For years, Mental Health and Physical Health have been treated entirely independent of one another. If a patient needed to be seen for a physical ailment, they would see their medical doctor. If the patient needed to be seen for a mental or behavioral health issue, they saw a mental health counselor or psychiatrist. Under this model of healthcare there was very little collaboration between healthcare providers other than knowledge of what medications the patient is on or any other information that is absolutely pertinent to the patient’s care.
In recent years that model has started to change, moving towards a fully integrated care model that focuses on whole patient care. The Integrated Behavioral Health program at Latham Medical Group is a unique, patient centered approach to behavioral health. The program focuses on whole patient care and is fully integrated into a family care setting.
“Full integration is where you share electronic medical records and you really interact with the provider,” states Cindi Stone, LMHC, NCC, and director of the Integrated Behavioral Health program at Latham Medical Group.
Under the integrated model, Cindi works hand in hand with the patient’s primary care physician, treating the whole patient, instead of working separately to treat different symptoms.
“It’s actually about helping people make better lifestyle decisions and changing lifestyle behavior,” says Stone. “And also working with the physicians because a lot of chronic disease have co-morbid behavioral health disease.”
Often times, patients with a physical disease have a coexisting behavioral or mental illness. If a patient who is obese or diabetic also is suffering from depression, they may not always take their medications properly or take the necessary steps to control the disease effectively like proper diet and exercise. Patients with a substance abuse disorder may also find their substance abuse issues have a negative effect on their overall health.
The team approach also seems to help reduce some of the perceived stigma associated with behavioral health.
“It breaks down a barrier,” says Stone. “There’s a certain level of trust already because they trust their PCP and we’re in the same office.”
The term “behavioral health” itself helps to break down barriers. Behavioral health is often used in place of mental health because it doesn’t carry the same stigma. Behaviors are things that can be changed, so the perception is behavioral health diagnoses can be controlled by the patient where as mental health has to do with traits that cannot be changed so easily.
Cindi also feels the term counselor carries a certain amount of stigma with it.
“Initially, a lot of PCPs would introduce us as counselors,” Stone recalls. “They would say, ‘we’d like you to see one of our counselors for your depression.’ So that put a mental health stigma on it. What we like to call ourselves is behavioral health consultants, because we are consulting for the doctor on a problem that the doctor has identified.”
Not only does the integrated model succeed in breaking down barriers and increasing access to care, but research has already shown it provides much better patient outcomes for both mental and physical health. Mental and physical health are no longer separate.
“The two are together,” says Stone. ” Behavioral health providers now have to learn about physiology and chronic disease,” and medical doctors have to understand more about behavioral health as it relates to the patient’s overall well-being.
And therapies are more effective. The entire care team is working together towards stronger results for the patient. That collaborative effort has paid off huge dividends.
Under the old model, Stone says “You can place a phone call and sometimes not be able to connect for a month. Whereas right now? I have a problem with a patient, I walk down the hall.”
According to Stone, she typically meets with a patient for 30 minutes as opposed to the hour long sessions usually associated with behavioral therapy visits. The patient will sometimes be transitioned from a typical doctor visit to the care of a Behavioral Health provider through what is known as a warm hand-off, where the doctor will call the Behavioral Health Consultant into the exam room, explain to the patient why the doctor feels the patient could benefit, and then leave the patient to finish up with the behavioral health consultant. Another model is the co-visit, where both the doctor and the behavioral health consultant are in the exam room together with the patient.
Both of these models provide immediate care for the patient and reinforce to the patient the idea they have an entire care team working for them. Visits typically use psychotherapy and behavioral tools to help guide the patient. The goal is to get the patient to change the behaviors that are having a negative effect on their health. Patients may actually leave with homework!
“It’s much more goal focused. So the patient leaves the visit with things to do in between. Now we do brief treatment and we’re getting really good results in two to four sessions as compared to six months to a year [with traditional psychotherapy],” Stone says. “The model is based on brief sessions and brief intervention.”
While the integrated care model has been around for quite some time, it has been slow to gain traction in this area. The success of the Integrated Behavioral Health program at Latham Medical Group has influenced other CCP practices such as Schodack Internal Medicine and Pediatrics and Latham Internal Medicine to start their own integrated programs. They recently garnered national attention in a newsletter from the Center for Medicare and Medicaid Innovation that features innovative medical practices. However, it is hard to find Integrated care programs in the Capital Region outside of Community Care Physicians who, as industry leaders for over 30 years, are once again leading the way with innovative ways to provide better care for patients.