We’ve seen vast changes in the health care landscape, and more are on their way. Largely ignored in this reform is how we address and treat mental health issues. Smart changes could have a big payoff in helping people live the healthiest lives possible.
Treating mental illness is expensive. But the cost of not treating it is enormous. It affects our population’s health in ways that range from obesity to homelessness and addiction.
Treating mental illness has traditionally been separate from treating physical illnesses. But that doesn’t really make sense, given what we know about both today.
Beginning in 2000, Intermountain Healthcare, where I work, began delivering integrated mental and physical health care in team-based clinic settings. Team-based care is just that: a team of health care providers from diverse disciplines — physicians, advanced-practice clinicians, nurses, mental health providers, and other staff members — who work together with patients, families, and communities to provide coordinated holistic health care services.
Here’s how it works. When a patient visits a primary care clinic, she or he is asked to complete a screening questionnaire. If it suggests mental health concerns, the doctor discusses that with the patient. Mental health professionals are embedded in the clinic and can immediately interact and provide treatment, under the doctor’s guidance. There are no referrals needed or long waits to get help.
A landmark 10-year study that my Intermountain colleagues published in JAMA shows that this approach pays off in several ways: better clinical outcomes for patients; more appropriate utilization of health care services (getting the right care at the right time); and lower costs, about $667 per patient each year for those with newly diagnosed depression. Based on Intermountain Healthcare’s experience and our findings, we project that the U.S. would save at least $4 billion a year in health care costs if our model was used nationally.
The program was honored with the prestigious Hearst Health Prize, which recognizes outstanding achievement in managing or improving health in the U.S.
Some people find it counterintuitive that better care can result in lower costs, but that’s often the way it works in health care. For patients, the bottom line is that getting care in a team-based setting where medical providers work hand in hand with mental health professionals results in higher screening rates, proactive treatment for both mental and physical ailments, and better clinical outcomes for complex chronic diseases.
At Intermountain, 80 percent of mental health care services are provided by primary care physicians supported by an integrated team that includes mental health professionals. This model helps primary care and mental health providers collaborate to meet a patient’s physical and mental health needs during each patient visit. They do that by focusing on prevention and early diagnosis, integrating care processes, using computerized health records, and partnering with community resources, such as government agencies and other not-for-profit entities.
With this team-based coordination, we screen 46 percent of patients for depression, a rate more than 10 times higher than in traditional physician practices nationally. Earlier detection of depression allows caregivers to provide medical and behavioral interventions earlier.
A team-based approach that includes mental health services also improves overall health. More patients in team-based practices stick with their diabetes care protocols and have documented self-care plans. Among individuals receiving care through our integrated program, emergency room visits declined 23 percent, hospital admissions declined 10 percent, and primary care doctor visits declined by 7 percent.
The results of team-based care are conclusive — better mental and physical health, lower costs, more appropriate use of health care services, and a healthier population.
We can’t stay the course with the way most doctor visits occur today, which provide fragmented care for physical and mental illnesses. It’s time to fully incorporate mental health into the doctor’s office visit.
Marc Harrison, M.D., is president and CEO of Intermountain Healthcare, based in Salt Lake City.
Where is the evidence this works? Why see a therapist the same day? Screening form in waiting room, this decades old stuff and people are not going to answer truthfully
What’s your problem? Seeing someone the same day makes it more likely that a distressed patient will actually form a working relationship with the psychologist (or whoever the medical team decides to recruit, hopefully a psychologist with health or medical rehabilitation background). Go ahead and put your bias out there where we can see it.
This sounds good. Does your team include actual psychologists?
I am the Director of Behavioral Health at an FQHC in Northern VA where we have been working toward a completely integrated model of care for several years as well. One of the aspects of this model that is so important is the role it serves to de-stigmatize mental health and reduce barriers for patients in underserved communities. The relationships patients build with primary care providers often serve as a wonderful stepping stone for the teaching and introductions to basic education about the ways mood and mental health impact physical health. That’s been our experience.
So true! Hopefully you advocate for professional psychotherapists (MSWs or psychologists), not paraprofessionals or nurses, to do the counseling/psychotherapy.
Spot on, Terry!!
Goodness if I could make a wish, click my heels and it come true, this would be it. My high school students are suffering at an alarming rate! The interwoven practices of mental & physical health in this article deserves a standing ovation. The numbers are there as evidence and as Jay-Z once said: “Men lie, women lie, numbers don’t.” How do I advocate for this as a Youth Transition Specialist at a Center for Independent Living? My work is with students who have a wide range of disabilities and I can plainly see that this would have a PROFOUND impact on overall wellness. Specifically teen suicide rates. Great article!
Yes!
Go for the trifecta, and include dental as well as mental health care in insurance, treatment, medical records, and Big Data. We are one interconnected organic and bioenergetic web and symphony of systems, and ignore this at our peril, and at the cost of many chronic diseases both physical and mental.
Yes! Agree!
Excellent article; thank you Dr. Harrison for sharing Intermountain’s leadership experience with behavioral health integration. This may be one of the most significant strategies for achieving the triple aim, improving individual and population health through fully integrated, team based quality patient care at lower cost. Furthermore, I’ll bet it helps achieve the quadrouple aim by improving the providers’ experiences as they have increasing success in meeting patients’ needs and see the positive results.
I am a Behavioral Health Integration Social Worker at a large FQHC in New York and I LOVE doing this work. I see the results first hand and am able to deliver behavioral health services to people who might otherwise have never connected to care. This should be (hopefully will be) standard everywhere! What they left out is that BHISWs also offer concrete services to patients, like assistance with housing, home care transportation, etc, to reduce barriers to care, and promote health and safety.
Yes – wrap around services
It’s TIME! I’ve been on anti depressants since age 22, I’m now 44. My long time partner however can’t stand the thought of being dependent of “something”, no matter if it helps for cholesterol, high blood pressure, depression, weight loss, etc, so he simply doesn’t go back to the doctor! I’m at my wits ends trying to help him with his heritable high blood pressure, that can only be cured with medication. He refuses to do anything about his cholesterol and weight, other than complain to me.
So I say YES, it’s Time, Doctors hold their patients accountable, as they know spouses cannot!