Mental health has long fought
social stigma. In fact, many mental health issues go unaddressed because of physicians’
inability to address psychological concerns in the primary care setting as well as patients not wanting to be labeled as 'crazy' or 'mentally ill'. To help combat some of the negative connotations associated with mental
illness, the state of Oregon is piloting a program that places psychologists in
the primary care setting.
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In a National Public Radio (NPR)
story Doctors Enlist Therapists to Deliver Better, Cheaper Care (2013), Kristian Foden-Vencil reports how having
access to mental health care in the primary care setting can help patients that
often come in with psychosomatic concerns such as migraines or stomach aches. These
maladies do not improve with traditional prescriptions and often stem from
issues in a patient’s life. The
patient may not even be aware that certain life events such as stress, divorce
or a death in the family can manifest as physical symptoms. Patients often
become frustrated because their symptoms are not relieved with medical
treatment. Primary care physicians can make recommendations and referrals for
patients to see a mental health professional, however, this advice is not
always followed. According to
Robin Henderson, a psychologist in Bend Oregon and part of the St. Charles
Health Care System, patients do not make follow up psychology appointments
because they do not want the stigma of seeking mental health assistance
(Foden-Vencil, 2013).
In Oregon, the Mosaic Medical Clinic
enlists psychologists to see patients during medical office visits. Pediatrician, Kristi Nix states,
“having a psychologist in the clinic has lifted a burden off her shoulders”
(Foden-Vencil, 2013). The psychologist can sit with a patient during a routine
office visit and delve deeper into concerns that may be causing physical
illness. According to the story,
this is a departure from the traditional way that psychologists practice. Instead of weekly or more frequent
therapy sessions, the psychologist visits the patient for 20 minutes during the
office visit.
Public
health can be greatly impacted by this approach. If Oregon is successful in this pilot program, access to
mental health professionals can greatly increase. This, in turn, can assist individuals that do not seek help
or have access to mental health care otherwise. Mosaic Medical Clinic primarily
services Medicaid recipients. This
is an important public health aspect because Medicaid recipients are often of
lower socioeconomic status. The
dual aspect of being of lower socioeconomic status and having mental health
issues can be intimidating and embarrassing for some to seek treatment. Having
access to mental health in the primary care setting built into a routine office
visit can increase a patient’s willingness to seek help and follow through.
In
addition to increasing mental health access, Mosaic Medical Clinic, estimates a
reduction in Medicaid costs, approximately $860 per patient. This novel approach may prove to
be beneficial in all aspects of public health. Patients can receive care that is often over looked or not acted
upon. The results of this care would be less physical manifestations of illness. Physicians have the ability to be more
successful in treating patients.
There is a multifaceted, teamwork approach to medicine in the primary
care setting. Finally, health care
costs can be decreased. The approach of mental health professionals in the primary care setting can reduce the stigma associated with mental illness and open new ways of treating the patient as a whole.
Very interesting, Sharyn, to see that there are physical and mental health partnerships developing that can care for the whole patient. I am curious to see how it's working in various settings, and was pleased to find a list of integrated care models compiled by the Substance Abuse and Mental Health Services Administration at http://www.integration.samhsa.gov/integrated-care-models/list. One in particular, the Four Quadrant Clinical Integration Model, rates a patient's risk/complexity as high or low in behavioral health (BH) and physical health (PH). The result places a patient in one of four quadrants--either low-low, low-high, high-low, or high-high--and outlines the levels of care s/he might need from PCP, psychiatry, NPs, case managers, home-based care, inpatient facility, etc. A model like this could guide health providers to structure their care to meet the needs of their patients.
ReplyDeleteI think this is a such a wonderful health care model. So many times in the hospital we see patients whose maladies stem from psychological rather than physiological origins. Often times, psychological strain can manifest itself somatically, but the solution of treating the resulting generalized pain, dizziness, or nausea with medication is superficial at best and harmful at worst. I think that a lot of times physicians and nurses sense that there is a deeper issue at hand but feel constrained by time and the fact that the patient is insisting that they require medication. When the therapies requested don't work, the patient and care provider both become frustrated, and the care provider might view the patient as unreasonable and cause the patient to become further ostracized. It can be so difficult to get a psych consult in the hospital, and it's so often the case the the patient should have been consulted early on in their disease process. i hope that this model gets more publicity and piloted in more health care systems!
ReplyDeleteI think having psychologists see patients during medical office visits is a great way to reduce barriers and to hopefully reduce the stigma associated with seeking mental health services. For my population health clinical, I am working with a community of elderly Chinese immigrants. Because mental illnesses are so stigmatized in traditional Chinese culture, mental health disorders are underdiagnosed in this population. One potential way to address this stigma is to offer mental health services, such as depression screenings, at culturally acceptable sites such as senior centers. In addition to convenience and accessibility, incorporating mental health services into the senior center culture would help minimize stigma associated with seeking help for mental health problems. I feel that incorporating mental health services into routine medical office visits would do the same for the general population.
ReplyDeleteGreat post, Sharyn! As you mentioned, there are many barriers to patients receiving the mental health care they need. One barrier may be nurses not feeling comfortable or competent addressing mental health issues. The American Psychiatric Nurses Association (APNA) has a number of resources on their website to help nurses provide mental health care to patients. These resources include: online continuing education, toolkits, screening tools and a list of community resources. More information can be found at: http://www.apna.org/i4a/pages/index.cfm?pageid=3859
ReplyDeleteThis is a really interesting idea. I know someone who works at a behavioral health center in southern Indiana, which is currently working on developing a new model to help provide better medical care for the patients with severe psychiatric issues that they treat. The concept is in some ways the opposite of this initiative-- providing medical care to patients who are already coming in to be treated for mental illnesses and who may have difficulty seeking out and utilizing outside medical treatment. But it's similar in that it seeks to integrate the physical and the psychological aspects of patients' care. This has the potential to be useful not only because it's a more convenient, one-stop-shopping style for patients, but also because the mental and physical aspects of health are often closely connected and intertwined.
ReplyDeleteThis is an excellent topic. I agree with having a psychologist in the office as many primary care providers state that they do no feel equipped to properly treat mental disorders. As you stated Sharyn, I think that people feel as if there is a stigma with being treated with a mental health issue. However, more people seem to be more comfortable talking to and being treated by a psychologist, because maybe this is the speciality that they chose and they have appropriate training to address it. In any manner, I find that the more resources that primary care givers can utilize for their patients, then the better care they may be able to provide.
ReplyDelete