By Elizabeth Gold — March 7, 2018
BOULDER — Treatment for mental health care continues to lag in the U.S. The Affordable Care Act has increased access to insurance for more people, however, getting treatment for issues like depression and anxiety can still be a challenge.
Programs at the federal and state level are focusing on filling in the gaps. Locally, Boulder Community Health’s integrated behavioral health team is working to make it easier for clinic patients to get the help they need. The two-fold focus aims to improve physical health by improving mental health.
Boulder Community Health runs 11 primary care clinics in the areas of Boulder, Lafayette, Superior, Longmont, and Broomfield. Each has some level of integrated behavioral care available onsite, according to Julie Jungman, integrated behavioral health supervisor. A group of seven clinical social workers is spread over the 11 clinics.
“Sometimes a doctor will bring me into the exam room for a quick conversation,” Jungman said. “It could be that the patient wants to talk about insomnia, and I can tell them a few things to try.”
In addition to these warm hand-off interventions, a patient can come into the clinic and see Jungman or one of the other social workers for up to three sessions of solution-focused therapy.
“It’s based on things a person can do to make their life less stressful — common strategies like exercising by setting up goals and action steps,” she said. “People can be referred for any behavior that can be strategized to improve their quality of life.”
The integrated behavioral team can be called in by a primary care provider to help patients work with issues like diabetes, weight loss and smoking cessation through behavioral goals and support. Depression and anxiety tend to be common struggles patients present.
“For any chronic illness, it’s not unusual for depression to go hand-in-hand,” said Betsy Duckett, director of integrated clinical services at BCH. “You can’t take care of your diabetes unless you treat your depression. We want to meet mental health needs to be able to better address physical health needs.”
To get to the heart of what a patient needs to be able to work with challenges like diabetes, for example, the integrated behavioral social worker could ask questions to get a bigger picture. Inquiring about the kind of social activities a person is involved in or what they do to manage their stress can help collect information that the primary care provider can follow-up on and vice versa.
“It’s great when a doctor tells you to lose 20 pounds,” Duckett said, but the directive can be overwhelming to a patient. When the integrated behavioral health professional asks the patient to outline steps they can take to lose five or 10 pounds and then have them check back in a month, the directive becomes an attainable goal.
The integrated behavioral health initiative started in BCH clinics four years ago and spread to all of its 11 clinics by 2017. The integrated behavioral team also provides assistance beyond meeting with patients when their primary care provider asks them to step in during a visit and short term follow-ups.
“People who have depression and anxiety can be daunted by the idea of finding a psychiatrist or provider,” Jungman said. “We help them navigate by helping them figure out who’s in their network and recommending three to four people in the community we think are a good fit.”
Monica Bartoli, D.O., is a family medicine physician in BCHs Northwest Family medicine clinic in Superior. One of Jungman’s tasks sometimes includes reaching out to patients Bartoli has seen about two weeks after the appointment to find out how a medication change is affecting them.
“For me, it’s helpful knowing how my patients are doing two weeks after care in case we need to change medications or make adjustments early on rather than waiting for their next appointment in six weeks,” Bartoli said. “It used to be that we would give referrals to patients for mental health care and then let them loose. This bridges the gap for patients who don’t know how to navigate the system.”
The integrated behavioral health program in BCH clinics is rooted in a few national concepts and programs. One, the Advanced Primary Care model, focuses on building closer connections between primary care and other clinical care as well as community-based services.
Patient-Centered Medical Home is a care delivery model where a person’s primary care physician coordinates treatment to ensure that necessary care is arranged when and where the patient needs it and in a manner they can understand.
The State Innovation Models (SIM) initiative provides federal grants to states and focuses on lowering healthcare costs, providing better care and improving population health.
SIM is “devoting resources to demonstrate the link between addressing mental health issues and improved physical health, which is difficult to do at the practice level,” said Jamie Jensen, chief population health officer and vice president of strategy at BCH.
BCH received $5,000 for a two-year involvement and about $40,000 for each clinic site. The dollars have helped cover a group visit room, a behavioral health specialist position, IT enhancements to better understand its patients needs and more.