Blending Mental Health Care and Primary Health Care

1. Blending Mental Health Care and Primary Health Care (Why it might be a good idea to reattach the head to the body.) Heidi Erickson MD, LCDR, USPHS Phoenix Indian Medical Center

2. The Current State of the World • Confusing mental health care infrastructure due to compacting, contracting, tribal vs. IHS sites, difficulty engaging state and local services • P and T committees that restrict psychotropic medications to psychiatry • Unavailability of psychiatric consultation

3. The World (cont) • Limited number of mental health care providers for the patient population • Psychiatrists • Psychologists • Therapists • Substance abuse counselors • Social workers • Psychiatrists and mental health care workers off in “the behavioral health” building/trailer/house

4. What is Mental Health care? • Behavioral Health—definition developed by managed care to include services of mental health, counseling, psychological testing, social services, and substances abuse (and then carve it out and not pay for it) • Psychiatry—Branch of Medicine concerned with diagnosis and treatment of mental disorders and related conditions

5. Primary Care The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.

6. Why putting PC and MH together may be important • Number of patients far exceeds the capabilities of the mental health care resources in IHS. • Many patients prefer to see their primary care doctor as opposed to “a psychiatrist,etc” • Less stigma and often much more accessible care in PCP settings.

7. What reattaching the mind to the body might add for providers. • Collaboration, support and ongoing training of primary care providers can: • Increase recognition of mental disorders possibly leading to increased treatment • Increase in effective treatment of primary psychiatric diagnosis • Increase feelings of competence among PCP’s • Decrease feelings of demoralization and sense of being overwhelmed • Decrease spending due to ordering of laboratory and invasive tests as comfort level with psychiatric diagnosis increases.

8. What benefits might there be for our patients. • Increase compliance amongst patients who are generally more comfortable with their PCP’s • Treatment of disorders that affect their quality and quantity of life • Improved sense of well-being • Destigmatization of psychiatric illness • In children, decrease in drug use, pregnancy, suicide, and a host of other problems. • In adults, decrease in disability, jail, suicide, etc

9. Ideas for improvement • Ask PCP’s what they think would increase comfort and desire to effectively treat mental disorders and then address perceived barriers. • Consider a pilot project to create a usable algorithm for treatment of a common psychiatric disorder in primary care • Strive to make collaboration a norm as opposed to an exception