Can integration, tech support boost mental health access?

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health IT since the late 1990s for a variety of publications.

The physical and emotional toll of the multiple and seemingly endless tragedies that have happened in recent weeks are shining a light on the urgent need for better access to mental health care.

The hurricanes in Houston, Florida, Puerto Rico and the Virgin Islands have left thousands devastated and displaced.

A gunman murdered 58 people and caused injury to 526 more in a horrific attack at a country music festival in Las Vegas on Oct. 1. His senseless actions devastated families and loved ones across the country.

More than a dozen fires raging in Northern California have killed at least 40 people, displaced at least 40,000, destroyed an estimated 5,700 homes and businesses and scorched 222,000 acres.

Those affected by these tragedies are in need of mental health services. Yet there is an estimated shortage of 45,000 psychiatrists nationwide, and many practicing psychiatrists are close to retiring. It’s estimated that we need to graduate about 2,000 psychiatrists per year to meet minimum patient needs, and currently medical schools are graduating around 400 annually, according to recent figures.

Meanwhile, it’s estimated that one in five people in the United States have a behavioral health issue requiring treatment. Among those with chronic conditions, that figure rises. Two-thirds of people living with diabetes are estimated to have a mental health conditions such as depression or anxiety.

As we look around at this seemingly insurmountable problem, some health systems are turning to technology to improve access to mental health specialists. To start, there is the growing movement of what’s called “behavioral health integration,“ where behaviorists, social workers and psychologists are being added to primary care teams in outpatient clinics. Accompanying this is behavioral health screening questions that patients are asked during primary care visits to determine whether they have an undiagnosed mental health condition or substance abuse problem. With team integration, sometimes it is possible to begin addressing that unmet need in a single primary care appointment.

Within this context of behavioral health integration, some health systems are using telehealth services to connect primary care providers with psychiatrists and other specialists on demand if a patient screens positive for depression, anxiety, substance abuse or suicide risk. Carolinas HealthCare System, a not-for-profit system based in Charlotte, N.C., and serving North and South Carolina and Georgia, is one example. Today, 70 of Carolina HealthCare System’s primary care practices and pediatric clinics are using a telehealth vendor (MyStrength) to connect primary care teams with mental health specialists. Patients complete a behavioral health questionnaire during a primary care appointment, and if they have an elevated score on any of their answers, their family physician will call a behavioral health hotline and be connected to a trained professional through MyStrength for further consultation. Depending on the diagnosis, patients receive follow-up calls and virtual health coaching. Patients who show positive suicide risk receive immediate interventions. Officials from Carolinas HealthCare System presented their approach at the Health 2.0 conference in Santa Clara, Calif., in October.

Carolinas HealthCare System reported that 36 percent of patients who received these integrated services were able to achieve remission from their diagnosed mental health condition. In addition, officials said primary care providers are providing more appropriate mental health medications such as antidepressants to patients under the guidance of trained psychiatrists available via the telehealth service.

Carolinas HealthCare System is just one example of how a community is seeking to improve access to mental health services within the confines of a national psychiatry shortage. What other examples can you find in your communities?

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