Jody Haines, director of telehealth services at the Eastern Montana Telemedicine Network
Photo: Jody Haines
In Wyoming and Montana, mental and behavioral health issues are widespread and compounded by the challenges of rural life, where isolation, transportation barriers and workforce shortages make access to care significantly more difficult than in urban areas.
Both Montana and Wyoming consistently rank poorly in national mental health measures, with high prevalence of depression, anxiety and suicide – Wyoming, for example, is ranked near the bottom for access to care and prevalence of mental illness, and many residents must travel long distances to reach a provider, said Jody Haines, who works at Billings Clinic and is director of telehealth services at the Eastern Montana Telemedicine Network.
Haines also is vice chair of the Northwest Regional Telehealth Resource Center and a member of the American Telemedicine Association Center of Digital Excellence.
Few mental health providers
"In rural America broadly, adults with mental illness are 1.5 times less likely to receive treatment than urban residents – and more than 70% of rural counties lack a psychiatrist," she explained. "In Montana, roughly 60% of residents live in areas with mental health professional shortages, with many rural counties having few or no practicing psychiatrists, psychologists or addiction counselors.
"And nearly half of Montanans who need care report cost as a barrier," she continued. "These gaps mean a significant number of people with serious mental health needs – especially youth and uninsured adults – go untreated, and rural residents often face long travel, limited local services and stigma that further deter care," she added.
The Eastern Montana Telemedicine Network began in 1993 as one of the first 10 telemedicine networks in the U.S. Since the beginning, mental health providers have used the EMTN to reach patients who lack access to local services. Thirty-three years later, Montana still struggles to attract mental health professionals and relies on tele-mental health services to help fill the void.
"In 1993, there were no psychiatrists practicing in the eastern one-third of the state," said Mark Horn, manager of telehealth at Billings Clinic. "Montana is the fourth-largest state; this area covers roughly 53,000 square miles. Even in 2019, it was reported that only one psychiatrist was physically practicing in this portion of the state.
"In July 2025, all but five of Montana's 56 counties were designated mental health professional shortage areas," he continued. "Because of the vast distances and lack of providers available, many patients' only option to receive mental health services is through telehealth."
A hub-and-spoke setup
The EMTN model used since 1993 is a hub-and-spoke system. Billings Clinic, a multidisciplinary Level 1 Trauma Center, serves as the hub. Spoke locations are spread across Montana and northern Wyoming. Until 2020, nearly all tele-mental health appointments occurred within this network – virtual appointments directly with the patient have become the primary tool to deliver services since 2020, Horn reported.
"Over the past five years, since the COVID pandemic, we have really reshaped the way we get to deliver this care to patients, essentially making geography irrelevant and creating healthier communities, one person at a time," Haines said. "The direct-to-patient telehealth flexibility and regulatory permanence has really been the biggest modality opportunity.
"Patients can be in their homes, or a convenient and safe location, to have the medical professional beam directly in to them via their device of choice," she continued. "Another telepsychiatry model of care has been within our inpatient settings, where we have coverage provided by our local team being beamed into and across campus, where and when needed."
Dive into the pool
Lastly, through a partnership model, there is a pool of providers that conduct telepsychiatry services to the Billings Clinic main campus or to the thirty-plus hospitals and care facilities on the telemedicine network.
"By offering these via telehealth, we have seen access to these essential mental and behavioral health services skyrocket – allowing patients to connect with providers within hours, not weeks," she concluded. "Through the continual commitment to optimizing patient care, these differing telehealth use cases have allowed us to continually innovate, providing better continuity and patient outcomes for those we serve."
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