By CRISTINA JANNEY
Hays Post
High Plains Mental Health Center is reaching new clients and reducing stigma by serving patients through integrated care in medical clinics.
David Anderson, High Plains director of clinical services, said no stand-alone clinics should ever been built. Integrated care is where we should have been all along.
“The truth is, this agency has been around for 54 years,” he said. “If we could go back knowing what we know now, we won’t tell them to build a mental health center by itself. The separation of mental health and physical health is really artificial. We would say to them we should be in primary care settings and schools.
“That would reduce the stigma and have us providing and intervening where people are. We would be working hand-in-hand with the people we should be working with instead of where we are now, which is separate from them. It has taken us a half century to figure this out.”
Between 30 percent to 50 percent of primary care doctors’ patients also have mental health issues. Only about 49 percent of people who are referred to a mental health provider follow-up. The median time a person waits to access mental health care is 10 years.
However, about 80 percent of people see their primary care physician at least once a year.
Anderson said some people, especially in small communities, may not want to be seen going into a stand-alone mental health center.
High Plain has started to offer a service known as side-by-side care, in which a therapist see clients in a medical clinic.
“The advantage is it reduces stigma because people can come, sit in a primary care clinic and get called in the back like everybody else. There is no differentiating why they are there,” he said.
If the a physician suggests a patient see a therapist for depression or anxiety, and that person is right down the hall, it can be easier to accept the help, said Amy Bird, integrated care/outpatient specialist.
Bird started seeing clients at the Hays Family Medicine in July. She sees clients there two days a week, and at the Phillips County Medical Clinic one day a week.
Bird said she has seen a decrease in stigma through her work in the side-by-side model.
“My clients really appreciate being in their primary care setting,” Bird said, “where a lot of times they have going for years so it is comfortable for them.”
Another significant advantage is Bird is able to coordinate care with the primary care providers.
“Through releases of information, we can talk about how the clients are doing,” Bird said. “Providers can let me know if they are concerned about some things. I can let them know if there are other concerns, so we are really treating the whole person instead of just looking at the mental health aspect or the physical aspect.”
Sessions may not be just for people who would be typically diagnosed with a major mental illness.
Almost any chronic medical condition is going to come with added stress, Bird said. A client may have issues with sleeping, anxiety or depression as a result. People often have to make big lifestyle changes to deal with chronic illnesses, and the therapist can help the client set goals and find coping strategies to handle the stress.
Bird’s sessions in the medical clinics are usually shorter, usually 30 minutes, rather than the full-hour therapy session at the mental health center. They are also more targeted and goal specific.
She helps her clients work on relaxation techniques to improve sleep or set goals to become more physically active.
At one time, a doctor might have prescribed medication for a patient who was having trouble sleeping, Anderson said.
“More and more if there is an opportunity for them to do behavioral work and talk to them about their sleep habits, they do that,” he said. “When do they go to bed? Do they go to bed at the same time? Are they avoiding any kind of alcohol or caffeine late at night? Are they using their electronics — all of the things that can disrupt a person’s sleep?”
Primary-care physicians have welcomed the change, Anderson said.
He said one doctor caught a therapist as the therapist was leaving a clinic and asked her what she had done to help his patient with her diabetes. He said it had never been under better control.
“The answer is that we haven’t done anything with her diabetes, but we got her depression under control,” Anderson said. “Once her depression was under control, she could do the things he wanted her to do to control her diabetes.”
Bird said integrated care is about care of the whole person.
“We know that mental health problem can affect physical problems, and physical problems can affect people’s mental health,” she said. “One of the things I want to emphasize is that we know a lot people are much more likely go to their doctor’s first even when it is a mental health problem rather than coming here.
“The other thing we know about treating mental health problems is that early intervention, just like physical problems, is key. When people go there and they have someone they can access in a place where they are comfortable, we know we are going to get better outcomes and ultimately they are not going to struggle so much down the road,” Bird added.
Colorado has been using integrated care models for some time. Anderson attended a panel discussion with primary care physicians on the model in Colorado, and one of the doctors compared it to a garage door opener.
“Before you had one, you didn’t really think you needed it and you just got by,” he said. “Then you find this and suddenly you go, ‘Why was I doing my work without having this?’ Like a garage door opener, once you have it, you don’t ever want to go back to not having one.”
High Plains has a 20-county catchment area. It covers 19,000 square miles and about 100,000 people. The agency has six full-time offices. In the other 14 counties, there are outreach offices in health clinics, hospitals or health departments. Therapists visit those outreach clinics for traditional mental health care one day a week, but therapists are not interacting with primary care physicians as they are in the side-by-side model. Many of these locations also have access to psychiatrists or therapists through telemedicine.
See Hays Post’s recent story on High Plains telemedicine: Telemedicine gives instant access to mental health services
Anderson said in the future there will be an increase in use of the side-by-side model and mental health professionals working more closely with primary care physicians.
Bird trained at Cherokee Health Systems in Knoxville, Tenn., which is a fully integrated health care model. At the location, mental and physical health is handled by the same team. Everyone who is being screened for physical health is also screened for mental health — and vice versa. Electronic medical records are co-mingled. Mental health and physical health service providers all dress the same so they are indistinguishable.
Anderson said this fully integrated model is where High Plains would like to be.
In the current side-by-side model, the clients who see Bird for mental health care are High Plains clients, and the two entities do not share electronic medical records. However, Anderson said he hopes that someday will change.
For more information about High Plains and its services, call 1-800-432-0333. If you are having a mental health emergency, call 911.
Also see Hays Post’s recent story on High Plains: Schwaller Center to offer care for uninsured