In primary care and family medicine, providers know that many of their patients face psychological conditions that impact their well-being, physical health and family life. We know that mental health conditions such as anxiety and depression that go untreated can adversely affect chronic illnesses such as diabetes, cardiovascular disease and asthma. We also know that many chronic illnesses are created, maintained and/or exacerbated by one's behaviors or lifestyle, such as tobacco use or inactivity. Research shows most medical treatments entail writing a prescription rather than engaging the patient in self-management. That approach takes responsibility, motivation and self-confidence away from the patient and places it in the overwhelmed hands of our understaffed medical providers.
I believe integrated behavioral health care offers something greater. Behavioral health can provide education, motivation and the opportunity for change to patients, families and communities. Trained behavioral health providers can look at the interaction of the physical, psychological and social components of a person's well-being. They can conduct immediate psychological and behavioral triage, enhance patients' motivation for self-management, and treat psychological conditions that may hinder the patient's quality of life.
Integrated behavioral health is a necessary evolution for healthcare in New Mexico. With the Affordable Care Act (ACA), primary care clinics statewide are working towards being designated as a Primary Care Medical Home (PCMH). This means a clinic is striving for quality care delivered in an efficient manner while increasing its accessibility to consumers. Therefore, primary care in New Mexico has an exciting opportunity to make great strides towards integrated care.
I have seen the potential for integrated behavioral health as a psychologist for La Clinica de Familia, a Federally Qualified Health Center with 13 clinics in Doña Ana County. La Clinica is an outstanding example of community-focused health care, providing medical, dental, behavioral health, Head Start and social services. I am also an assistant professor at New Mexico State University, teaching Primary Care Psychology and Behavioral Health Practica for master's and doctoral level students in counseling and psychology. I collaborate with other community agencies, including the Southern New Mexico Family Medicine Residency Program, where we implement integrated behavioral health care and inter-professional training.
Integrated behavioral health is only one of many different care models for behavioral or mental health. "Specialty care," for example, typically involves a stand-alone mental health agency. Patients go to a clinic that offers counseling and medication management by a psychiatrist or another mental health prescriber. When a primary care provider refers a patient to specialty mental health, however, more often than not the patient does not follow through with that referral – perhaps in part because of the stigma attached to mental health treatment.
Another model, "co-located behavioral health care," offers behavioral health services onsite at a medical clinic, with no outside referral needed. But the electronic health record is not integrated, and the behavioral health provider may not attend clinic team meetings. So communication of care and patients' needs may often be disjointed.
Integrated behavioral healthcare connects the whole treatment team, which should include the medical providers, nurses, patient navigators, promotoras and so on. This model provides immediate care in a brief way, increasing access to patients who may not follow up with specialty mental health or who need treatment focused on harm-reduction and self-management of their conditions. When a patient is introduced to a behavioral health provider on the same day as his/her appointment and the family doctor says, "This is someone I trust," it reassures the patient. Research has shown such an approach can increase the likelihood of follow-up with behavioral health providers by as much as 50 percent.
Integrated behavioral health is not designed to "fix it all," but it does provide a much-needed and valued service directly to patients, families and their communities. In rural areas, which make up the majority of New Mexico, integrated behavioral health care provides access, while also promoting the efficiency and effectiveness of the healthcare team. The behavioral health provider can help manage challenging or complicated patients who otherwise make it difficult for medical providers to get through their appointments for the day.
An integrated approach also means that patients don't have to wait weeks, sometimes months, to see a behavioral health provider, but instead can be triaged during their doctor visit. It also promises less waste of healthcare resources and dollars, lower ER admissions, and better treatment adherence.
Integrated behavioral health care is nothing new. Cherokee Health Systems in Tennessee and other organizations have shown the effectiveness of this model and the positive difference it can make. Now is the time for New Mexico's health care system to evolve and better meet the needs of our patients, families and communities by working together for holistic care.