needing help after school, staffed by psychiatric nurse practitioners
who can spend a worthwhile amount of time with each patient.
After years of planning and preparation, a location was found,
rented, stocked and staffed in time for the start of 2014. As luck
would have it, a location presented itself just across the street from
Dr. Frankel’s private practice on Lime Kiln Road.
Today, the Couch’s waiting room is decorated with modern chairs
and sofas sporting intricate patterns and lacking arm rests. On the
walls hang bright paintings as well as photos taken by Dr. Frankel’s
husband during a visit to Peru. An electric fireplace adorns the
front desk. While I was inside The Couch for just a few moments,
a woman in her early 20s came in without an appointment, gave
her information, and sat for a moment before being called back to
speak with a psychiatric nurse practitioner.
“I think nurse practitioners are much more holistic in their
approach. They’re taught in nursing school to think of the whole
patient and be a patient advocate,” said Dr. Frankel.
The Couch is also under the supervision of Dr. Frankel’s friend
and business partner, Dr. Debbie Thomas, Ed.D, APRN, who serves
as the facility’s Medical/Clinical Director.
“Urgent mental health care is a no-brainer,” said Dr. Thomas, a
nursing professor who operates her private practice, Here & Now
Psychiatric Services, out of the same building. “With some of the
changes in the Affordable Care Act and lack of enough psychiatric
in-patient and out-patient facilities, there is a huge gap in access to
mental health care. Often patients are discharged from a hospital,
and there is no one for them to follow up with. They shouldn’t
have to wait anywhere from 3 to 12 weeks to get an appointment.
Dr. Thomas also serves as Assoc. Professor and Coordinator
of the University of Louisville School of Nursing Graduate Psych
Nurse Practitioners program. The program has enjoyed a 100 percent overall pass rate for the past seven years of her involvement.
“A psychiatrist friend said to me years ago, ‘Primary care providers are the foot soldiers in the field for psychiatric mental health
care.’ That has rung in my ears many times. … This just isn’t a role
of the primary care provider, and I think many of them who are
friends of mine would be the first to say that. They want to refer
to Psych but no one is taking new patients or they can’t get them
in fast enough.”
“Debbie and I are good buddies, and she was incredibly helpful
as I was working on the idea for The Couch,” said Dr. Frankel. “So
she moved her private practice, and periodically brings graduate
psychiatric nurse practitioners in to shadow her.” These graduates work under the supervision of an experienced senior nurse
practitioner at all times as well as the direction of Drs. Thomas
and Frankel.
“It was no small thing to move my thriving private practice
from Crescent Hill to The Couch,” Dr. Thomas said. “I decided
it made sense and helped us to really forge a system conducive to
good program oversight and good communication. I like how we
focused on the environment being a calm and comfortable place.”
Treatment at The Couch is typically divided into two sections
based on the needs of each patient. Visitors can pay for a 30-minute medication check or an hour long psychiatric evaluation for
$110 or $225 respectively. Those times aren’t set in stone however.
“I don’t like rushing people in and out. That idea bugs me. So if
there’s nobody in the waiting room, and you’re seeing the nurse
practitioner, they may spend 90 minutes with you. The people we
have like to do therapy. They like to talk to patients. If anything,
I’m having to be the bad guy to reign them in,” laughed Dr. Frankel.
The Couch is not within an insurance network, but has forms
available so patients may submit out of network coverage to insurance companies. “Some people think without insurance coverage
they shouldn’t come at all, but the truth is that deductibles are
upwards of $1,000. Even if they visited psychiatrists covered by
insurance, they’d likely be paying out of pocket anyway.”
Patients vary widely from adults to grade school age. Diagnoses
naturally follow a similarly wide swath. Dr. Frankel notes the most
common issues her patients face are anxiety, depression, panic
attacks, and suicidality. Parents may bring in their children if there
are behavioral issues, perhaps stemming from Attention Deficit
Disorder or social issues.
The Couch is open until 8 p.m. on weekdays and Saturday from
10 a.m. to 4 p.m. which Dr. Frankel explains as a simple way to
decrease the stress of patients attempting to get proper care. “We
wanted to create hours that would accommodate working people.
I think of The Couch as a bridge. It’s for those who can’t get in to
see their psychiatrist or for a one time issue where a person just
needs to talk to someone professionally and privately.”
So far, the experiment seems to be working. The Couch is already
drawing as many as a dozen visitors per day. There are currently two
nurse practitioners on staff with enough room for four operating at
any given time. There has been zero paid advertising so far, with all
business has come from Facebook, television interviews and word
of mouth. “I think the word is spreading. Certain schools, certain
therapists are starting to send us a lot of business.”
Despite the increased demand,