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Creating a circle of care to support primary and mental health needs

The mental health crisis is something that has burdened millions of Americans a year and shows no sign of stopping. Collaborative care is what the U.S. needs to support vulnerable patients seeking care.

Sarah repeatedly visits her primary care physician due to ongoing stomach pain issues, but all relevant tests come back normal. Instead of sending Sarah away with no answers or a half-baked care plan, her primary care physician (PCP) connects with a mental health clinician within the same practice  to discuss whether the pain could be a result of a mental health issue. Together the PCP, therapist, and Sarah work together to identify a treatment plan for anxiety. 

This is what smooth team-based patient care should look like in the United States, but the truth looks much different. In reality, patients spend hundreds of dollars seeing multiple providers in hopes of an answer and providers lack the time and resources to work together on patients’ care.

Primary care and mental health professionals work in silos and it makes patients like Sarah with increasingly complex physical and mental health needs suffer physically, mentally, and financially.

The scope of the mental health crisis for Americans

The APA Center for Psychology and Health reports that “as many as 70% of primary care visits are driven by patients’ psychological problems, such as anxiety, panic, depression, and stress.” Additionally, the NAMI (National Alliance on Mental Illness) found that almost 30 million adults and children in the U.S. live with mental health conditions and suffer without any treatment. And another 30 million still seek treatment. 

Despite demand for treatment, there is simply not enough supply: 33% of US counties have no records of licensed therapists and 75% of counties have less than 5. With supply so far below demand, it is time for us to find additional ways to treat those burdened by a system that can not care for them. Luckily, there is a proven model that can help: the Collaborative Care Model. 

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This model helps PCPs proactively manage mental disorders by pairing them with a team of psychiatrists and care navigators. This approach embodies a “patient first” approach and bridges the gap between primary care and mental health providers to help break down barriers caused by cost, accessibility, and stigma. While this can’t be achieved overnight, taking small steps to implement a Collaborative Care model will be crucial to increase provider and patient satisfaction rates and present better healthcare outcomes

Removing barriers to better collaborative care 

Scaling a Collaborative Care model requires collective change from administration, education, and healthcare policy makers in order to truly scale and ultimately empower providers to be more informed and to provide patients with affordable, high-quality care.

A Collaborative Care model necessitates resources, tools, training, and education for teams to provide a space for better collaboration and understanding, to create a space where providers and patients feel comfortable. When providers are communicating and patients have an environment that helps decrease stigma and safely create a relationship with a trusted primary care and mental health professional, it leads to better care for the patient.

Time is always one of the biggest barriers for physicians who are stuck in a fee-for-service system. As such, health systems must compensate physicians in some way for the time it takes to effectively collaborate with their teams. By adopting more value based models or compensating clinicians on a salaried basis, we can ensure that providers feel motivated to adopt this kind of care and that it can be effectively scaled. 

The time for collaborative care is now

The pandemic has been a catalyst for change and has opened the door for innovative and effective ways of improving care. In order to effectively scale collaborative care it’s essential to: 

  • Set intentions for implementing change. Without a commitment to change, the best current healthcare reform efforts will fail. It’s crucial for providers and stakeholders to commit to encouraging growth and change for a better healthcare experience.
  • Get the buy-in needed for success. Many healthcare organizations struggle to implement and sustain initiatives because of lack of organizational buy-in and involvement. It’s essential to listen to the unique needs of each team, build a plan that addresses each of those concerns / needs and get it approved by top organizational leaders who can make the changes.
  • Identify a change agent to lead the charge. Select one champion who can communicate to all necessary team members, start a registry to document change, share educational insight so involved teams can better understand and implement the collaborative care model and identify resource gaps that are needed. If there are communication silos between teams, it will prevent the success of the overall effort. 

The mental health crisis is something that has burdened millions of Americans a year and shows no sign of stopping. Collaborative care is what the U.S. needs to support vulnerable patients seeking care. By implementing more resources and improving provider pay structures and removing time barriers, healthcare organizations have the ripe opportunity to positively impact thousands of patient lives each year.

Photo credit: Aleksei Morozov, Getty Images

Dr. Rachelle Scott MD is a board certified adult psychiatrist and serves as Medical Director of Psychiatry at Eden Health where she leads the mental health team. She received her Medical Degree from Tufts University School of Medicine in Boston and completed residency in psychiatry at the Zucker Hillside Hospital in NY. Prior to joining Eden Health she worked as a consulting psychiatrist with the Mental Health Service Corps, an initiative of THRIVE NYC, and subsequently became the Medical Director. She has many years of experience treating adult psychiatric patients in a variety of inpatient and outpatient settings but has been most passionate about providing holistic and integrated mental health care. Dr. Scott has contributed to pieces in Business Insider, NPR, Forbes, Employee Benefit News, and many other outlets.

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