A Lifeline for Rural Communities: Sutter Health’s Bold Behavioral Health Access Expansion

Summary

---

Podcast Summary

Podcast: Advancing Health
Episode: A Lifeline for Rural Communities: Sutter Health’s Bold Behavioral Health Access Expansion
Date: November 19, 2025
Host: American Hospital Association
Guests:

• Dan Peterson, CEO of Behavioral Health Services & CEO, Sutter Center for Psychiatry, Sutter Health
• Dr. Matthew White, Chair, Behavioral Health Service Line, Sutter Health
• Moderator: Rebecca Chicky, Senior Director of Behavioral Health, American Hospital Association

---

Overview

This episode explores Sutter Health’s ambitious strategy to expand behavioral health services in Northern California’s rural communities. Instead of focusing only on building new facilities, Sutter Health combines capital investments, community partnerships, and innovative care models—including telepsychiatry—to overcome critical access challenges. The discussion highlights the severity of the mental health workforce shortage in rural America and details Sutter’s multipronged efforts to deliver accessible, patient-centered behavioral health care.

---

Key Discussion Points & Insights

1. The Rural Behavioral Health Crisis

• Workforce Shortages:
  • 65% of rural counties lack a psychiatrist; 70% have no child and adolescent psychiatrist.
  • Suicide rates in rural America have been consistently higher for nearly two decades.
  • (00:35–01:30)
• Sutter Health's Role:
  • Large, integrated system with 23 hospitals across diverse geography—from urban San Francisco to remote Crescent City.
  • Presence in rural areas and commitment as sole provider in certain communities.
  • (01:53–02:45, Dan Peterson)

2. What Is a Critical Access Hospital?

• Definition & Importance:
  • Critical Access Hospitals are the primary, sometimes sole providers in isolated, rural areas.
  • Patients often can’t travel to other hospitals; care must come to them.
  • (02:46–03:45, Dan Peterson)

3. Capital Investments to Expand Access

• New Facilities:
  • 18,000 sf office/urgent care building in Crescent City, near Oregon border.
  • Launching an Empath unit—a therapeutic crisis care facility for patients in behavioral health crisis, adjacent to the emergency department (3,000 sf).
  • 7,000 sf medical office building at Lakeside Hospital, Lake County ($5.5 million investment).
  • New rural health clinic to open in Los Banos, outside Modesto, next summer.
  • All facilities aim to integrate primary and behavioral care.
  • (04:03–05:20, Dan Peterson)

4. The Empath Unit: Crisis Stabilization Reimagined

• Design & Purpose:
  • Inspired by a state grant for crisis care—Empath units offer a more therapeutic, less clinical experience compared to standard ERs (soothing design, chairs instead of gurneys, less stimulation).
  • Demonstrated to reduce hospitalization rates and length of stays.
  • Memorable Quote:

    “It’s really just a much more soothing environment. And it's shown to have significant reduction in hospitalization rates and reduced lengths of stay.”
    —Dr. Matthew White (05:32–06:20)

• Impact:
  • Unlike typical ERs, most patients can be stabilized within 23 hours or less instead of waiting days for rare inpatient beds.
  • (06:52–07:23, Dr. White)

5. Community Partnerships: The Rural Advantage

• Collaboration for Solutions:
  • Empath project grew from ongoing work with behavioral health and tribal entities; early seeds grants led to successful, “shovel-ready” state funding.
  • Building relationships is easier in rural settings, with all stakeholders able to collaborate closely.
  • Notable Quote:

    “You truly can bring the whole community together and come up with a dream and a vision…in a way that is far more difficult in a metropolitan area.”
    —Dan Peterson (08:28–09:16)

• Personal Touch:
  • Rebecca Chicky shares her own rural upbringing, affirming the unique strengths of rural collaboration.
  • (09:16–09:50, Rebecca Chicky)

6. Virtual Care, Workforce Maximization & Collaborative Care

• Telepsychiatry & Collaborative Care:
  • Use of virtual behavioral health models (including Concert Health as a partner) to embed behavioral care in primary clinics.
  • Primary care physicians get remote psychiatric/nursing support for medication management and therapy.
  • In Los Banos, nurse practitioners are now available in the rural health clinic.
  • (09:50–10:37, Dr. White)
• Workforce Efficiency:
  • Collaborative care enables clinicians to “practice at the top of their license.”
  • Allows for maximal impact of a scarce psychiatric workforce.
  • Models let community physicians continue managing care with expert consult support—crucial where recruitment of psychiatrists is nearly impossible.
  • Notable Quote:

    “By embracing other care models…it helps you sort of maximize the impact of the workforce that you do have available.”
    —Dan Peterson (11:05–11:30)

• Positive Outcomes:
  • Integrated, collaborative models not only improve patient and workforce satisfaction but also help reduce stigma in small communities.
  • (12:06–12:55, Rebecca Chicky & panel)

---

Notable Quotes & Memorable Moments

• On Critical Access Hospitals:

  “You really are the provider that those residents have to depend on…The communities really depend on these providers…to do a great job for them.”
  —Dan Peterson (02:48–03:40)

• On Rural Community Engagement:

  “It is logistically possible to bring together all the stakeholders…get them all physically at the same table and co-develop some of these ideas.”
  —Dan Peterson (08:28–09:16)

• On Empath Unit Impact:

  “Folks don’t end up getting hospitalized quite as frequently and can get the care they need right then and there, instead of going a long distance after a long stay.”
  —Dr. Matthew White (06:52–07:23)

• On Maximizing Workforce:

  “It really allows our clinicians to work at the top of their license…those models really lend themselves towards virtual support.”
  —Dan Peterson (10:37–11:10)

---

Timestamps for Key Segments

• Rural Behavioral Health Access Context: 00:35–01:30
• Sutter Health’s Rural Footprint: 01:53–03:45
• New Facilities & Investment Details: 04:03–05:20
• Empath Unit Explained & Patient Experience: 05:25–06:52
• Community Partnering & Grant Funding: 07:36–09:16
• Virtual Care, Collaborative Care Model: 09:50–11:10
• Benefits of Integrated Care: 12:06–12:55

---

Tone and Final Thoughts

The conversation is practical, innovative, and hopeful—acknowledging the real, persistent struggles of rural behavioral health while highlighting Sutter Health’s creative, community-centered solutions. The theme of “meeting patients where they are,” both literally and figuratively, runs throughout, reinforced by concrete investments, cutting-edge care models, and heartfelt partnership. The episode underscores not just the need, but the possibility and power of collective action to address rural health inequities.

---

Listeners interested in resources for National Rural Health Day can find more information in the episode show notes.

Transcript

[A]

Welcome to advancing health. Behavioral health resources are in especially short supply in many rural areas of the country. Sutter Health in Northern California is committed to dramatically expanding access to behavioral health services for rural residents. And as we hear in this discussion, its game plan goes beyond just constructing new facilities.

[B]

I'm Rebecca Chicky, the senior director of Behavioral health at the American Hospital association, and it is my honor, truly today to have two speakers for this podcast. Dan Peterson, who is the CEO of Behavioral Health Services as well as the CEO for Sutter center for Psychiatry at Sutter Health, and his colleague, Dr. Matthew White, who is the chair of the Behavioral Health service line at Sutter Health. Welcome to both of you, and thank you for being willing to share your time and expertise on how Sutter is expanding access to behavioral health in rural communities. Before I launch my first question to you, though, I just want to set the stage for the listeners who may not know the severity of accessing services in rural communities. 65% of rural counties do not have a psychiatrist, and 70% of rural counties have no child and adolescent psychiatrist. And for nearly two decades now, suicide rates have been consistently higher in rural America compared to urban America. So just a level set how important it is that Sutter is doing this work. As we start, could you give the listeners a sense of what is Sutter Health, you know, what's its clinical footprint? And Dan, I'll pitch it to you, and then Dr. White, please weigh in.

[C]

Yeah. So Sutter Health is a large integrated healthcare system. We're really geographically focused in Northern California, but we cover the breadth of services across our footprint of Northern California. We have 23 hospitals. We have 57,000 employees, 6,000 physicians, clinicians. In our medical group, almost 6,000. And so we're really quite a large health system, but we are also quite geographically diverse. Right. We have hospitals and clinics everywhere from downtown San Francisco, right in the middle of the city, all the way up to Crescent City, a small town up on the Oregon border, eight hours north. We have a number of rural hospitals, critical access hospitals, and rural health clinics that very proud to support.

[B]

And for the listeners who may not be healthcare experts per se, can you describe a little bit of your critical access hospital? Yeah.

[C]

Thank you. A critical access hospital is just a designation for a hospital that is essentially a sole provider in a community. You have to meet certain geographic distance requirements from other hospitals and really by definition, be in a rural area. I was actually the CEO at Sutter Lakeside Hospital in rural Lake county several years ago, about eight or nine years ago, serving in A community living in a town of Lakeport with just a couple thousand people there. And it's really meaningful care provided in those communities because you really are the provider that those residents have to depend on. Many of them simply cannot travel either can't afford to travel, don't have the means to travel, or logistically, because of the needs of their care, cannot travel long distances in order to reach another provider. So the communities really depend on these providers in the rural communities to do, not just to be there, but to do a great job for them.

[B]

Well, and I can tell there's a piece of your heart that is clearly committed to rural communities. Sutter has recently made investments to expand behavioral health services in two rural areas in California. Can you tell me about that? Let the listeners know what you're doing and why?

[C]

Yeah, I'll start with some of our capital investments and then maybe Matt can talk about some of the programs we have recently announced. We're building more infrastructure in these rural communities. That's an important piece of what we have to do. So we are going to be building some additional office buildings, about 18,000 square feet of additional office buildings for primary care and urgent care up in Crescent City on the Oregon border. We're also really excited to announce something called an Empath unit, which is, which is a crisis care unit for individuals in a behavioral health crisis immediately adjacent to our emergency department there in Crescent City. It'll be a 3,000 square foot facility really designated for behavioral health crises. We're also building an additional medical office building in Lake county at our Lakeside Hospital, another 7,000 square feet or so. About a five and a half million dollar investment in that community. And this coming summer, we'll be opening another rural health clinic in Los Banos, actually just outside of Modesto. We have a rural hospital there and we're excited to open a new rural health clinic there, which does tie into our behavioral health strategy as well as we're really looking programmatically to embed these services in our primary care offerings at all these communities. And Matt, as a psychiatrist, can probably talk a little bit better about that, the strategy behind that and why that really works.

[B]

Well, Dr. White, you're up first.

[D]

I'll expand on the Empath unit a little bit and then talk about some other ways in which Sutter is supporting behavioral health in these rural communities. As Dan articulated, Crescent City is up on the far, far north coast of California. It's really pretty much an island in a very rural community. If you're in a behavioral health crisis, you end up in our emergency room there more often than not. Sutter recently got some state funds to build a specialized kind of crime crisis care unit, a crisis stabilization unit. But an empath unit is really a particular type of crisis stabilization unit. It's designed differently in a more therapeutic way. Doesn't have the bright lights of an emergency room. It tends to have chairs rather than gurneys. It's really just a much more soothing environment. And it's shown to have significant reduction in hospitalization rates and reduced lengths of stay. So we're really fortunate to be able to leverage a state grant opportunity to kind of provide a place where folks in crisis in that area can go to get more therapeutic relief than the current state.

[B]

So it sounds much more patient centered for someone who is in a psychiatric crisis compared to an emergency department, which, as you articulated, can be loud with lots of lights and lots of activity. You really are being able to deliver patient centered care in a different way. Is there an average length of stay? What is the time period?

[D]

Usually it's significantly less than 23 hours. So that the average length of stay in an emergency room in these rural communities can be literally days sometimes. Because if you need to be in a hospital, there's very few resources around. So people can spend several days, sometimes waiting to get a hospital bed and then travel six hours to the nearest hospital. Because empath units are more therapeutic. Actually, folks don't end up getting hospitalized quite as frequently and can get the care they need right then and there instead of going along long distance after a long stay.

[B]

If that's not patient centered care, I don't know what is. I know that Sutter has been the driving force behind some of these initiatives, but have you had engagement or worked with community partners?

[D]

Yeah, the empath unit is a perfect example. It actually started a number of years ago where our community benefits liaison had been working with local behavioral health and local tribal entities because it's been a long identified problem. And they actually got some early seed grant funding a number of years ago to sort of plan for something like this empath unit. So when this larger grant opportunity came along last year, which was prioritizing projects that were kind of, quote, shovel ready, ready to go because of the existing kind of groundwork that Sutter had done, working already with the local communities and hoping and planning for one of these empath units, it was a project and a grant application that really rose right to the top and got funded because again, some of that community work that had already been happening.

[B]

Dan, anything you'd like to add about the community partnerships.

[C]

One of the things that I have loved about working in rural communities is you have an opportunity to truly rally everyone in the community around something, right? Because there just aren't that many people to rally. And so it is logistically possible to bring together all the stakeholders, to bring together multiple interested parties, multiple interested, interested organizations, and get them all physically at the same table and co develop some of these ideas. It's an ideal scenario in many ways. I think sometimes we think of the rural communities as having challenges and difficulties, because that's true. But on the other hand, there are some of these advantages where you truly can bring the whole community together and come up with a dream and a vision as a community in a way that is far more difficult in a metropolitan area.

[B]

Oh, I so concur. I grew up in rural Alabama in a community of about 30 homes. So everyone knew everybody. The local police officer, you know, of the tiny little town seven miles away, used to come mow my mother's grass. I mean, her primary care physician was right down the street. And so the support system and the ability to identify needs and then come together and collaborate to meet those needs, it's truly unique in rural communities. Beyond the empath unit, can you share how Sutter is working to expand access to care in rural areas in California?

[D]

There's a couple ways, actually, a number of ways. As Dan mentioned earlier, finding a psychiatrist or even a therapist is so challenging in those environments. One of the initiatives Sutter has been leveraging virtual opportunities in telepsychiatry. And one such way is through embedding primary care into behavioral health using a nationally recognized model called collaborative care. And so we've been able to stand up collaborative care using a virtual provider. So this is where a primary care physician can get support and access to a therapist for the patient and psychiatric support for help medication management through Concert Health, our virtual partner. Additionally, in Los Banos, which Dan mentioned earlier, Sutter has recently hired some nurse practitioners to serve patients in their rural health clinic.

[C]

One of the reasons that this model is so successful in Sutter Health we've embraced this collaborative care model is because it really allows our clinicians to work at the top of their license and it allows us to maximize our clinician workforce. Right. There are only so many psychiatrists out there and there are only so many psychiatric nurse practitioners and advanced practice clinicians, like clinical workforce, especially in rural areas, is difficult to come by. Recruitment is difficult. There are many rural communities that you just can't find a dedicated psychiatrist to come move to that rural community. But by embracing other care models that sort of allow these clinicians to come in and consult on the care of the patient and allow the primary care doc to continue to be the prescribing clinician, but with the support of a psychiatrist, the those models really lend themselves towards virtual support, which is very helpful in the rural communities. And second of all, it helps you sort of maximize the impact of the workforce that you do have available. And so then, you know, we look at places like Los Banos where we haven't been able to bring in a psychiatrist for that model, but we have had success in recruiting a psychiatric nurse practitioner or some of the other areas where we're able to find some therapists, and they just need some support, or we have a strong core of primary care docs, but they just need some support, support from a psychiatrist. Embracing different types of models like that really just helps logistically embrace the challenge of recruitment in those areas.

[B]

So it sounds like from this approach, you are meeting the patients where they are. You're better supporting the staff, the clinicians that you do recruit practicing at the top of their license. I've seen some studies in integration that show that integrated care or collaborative care not only improves patient satisfaction, but workforce satisfaction. It can reduce stigma, which can be great in rural communities. It has just an abundance of positive outcomes. So thank you for taking it there. Dan, Matthew, thank you so much for being here with us today and for sharing your experiences and your innovative ideas on how you're improving access to behavioral health services in rural communities. And before I go, I'd like to remind everyone that November 20th is national rural Health Day. Be sure to check out the links in the show notes below for a wide variety of resources that will allow you to participate in this important awareness day.

[A]

Thanks for listening to Advancing Health. Please subscribe and rate us 5 stars on Apple Podcasts, Spotify, or wherever you get your podcasts.