Project ECHO Aims to Improve Access to Mental Health Services

By Arianna Talaie

Mental health treatment need is expanding exponentially, and mental health providers are scrambling to keep up with demand from urban centers to rural communities, from academic medical centers to primary care facilities, across the United States, and outside its borders. With the launch of a new mental health initiative under Project ECHO (Extension for Community Healthcare Outcomes) through a grant from the GE Foundation, we have a replicable model to provide mental health care and substance abuse treatment to patients in settings that are convenient and comfortable.  

Project ECHO, headquartered in Albuquerque at the University of New Mexico Health Sciences Center, connects specialists at academic medical centers with primary care clinicians in local communities to serve patients with complex and common conditions. The model employs videoconferencing technology to foster weekly teleECHO clinics, in which primary care doctors, nurses, and physician assistants from various sites present challenging patient scenarios to specialist teams and confer on treatment plans. Specialists then share their medical knowledge with primary care clinicians, bringing high-quality, specialized service by providers to patients who might otherwise not be able to receive it in their communities. 

“Project ECHO is a system intervention,” says Sanjeev Arora, MD, founder of Project ECHO. “It de-monopolizes the knowledge base and shares it, so that people in primary care can become as good as the specialists are.”

The innovative difference lies in the transformation of primary care clinicians into behavioral health care specialists who work full-time in community settings. The patient gets increased access to specialized care without long wait times or travel. ECHO enhances the integration of mental health with primary care, combining a behavioral and physical visit, often on the same day.

“The component of the model I like is the talking—taking more time with people by having a conversation,” says Michael Hogan, MD, former New York State Commissioner of Mental Health. “The challenge is the separate system for mental health. Having one treatment for the head and another for the body just doesn’t work.”

The project will train 16 nurse practitioners and community social workers to diagnose and treat patients with behavioral health conditions at eight federally qualified health centers in rural New Mexico. If the model proves successful over three years, replication will begin in other areas. Funding for the Project ECHO mental health initiative comes the GE Foundation. Additional funding and support for Project ECHO comes the Robert Wood Johnson Foundation, who has supported Project ECHO since 2009, the GE Foundation, the Center for Medicare & Medicaid Innovation, the New Mexico legislature, New Mexico Medicaid, the University of New Mexico Health Sciences Center, and the New Mexico Department of Health.

“Academic medical centers have a wonderful opportunity to position themselves as the new central nervous system of our health care system,” says Arora. “Working with new kinds of delivery models such as Project ECHO, academic medical centers can engage clinicians in every part of the country and across the continuum of care in lifelong learning and collaborative practice while expanding our capacity to treat patients.”

By transferring the expertise of medical schools to the community level, greater access to care for underserved patients with chronic conditions will no longer be a project, but the norm.

“This model provides an opportunity for academic medical centers to do what they do best: knowledge dissemination to local doctors and communities,” says Coleen Kivlahan, MD, Senior Director of Health Care Affairs at the Association of American Medical Colleges. “It is the model for our future.”

Arianna-Arianna Talaie is a Health Care Affairs intern at the Association for American Medical Colleges in Washington, D.C. She is a rising sophomore at the College of William & Mary, studying Government and Global Studies with a focus on Public Policy.