Researchers at UCLA last week released a report examining five California community clinics that have taken initial steps to incorporate mental health care into the primary care setting.
“We wanted to show some examples of clinics that were integrating mental and physical health care,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research and lead author of the policy brief.
“We wanted to provide sort of a road map for different providers,” she said, “by highlighting things that different providers are doing to get there, and this should help as a tool to other providers.”
According to the policy brief, 70% of behavioral health diagnoses are made at the primary care level, and yet actual mental health care is separated from that setting by referring patients to mental health services in other locations and not being kept in the loop about progress of that care.
The report singled out a number of best practices for integrating mental health care, including:Proximity of providers, so mental health professionals work in the same building with primary care providers for the so-called “warm handoff” that ensures mental health professional involvement; Sharing of data between behavioral and physical care providers; Communication and collaboration between providers; and Joint treatment plan development by mental and physical care providers.
“One of the clinics, for instance, had two psychiatrists on board, and just the presence of those psychiatrists is significant, in part because physicians often prescribe [anti-depressants or anxiolytics] but not every physician is comfortable with those medications,” Pourat said. “One provider said they had a patient in the exam room suddenly burst into tears and he thought, ‘Well, what do I do now?’ If there’s a psychiatrist or social worker [on-site] they can introduce them then and there.”
For severe psychiatric issues, some patients will need to be sent to a separate facility, but that’s not the bulk of cases, Pourat said.
“I don’t think you can get away from specialty providers housed away from primary care. The issue we bring up is for patients who need mild or moderate care,” she said.
The idea is to change the way those mental health referrals are made, and the approach to follow-up on them, Pourat said.
“So it’s not just a referral like, ‘Here’s a list and go find somebody,'” Pourat said. “You actually have a person in the clinic who helps make the appointment, gets the information back to the primary care provider. As a primary care provider, you need to know if they’re taking anti-depressants, for instance. If you have no contact, you’re not providing the best care.”