Blend Medical, Mental Health Services?
General medical and mental health services have been traditionally provided to individual patients at different sites. But a new study by UCLA researchers suggests that merging the two into a “one-stop shop” format might be more clinically beneficial.
The study, which was conducted by the UCLA Center for Health Policy Research, noted that about 70% of all mental health issues are diagnosed in a primary care setting.
"A general practitioner might spot a mental health issue, but patients often fall through the cracks because they have to wait weeks and travel to separate facilities before they get care. Many don't even go," said Nadereh Pourat, director of the center's Health Economics and Evaluation Research Program and lead author of the study. "But if a mental health professional works in the same office and even sees the patient at the same time as their GP, treatment is more likely to be immediate and effective."
The study investigated the blending of the two services at five community health centers throughout California. All scored high on the integration scale created by two federal agencies, the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration.
The centers all employed at least one full-time clinical psychologist. Three employed psychiatrists, two employed marriage and family therapists and one employed a team of substance abuse/addiction specialists. Most had sophisticated systems for maintaining and updating electronic health records.
Nevertheless, the five providers faced challenges. The study concluded that having a psychiatrist on staff was key because they could prescribe medications and provide critical input to the clinicians on the primary care side of the clinic. However, not every clinic had the means to retain a psychiatrist. Bilingual clinical psychologists were also dificult to recruit.
The clinics were often also challenged to provide what is known as a“warm handoff” – transferring a patient with a behavioral health issue that has been identified by their medical provider immediately to the appropriate behavioral health provider. One reason is that even though the parties may work for the same organization, their workspaces are often physically separated by some distance.
“In most cases, behavioral health providers were still physically separated from the primary care physician teams and were in private offices, particularly because the particular requirements of BHP offices (e.g., comfortable seating, appropriate lighting, longer appointments) differ from
PCP offices,” the study said.
Or, if a patient with a severe mental illness was being seen, their behavior could also prove disrputive to operations. One clinic resolved this by having a psychiatrist on staff who was also certified in internal medicine, but that is not the type of clinician who is easy to recruit.
Another challenge was linked to reimbursement for services rendered. That's primarily due to the fact that both public and private payers are often reluctant to approve coverage for such treatment on the same day without some form of coverage or utilization review.
The study recommended that reimbursement policies be changed in order to ensure more orderly integration of both services and make recruitment of the key personnel easier.
