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Longmont United Hospital, Centura Health add mental health resources for primary care physicians

Daily Times-Call - 1/31/2019

Jan. 31--Where the mind goes the body will follow. It only makes sense then that doctors assess mental health as well as physical well-being.

This medical philosophy known as collaborative care began to gain popularity in the mid-2000s, when the Affordable Care Act was unveiled and legally required health care providers offer mental health services. At the same time, several studies were released demonstrating the collaborative care model's shockingly effective results, and little by little medical providers began to adopt it.

After the Substance Abuse and Mental Health Services Administration reported that approximately 43.6 million Americans report experiencing some mental illness, and The Colorado Health Institute reported a record-high 1,175 suicide deaths in Colorado during 2017, Longmont United Hospital and Centura Health Physicians Group decided it was time to add their name to the growing list of collaborative care providers.

Rather than merely suggesting patients see a therapist or psychologist, the collaborative care model embeds mental health care professionals in primary care physicians' offices to ensure patients are getting the most-thorough care possible.

"It's like a regular doctors office, but what ends up happening if the doctors meet somebody who is struggling with some sort of mental or behavioral health issue, like they're not taking their medicine or their clinical situation has deteriorated and there is no real explanation for it, they'll just call me in," said Alice Vienneau, a cognitive behavioral therapist who works as a licensed clinical social worker with Centura Health Physician Group. "Very often it's a mental health issue that's getting in the way of the patient taking care of themselves."

For example, a patient keeps forgetting to take her diabetes medicine and when she does remember she gets mad at herself and just skips it. She has no social supports or people looking in on her, so she's lonely, isolated and very likely depressed and anxious.

"In this case," Vienneau said. "I can go in meet the patient, have a short assessment, invite the patient to come back in and do some work with me and provide some short-term, solution-focused therapy."

In instances where substance abuse or more serious mental disorders are involved, Vienneau said, embedded mental health professionals like herself also can "play social worker" and help people get the resources they need.

A 2018 study compiled by Athena Insight, a health care research group associated with Athena Health, found that 95 percent of patients referred via collaborative care are actively engaging in treatment. Compare that to the national average, in which only 50 percent of patients referred for mental health care actually follow through.

Mia Taylor, the manager of clinical programs at the Queen's Clinically Integrated Physician Network in Hawaii, believes that increased screening -- the first step in the collaborative care model -- might be catching as many as 70 percent more patients who have anxiety and depression.

Vienneau said, "There is still a large stigma that surrounds mental health issues, which prevents a lot of people from seeking the help they need. Working side-by-side with primary care providers allows us to assess and begin addressing mental health issues which come up at patients' medical appointments.

"We are making introductions to a behavioral health provider a normal part of the visit, thus, diminishing the stigma. Patients who address both their physical and mental well-being have the best outcomes."

A 2013 study released by the Center for Health Care Strategies showed that test subjects engaged in collaborative care were more than twice as likely as those in the usual care control group to experience a substantial improvement in their depression after 12 months. They also had less physical pain, better social and physical functioning, and better overall quality of life than patients in care as usual.

Furthermore, that same study found that patients receiving collaborative care had substantially lower costs in every category of health care, including pharmacy, inpatient and outpatient medical, and mental health specialty care.

During the four-year study researchers found that an initial investment in collaborative care of $522 during year one resulted in net cost savings of $3,363 over years one through four, corresponding to a return on investment of $6.50 for every dollar spent and $841 in annual savings.

"Mental health services have been available to folks with commercial insurance and folks who have money to pay out of pocket forever," Vienneau said. "What's wonderful about what is happening now is that with Medicaid expansion and the Affordable Care Act, we are now required to provide mental health services for everybody. ... Those changes in our medical and insurance systems has opened up whole new worlds for folk who couldn't take advantage of that."

John Spina: 303-473-1389, jspina@times-call.com or twitter.com/jsspina24

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