Janice Berry Edwards, PhD, LICSW, LCSW-C, BCD,
ACSW
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Integration of mental health services into the primary care setting,
will lead to improved access to mental health services and
communication with providers of health care.
Integration of care allows for the promotion of optimal social and
emotional wellness, because the whole person is being treated and
not just a part.
Safe and effective mental and physical health care requires
collaboration and communication between all providers of health
care.
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Health care visits often have underlying psychosocial
influences.
70% of all health care visits are generated by psychosocial
factors. (Fries et al., 1993; Shapiro et al., 1985).
Mental Health problems can arise from physical problems.
The majority of visits in primary care are related to behavioral
needs but not to identified mental health disorders. Many
patients respond to psychosocial stress by developing
vaguely defined, distressing physical symptoms that have no
organic cause. (Kroenke et al., 1989)
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An estimated 75% of patients with depression
present physical complaints as the reason they
seek health care. (Unutzer et al., 2006).
Medical outcome studies reveal that depression
results in more functional impairment than chronic
diseases such as diabetes, arthritis and angina.
(Wells et al., 1989).
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A national survey found that 32% of undiagnosed,
asymptomatic adults would likely turn to their
primary care physician to help with mental health
issues; only 4% would approach a mental health
professional. (National Mental Health Association,
2000).
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Will allow for the early identification of
mental health problems and
interventions.
Improved care coordination among, all
providers of health care and especially
patients, families, among community
mental health clinicians.
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Increased knowledge, and enhanced
abilities in diagnosing and responding to
presenting and underlying mental health
problems.
Enhanced abilities in diagnosing and
responding to both physical and mental
health problems.
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Implementation and discussion of
therapeutic and psychopharmacologic
services.
Development of a means for the
collaborative measurement of treatment
outcomes.
Integration of culturally sensitive and
evidence‐based mental health services.
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https://www.youtube.com/watch?v=IFFYkB6n
-_g&list=PL2737C2C6E81E9177
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We are at a time where there is a critical public health need
for evidence‐based mental health services. Improved and
better working relationships between all providers of care can
significantly enhance mental health services outcomes across
populations.
Successful collaborations can lead to significantly influencing
the psychiatric care of larger numbers of patients.
Collaborative care will also allow for advocacy, the promotion
of prevention, early identification, timely intervention, and
treatment of psychiatric illness.
http://camhblog.com/2015/04/01/promoting-collaborative-mental-healthonline/
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“Real time” communication is important to
collaborative mental health care partnerships this
requires availability.
Answers to clinical questions ideally are provided
to Primary Care Clinicians (PCCs) within a time
frame that allows them to respond in a timely
way to patients and their families.
PCCs see a higher volume of patients and as
such, their workflow requires efficient use of
their decision‐making and time. Timely access to
consultation can provide practical and
understandable advice.
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Timely access assures real time discussion of
plans in collaboration with the PCCs. It helps
PCCs to support therapeutic goals.
Particularly in collaborative consultation
timely access can foster the development of a
growing sense of trust and confidence
develops that encourages PCCs to extend
their involvement in mental health care
beyond their usual scope of practice.
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The development of a communication protocol can be
helpful to enhance the quality of the consultation and
collaboration. Social Workers who are working closely
with PCCs can identify their ability to handle
psychiatric problems in their practices and when
necessary, can help facilitate referrals to other mental
health or community agencies.
Social Workers in consultation with PCCs can serve to
triage primary care patients, based on acuity and
complexity, to the appropriate level of service
intensity (e.g., direct evaluation and treatment by the
appropriate clinical provider of care, or emergency
care and inpatient hospitalization when indicated).
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Consultation or collaboration can involve scheduling
the evaluation in the offices of the PCC and/or mental
health clinicians.
The use of telepsychiatry is an option, particularly in
rural settings. When used in the context of a
collaborative system of care in which both the mental
health clinician and the PCC share responsibility for
the success of the treatments, telepsychiatry can
prove a valuable resource.
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The psychiatric evaluation or consultation should
include biopsychosocial formulation, diagnostic
impressions, and treatment/referral
recommendations.
It is important to have specific recommendations
for the PCC that include in the consultation prompt
communication of the findings and
recommendations.
Initial communication regarding urgent findings
requiring immediate response by the PCC can
occur in real time.
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Given the complexity of the nation’s health care
system, care coordination (or case management) is
essential to helping patients and their families
navigate access the appropriate level of psychiatric
services (e.g., outpatient, urgent, emergency,
inpatient).
Care coordination is an important component of
effective collaborative partnerships.
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Care coordination needs to be part of the
collaborations. PCCs should consider in the their
practices the inclusion of Social Workers who can
be responsible for care coordination and case
management.
Social Workers are well versed in utilizing the
available community mental health resources.
Social Workers are well trained in both of these
roles.
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Social Workers and other Mental Health
clinicians have the opportunity to educate
PCCs regarding mental health issues and
treatments that allow PCCs to extend their
involvement in mental health care beyond
their usual scope of practice.
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They also have the opportunity to guide PCCs
in the education of their patients and their
families. Mental Health clinicians working
with the PCC can “lunch and learn” in primary
care practices about cases, diagnosis,
treatment, best practices, therapies, and
community resources.
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Opportunities to involve mental health
providers of care in CME training events, case
conferences, and collaborative office rounds
can enhance the relationship as well as
provide an opportunity to share opinions on
the care of selected patients.
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Advocating for collaborative mental health
partnerships ranges from simple networking
with community PCCs, to implementing a local
community program, or to building large‐scale
partnerships.
Working with PCCs have proven to be a
successful combination in building a strong
foundation of awareness and concern among
the widest array of stakeholders about the
problems of access to mental health services.
“The walls between professions and institutions
will crumble, so that your experiences will
become seamless. You will never feel lost.’’
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Institute of Medicine, Crossing the Quality Chasm. The New Health System for the
21st Century. Washington, DC: National Academy Press; 2001