In 2011, the New York Times reviewed a memoir called The Memory Palace written by Mira Bartok. The book shares Bartok’s highly personal story about life with—and without—her schizophrenic mother. In the book, she said, “I felt held hostage by her illness and by the backward mental health system that once again was incapable of helping our family in crisis.” Recently, multiple pieces of legislation introduced in Congress have put the spotlight on the healthcare industry’s less than stellar approach to mental health, but healthcare providers aren’t waiting for legislation to begin tackling this thorny issue. The industry has already seen some movement toward providing culturally competent care for patients with mental health issues.
Incorporating Mental Health into the Care Continuum
Recently, Kaiser Health News (KHN) spotlighted a trend in Connecticut where “behavioral health homes” are writing a new story when it comes to controlling healthcare costs and improving patient outcomes. Referencing a recent article series published by The Connecticut Mirror, KHN identifies two approaches that are gaining traction as mental health takes center stage in Washington D.C. and elsewhere.
1. Primary Care Takes the Lead
The first approach, highlighted in the Mirror article published on September 8, involves incorporating behavioral healthcare into the primary care practice model. This isn’t new. In fact, Dr. Stephen Kaye, who was interviewed by the Mirror, said that he had referred his primary care patients to a therapist in the past if he believed they needed mental health help. The problem was a lack of follow-through by patients. Some patients didn’t make the recommended appointments. Others learned that their insurance didn’t cover the recommended provider or that there was a long wait for an appointment. That’s not uncommon, according to James F. O’Dea, vice president of operations for Hartford Healthcare’s Behavioral Health Network. The organization knows from experience that less than 25 percent of patients who receive a recommendation for counseling to address depression or substance abuse actually make the call.
These days, the Backus Family Health Center where Dr. Kaye practices doesn’t have that problem. Since March, the practice is taking a different approach, thanks to an initiative by its parent company, Hartford Healthcare. It now has a psychiatric social worker on staff who immediately engages with patients, ensuring that they get connected with behavioral health services they need rather than leaving it to the patient or to chance.
2. Behavioral Health Integrates with Primary Care
The second approach, showcased in a follow-up Mirror article on September 9, sees mental health agencies step into the role of care coordinator. Cheryl Stockford, an official at the Connecticut Department of Mental Health and Addiction Services, says that the initiative involves 15 mental health agencies that now function as behavioral health homes. Like other patient-centered medical homes, the behavioral health homes address primary care needs, offering wellness programs and tracking of chronic health issues to improve the health of its patients. The difference is that these homes are also “… addressing barriers—such as past experiences with trauma—that can keep clients from getting the care they need.
The idea behind these behavioral health homes is that individuals with serious mental illness may need a more hands-on approach from behavioral health services; though the focus may be on mental health, necessary medical care can be looped in as needed. Colleen Harrington, director of the managed services division at the Department of Mental Health and Addiction Services said that the department chose this approach because individuals with severe, long-term mental illness often have an established, trusted relationship with behavioral health professionals, so it makes sense to leverage that resource to connect patients to the appropriate medical care services. States interested in replicating Connecticut’s efforts—or rolling out their own versions of behavioral health home—will find that resources have been made available with the passage of the federal health law.
Inching towards Integrated, Comprehensive Care
The facts are clear: Patients with behavioral health needs tend to have both higher medical costs and higher rates of hospitalization. In addition, untreated mental health issues—whether depression, schizophrenia or substance abuse—negatively impact patients’ abilities to manage chronic conditions like diabetes or heart disease. In a reform era that is focused both on reducing costs and improving outcomes, offering comprehensive care to individuals that are likely to fall through the cracks is critical to success. Dr. Pamela Riley, assistant vice president for delivery system reform at The Commonwealth Fund, says that making behavioral health a priority within the overall scope of healthcare delivery is crucial. She said, “This is definitely one of the high-priority issues for health care providers and systems and states right now,” also noting, “We’re seeing a lot more interest in this.”
How is your organization adjusting to meet the needs of patients with behavioral health issues?