Focus, Government, and Health Care

Effort underway to integrate physical, mental health services

Argument is that patients would get better, faster care.

November 10, 2012
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LANSING — The look of health care in the future will combine behavioral health and physical care for more uniform treatment, according to James Haveman, director of the Department of Community Health.

“There’s a great deal of effort being made to integrate mental health, substance abuse and physical health care,” Haveman said. “If we build connections between these different forms of care, we can make sure people have cost-effective access to the treatment they need.”

According to Haveman, those connections range from changes in health policy to bringing rehabilitation centers into hospitals, rather than expecting patients to seek a separate facility.

For example, Michigan Health Information Network, a state entity, promotes health care through electronic exchange of information. The network now uses the PatientSecure system, an electronic directory, for health-care providers across the state.

PatientSecure, when fully implemented, will help the integration process by creating a statewide provider directory and patient directory services, according to Tim Pletcher, executive director of the network. Patients will then be able to access information electronically about other forms of care.

Another development supporting integration is a new emphasis on screening, brief intervention and referral to treatment, or SBRIT.

SBRIT can be done by professionals at primary care practices. It entails identifying and providing support for patients with substance abuse or mental health problems.

Jeff Wieferich of the department’s Bureau of Substance Abuse and Addiction Services said that, in addition to a stronger screening process, medical practices must follow through if substance abuse or mental health care is needed.

“We have to review and ensure the availability of adequate psychiatric services and establish a better process for how medication assistance will be provided ahead of time,” Wieferich said.

With the rate of depression on the rise in recent years, some researchers argue that mental health screenings such as SBRIT during visits to primary health centers can provide patients with more well-rounded care.

A new study by the University of Michigan showed that people who suffer from clinical depression have a hard time identifying emotions, such as guilt and anger. Being incapable of distinguishing emotional experiences can affect how those people cope with stress in their lives, according to Emre Demiralp, the lead author of the study.

“We wanted to investigate whether people with clinical depression had emotional gauges that were informative and whether they experienced emotions with the same level of specificity and differentiation as healthy people,” Demiralp said.

More thorough mental health screenings at the doctor’s office and resources for referrals by primary care physicians are possible solutions for people who may not recognize they have a mental health problem.

According to the Michigan Primary Care Association, enhanced coordination of health care providers can also help.

Coordination helps ensure that primary care providers can easily refer patients to specialists, that needed information flows among providers and that those providers feel confident treating patients with behavioral health conditions, the association said.

Rebecca Cienki, the association’s chief operating officer, said providing primary care in a more integrated fashion is not just important, but essential.

“We’ve found that people with mental health problems and illnesses are dying up to 25 years earlier, and that’s a disparity we need to address,” Cienki said.

According to Cienki, many patients come to primary care facilities with mental health concerns but find those providers lack the resources to help them.

“For about 70 percent of people in a given community, when they come into a primary care facility, their problem is psychosocial-related,” she said. “We need integrated community sites and better training of mental health providers so they can work efficiently in an integrated system.”

As Community Health’s Haveman said, enabling behavioral health and primary care providers to practice at the same site can facilitate whole-person care.

A shared location also promotes “warm-handoffs,” so a patient can visit a behavioral health provider immediately after a physical health appointment, according to the association.

The state has already seen some success with integrated systems. For example, at the Center for Family Health in Jackson, patients can be matched with the appropriate level of mental health care through the primary care site.

Adria Clark, a social worker who works with both the center and LifeWays, the Jackson County mental health agency, taps into resources from both her employers and keeps lines of communication open among providers.

Patients are assessed at the center and connected with the necessary mental health services, and can consult a staff psychiatrist from their primary care facility.

“It’s integrated health at its best,” Clark said. “Every day I feel pleased we’re able to assess and guarantee patients get the services they need. Patients can come here and receive medical and mental health services all in one appointment.”

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