after hospitalization. And we know, if we look at statistics when it comes to patients getting rehospitalized, about a quarter of our patients, within 30 days of being discharged, are rehospitalized, and we know about 68% of patients after discharge, within 6 months, aren't even taking their medication. So, we know adherence is a huge issue after discharge from hospitalization. We need them to be able to be seen by providers in an outpatient [setting], which we know is also a gap.

So, where can we fill that gap? If you think about an individual getting a long-acting injectable when they're in the hospital, then at least they have medication coverage until they're able to be seen by an outpatient provider. Yeah, there are other providers. We have case management, nurses, other people are seeing them along the way, but at least they have medication on board. And you know, those that you discharge, and they never even went to fill the prescription when they left the hospital, you don't have to worry about that—before we had to wait for them to be seen. And we learned some of these things as time goes on. Now, we're able to intervene much earlier. Another advantage of a long-acting injectable is you know right away when a patient becomes nonadherent to medication, so you can have early intervention, hopefully then preventing a hospitalization, rather than trying to fix it after the fact.