“Mental health is not just depression, schizophrenia, a mood disorder, anxiety; it has all of the things. We are trying to help patients where they are, rather than asking them to come to the place where we are,” Dr. Sanket Dhat, founder of Credence Behavioral Health, said at the recent ribbon-cutting for their Wiggington Road clinic. This sense of urgency is one echoed reality: Central Virginia’s mental health care shortage has been growing, with locals aplenty especially feeling Lynchburg struggling to get timely, affordable care.
CBH’s two-year milestone marks a turning point for the region, serving over 1,700 patients 16 and older with disorders ranging from depression and anxiety to substance abuse and addiction. The opening of the clinic is scheduled as the area is hit by a severe lack of psychiatrists and psychiatric nurse practitioners a deficit replicated in much of rural America, where almost half the population lives in mental health workforce shortage areas, the Kaiser Family Foundation stated. The dearth, paired with financial pressures and pandemic trauma, has left numerous waiting months to seek help or traveling great distances to get it.
What sets CBH apart is not just its integrated treatment on-site therapy, psychiatry, and cognitive testing but its commitment to cutting-edge treatments for those who have not found relief anywhere else. For patients with treatment-resistant depression, CBH offers Transcranial Magnetic Stimulation and esketamine nasal spray. These therapies are gaining popularity nationwide as miracles for those who’ve taken dozens of medications with zero results.
TMS, a surgical-free procedure using magnetic pulses that stimulate brain cells, is “gentle pulses of magnetic fields to stimulate nerve cells in the brain,” according to Dr. Katharine Marder with UC Davis Health’s Advanced Psychiatric Therapeutics Clinic. In contrast to typical antidepressant medicines, TMS avoids such common side effects as weight gain and sexual dysfunction, and is recently approved for use by adults who have achieved no success on two or more drugs. The treatment is typically administered in daily sessions over several weeks, with most patients experiencing remarkable improvement.
Esketamine, meanwhile, promises rapid relief. As described in a recent review, esketamine is the sole FDA-approved glutamatergic medication for treatment-resistant depression, showing rapid effects for those who are in acute distress. Quick improvement for some patients happens within days a stark contrast from the weeks or months for common antidepressants. Though not effective for all, with observation required due to potential side effects, clinical trials have established esketamine reduces symptoms and suicidal ideation in high-risk patients.
Insurance coverage is a major barrier for many seeking these advanced therapies. Dr. Dhat observes, “It’s hard on their pockets, especially with the economy, we do cover almost all commercial insurances as well as some of the VA insurances.” This is significant, since insurance coverage for IV ketamine or esketamine therapy varies highly and typically leaves patients with substantial out-of-pocket costs. More standardized insurance coverage is in demand, as highlighted by University of Michigan Health experts, who call for more easy access to these potentially life-saving treatments. Beyond new drugs, CBH is combating another longstanding obstacle: stigma.
“Educating people about the stigma,” Dr. Dhat asserts, is most important. He likens psychiatric conditions to diabetes: When you’re struggling with depression or anxiety, or ADHD, your brain is not getting enough supply of the serotonin or dopamine, or something like that.This message is gaining ground as more providers in the region like Carilion Mental Health and Centra Health’s emPATH unit rebrand and expand, aiming to make mental health care as accessible and accepted as any other medical service. Telepsychiatry is also revolutionizing access in rural and underserved areas. Telehealth models now connect patients to specialists from home or in local clinics, reducing travel time and wait. The Veterans Health Administration, for example, found that “probably 95 to 96% of the patients like [tele-mental health] better,” according to an ED/UCC nurse, with improved satisfaction and prompt care.
However, provider shortage remains. Efforts like the RISE-UP program at James Madison University are training new clinicians to practice in rural settings, and team-based care models and telehealth help in the extension of existing resources. Cost containment, workforce retention, and reduction of stigma will be crucial for sustaining momentum.
As Lynchburg’s new clinic goes into operation, the message is clear: Innovative treatments and community-driven solutions are reshaping mental health care but closing the access gap will require sustained commitment, partnership, and compassion from every corner of Central Virginia.
