Get to Know Caroline Sica

On Maryland’s Eastern Shore, and in rural communities across the country, access to psychiatric care can be severely limited. Distance, workforce shortages, and smaller healthcare systems can make it significantly harder for individuals in crisis to access necessary mental health services. Bloomberg Fellow Caroline Sica, a psychiatric mental health nurse practitioner on the Eastern Shore, sees the outcome of these barriers to care in each of the four hospitals she serves.  

Sica’s path to rural psychiatry began in emergency nursing, where she saw firsthand how patients in crisis move through a system that is not built to identify and support struggles early on. Today, she provides psychiatric evaluation and medication management in an inpatient behavioral health unit, responds to hospital consults across a community hospital, and treats patients in a Substance Use Disorder Intensive Outpatient Program. She also extends care beyond hospital walls through telehealth, covering emergency departments across the region.

Through her work, Sica has found that access to care is not just about whether the services exist, but also about whether a patient can realistically access them. On the Eastern Shore, some of Sica’s patients live 45 minutes or more from their nearest providers, meaning follow-up care can be limited or nonexistent.  For many, that alone is enough to delay or prevent continued care. Telehealth has helped extend her reach, but it is not a complete solution. “Good psychiatric assessment depends on nuance: body language, affect, the feel of a room,” Sica explains. “A screen flattens all of that.”

Stigma also operates differently in rural settings. Tight-knit communities can be a source of support, but they can also deter people from seeking care. As Sica notes, “When everyone knows everyone, seeking help carries a social risk that urban patients often do not face in the same way.”

At the center of her approach to combating this stigma is an understanding that everyone goes through difficult times. “Life is exceedingly hard, and we all have brains that generally work quite well but sometimes don't. The beautiful and awful part of our shared human experience is that, at some point or another, we all need help.”

Sica notes that while anyone can find themselves in crisis, oftentimes, they could have been prevented with greater access to outpatient care. On the Eastern Shore, and in rural areas across the country, there are not enough providers to meet demand for therapy and medication management, leaving patients with weeks or months between discharge and follow-up. That window is where many fall through.

For Sica, the solution starts with increased investment in prevention, mental health literacy, and community-based support. “We spend enormous resources treating psychiatric crises that were years in the making,” she says. “If we invested more upstream, the impact would be significant.”  

Through her Bloomberg Fellowship, Sica hopes to gain the skills and connections she needs to build stronger systems and fill the gaps in care to better serve her patients.