October 2, 2014
I’d like to begin by saying thanks for visiting Dane 1 in 4! We’re so excited to launch this initiative with partners from our three participating health systems—Group Health Cooperative (GHC), Access Community Health Center (Access), and UW Health.
Our first public event was a forum at the United Way on September 22, 2014. At the forum, we had 31 attendees from over 15 agencies including members of the school system, health care delivery systems, advocacy organizations, justice system, and counseling services throughout the Madison area. The forum included presentations from representatives of Access, GHC, and UW Health about their current and future planned efforts to integrate mental health into primary care. GHC and Access use the Primary Care Behavioral Health Model, along with a consulting psychiatrist. UW Health is implementing routine depression screening and the collaborative care model. Following the presentations, small groups discussed the positives and negatives they perceived about each approach. Attendees also reported back what outcomes they would like to see from integrated mental health care, and additional needs they perceived in the community that were not being met.
The groups had good discussions, and we learned a great deal to be shared back to the health systems in order to inform their care. Overall, groups liked the warm handoff from the primary care doctor to the Behavioral Health Consultant (BHC) that occurs during an appointment and thought model breaks down stigma. The model was seen as proactive rather than reactive, and there was appreciation for the fact that it allows a patient to see someone for mental health issues without having to travel to another location. Some thought this model was especially beneficial for those with low incomes, those with a low level of mental health issues or who had long term mental health needs.
Questions and concerns brought up in the groups were different for each of the models, with some overarching themes. Concerns about screening and collaborative care was that the model seemed impersonal and the nurse care manager in this model may not be properly trained in mental illness or have a particular interest in mental health. Concerns about Primary Care Behavioral Health included how well the doctor communicates the patient’s problem to the BHC and vice versa in the warm handoff. Concerns about both models included how those with substance abuse were managed, and the process by which referrals for more serious cases were handed (i.e. serious mental illness that exceeds the scope of care that can be provided at the primary care doctor’s office). Groups also wanted to know how integrated care could best be linked back to community resources, in order to provide broader coverage for patients such as managing substance abuse, domestic violence, and linking to schools. Several groups also had questions and concerns regarding the use of medications in this model, including how the primary care doctor can accurately prescribe for the patient when the BHC handles most of the patient’s mental health issues and how often medications are prescribed. Another concern was how these models could be funded in other primary care settings.
Our next step is to expand this conversation through gather input from community members who watch videos of these models in action. Please take our survey, and encourage others to do so. Look for our team at public events like farmer markets. If you have an idea of where we can ask people their opinions, please let us know.