Bringing Behavioral Health into Primary Care Settings

The integration of behavioral health into the primary care setting has resulted in a number of benefits. Traditionally, behavioral health and medical health operated separately, but in recent years, the integration of these two systems has improved access to care, ensured continuity of care, reduced stigma associated with seeking care and allowed for earlier detection and treatment of mental health and substance abuse issues. By bringing behavioral health specialists into primary care facilities, healthcare systems have streamlined care and brought down costs, working collaboratively and reducing the number of appointments and hospital visits.

At Carolinas HealthCare System, we use technology to take behavioral health integration one step further. A robust behavioral health integration project was developed through myStrength, using virtual and telehealth technology to ensure that every primary care practice has the capabilities for early detection of mental illness and substance abuse and upstream intervention, easing the connection between behavior health specialists and patients who might otherwise be averse to seeking professional help.

Mental illness touches each of us personally: one in five individuals struggles with mental health issues, yet access to care is one of the biggest issues facing North Carolina residents today.

As of 2015, 29 out of 100 counties in North Carolina do not have a single psychiatrist and 58 out of 100 counties have a shortage of mental health services. Programs and technology that integrate behavioral health with primary care allow us to bridge the access gap and address mental health issues sooner. Our team of 25 remote providers are connected to over 70 practices, and have supported more than 8,000 patients in the past two years. Virtual teleconferencing also provides rural communities with greater and more consistent access to behavioral health treatments – an important point for a large population that often does not have the immediate ability to seek out a specialist in person.

Of the 40,000 suicides in the US last year, 64% of those people saw their primary care physician a month before taking their life, and 85% of individuals with a substance abuse or mental health disorder visit a primary care physician at least once a year. If we can integrate behavioral health into these primary care conversations – using technology to make this process even more streamlined for our strapped primary care providers – we can provide greater quality care that addresses patient needs across several access points, and get people the help they need before it’s too late.

We’ve also found that the stigma associated with visiting a behavioral health provider is reduced by coupling behavioral and medical treatments into a single appointment. Primary care physicians can connect patients to behavioral health specialists instantly during an appointment, opening new opportunities for people to seek out treatment for mental health issues. Through virtual teleconference follow-up appointments, patients can easily schedule check-ins with their behavioral health specialists, and the burden of carving out travel time from one appointment to another is reduced significantly.

The results we’ve seen from this program are remarkable: year to date, 84% of patients that had reported suicidal thoughts at the initiation of our program no longer reported suicidal thoughts at the completion of health coaching. The impact that behavioral health integration has had in our community is what makes me proud to be a part of this team.

Innovative treatment options that help patients closer to home, allow for earlier detection of illnesses and streamline difficult conversations are what strengthen the industry’s commitment to ensuring patients are always the top priority. The implementation of services like virtual treatment capabilities not only supports access to care with a better patient experience, it also helps control costs, ensure continuity of care for patients with both behavioral health and medical diagnoses, and can enhance overall quality of care.

Martha Whitecotton is SVP of Behavioral Health Services at Carolinas Healthcare System

1 reply »

  1. Slowly, but surely, the awareness that certain social determinants will adversely effect a person’s health has become much more important than we have ever recognized, especially during the first three years of life. If you don’t start Kindergarten with the capability to learn, the eventual capability to teach yourself by reading is markedly impaired. Virtually all learning after grade school requires this skill. It is known that the return on Investment for a community’s economic growth ( aka ROI ) from an investment in early childhood education is $7:$1. Similarly, the worsening level of health spending within our nation’s economy (GDP) is significantly related to the declining level of Social Capital generally throughout our nation. ( see “BOWLING ALONE” by Robert D. Putman, 2000)
    Ultimately, we cannot expect the healthcare industry to continue assuming a responsibility to mitigate the effects of the declining Social Capital that drives the .Unstable HEALTH. for so many citizens. But, it is also clear that the increasing mental issues within our society have virtually “flooded-out” out mental health capability. So then, how do we achieve an enhanced capability to engage the disruptive events that spontaneously occur within the midst of standard healthcare for a citizen’s Basic Healthcare Needs, especially the capability for learning, caring and creativity?
    It is likely that a community by community strategy that is nationally promoted will be required. I prefer a new nationally sanctioned, semi-autonomous institution. A good model would be the FEDERAL RESERVE created by Congress in 1913. This new Institution would mandate a community by community ( defined as @400,000 citizens ), locally sponsored and managed group of community stakeholders to assure that Primary Healthcare is equitably available to each of its citizens. This local group would also take up a responsibility *) to monitor the locally focused improvement of its community’s Social Capital and *) to annually reassess its Disaster Mitigation Planning Strategy. The national portion of the new institution would develop a means to structure the economic support of enhanced Primary Healthcare ( including provisions for its mental healthcare) and a national certification process. The certification process would validate the clinics with the capability to offer advanced . Health Care . for Basic Healthcare Needs as a basis for its access to the nationally promoted, advanced economic support. My own preference for the economics would be capitation with a site by site stop-loss provision as now mediated largely by fee-for-service.
    .(— See http://www.nationalhealthusa.net/home/rationale/ —)
    There are absolutely no provisions within our nation’s current strategy for healthcare reform that will solve the cost and quality problems of our nation’s healthcare. The irony of all this is simple. The year after the Federal Reserve was formed in 1913 to manage our nation’s “Money Supply,” the same Congress in 1914 passed the Smith Lever Act that established the Cooperative Extension Service, county by county, to improve our nation’s agriculture industry. So, our nation’s agriculture is the most efficient and effective for producing food for our nation; our nation’s healthcare industry is the least efficient and effective for our nation’s HEALTH; and both stand in comparison to all of the other developed nation’s of the world. We must begin community by community with a means to promote equitably available Primary Healthcare that eventually is known to be ecologically accessible, justly efficient, and reliably effective for EACH citizen. I have proposed that a new semi-autonomous institution, instituted by Congress, should be limited to a budget of $1.00 per citizen per year as supported by the Federal government.
    We have solved the SCIENTIFIC MANDATE for the health care of Complex Healthcare Needs for each citizen, but we have neglected the HUMANITARIAN MANDATE for the health care of Basic Healthcare Needs for these citizens. The most important evidence for this is our nation’s maternal mortality ratio. As compared to the 10 developed nations ( 51 total) of the world with the best level of maternal mortality, there are at least 500 citizens who die annually in association with a pregnancy just because they were living in the wrong nation. This has been worsening for at least 25 years.