Making a difference, one patient at a time.
By Dr. Larry Ford, Faculty Associate, DBH Program
May 2, 2017
Primary Care Practices in the U.S. are failing to effectively treat our most vulnerable patients.
Patients who complete or attempt suicide are more likely to seek medical treatment from primary care providers for physical symptoms of mental health problems (i.e., physical symptoms of depression), making primary care the “superhighway” to mental health assessment and treatment for most Americans. In fact, research estimates that 83% of people who die by suicide had contact with their primary care provider (PCP) in the year prior to their death. More alarming still, statistics indicate that 45% of patients who committed suicide had contact with their PCP in the month prior to their completed suicide, while only 20% of suicide completers will have seen a mental health provider in that same time period.
Recent publications from OPEN MINDS have offered reasons that suicidal patients aren’t receiving mental health assessments or referrals to treatment:
- Only 68% of primary care practices report readiness to handle basic social needs of their patients
- Almost 25% of primary care practices report poor readiness to coordinate care with social service providers
- A whopping 84% of primary care practices report they don’t coordinate or communicate with mental health providers for patients with mental illness
- Depression is now the leading mental illness in the United States, affecting 26% of the population (CDC, 2013). Depression is the leading indicator of suicidality in patients, and by 2020, depression will be the second leading cause of disability worldwide, following ischemic heart disease. Yet only 4.2 % of US adults are screened for depression during visits to primary care.
Let’s imagine for a moment that these grim statistics were reported by primary care practices for assessing chronic illnesses such as Diabetes, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease (COPD). One would surmise that many local, state, and federal initiatives would be implemented to address these rates head-on to immediately improve prevention and treatment for these top killer diseases. Why is this not the case for mental illness, in general, and more specifically, for Depression, now the top chronic illness in the US and second cause of disability globally? Individuals with a mental illness diagnosis die an average of 25 years earlier than others without a mental diagnosis, yet what has the medical world done to target interventions to address this growing population of patients?
Patients afflicted with mental illness routinely visit their PCP’s for conditions that have an underlying psychological and/or behavioral component. The link between stress and development of many chronic illnesses has been well documented (Cucciare & O’Donohue, 2003). Individual lifestyle habits, including inactivity, poor diet, and alcohol and drug use have a major impact on health and therefore increase medical utilization. Patients with poor social support, or socioeconomic challenges tend to be less engaged in self-care, leading to poorer health. Many patients who present to primary care with bodily complaints are suffering significant emotional distress expressed through physical symptoms. These patients suffer more when the social and emotional causes or contributors to their disease are ignored, untreated, or under-treated by our primary care health delivery system.
Most acute hospitals make follow up primary care appointments for patients when they are being discharged from services, including inpatient stays or emergency department visits. Those follow up appointments typically seek to address only medical concerns, neglecting mental health needs.
So, there has to be a solution, right? At Cummings Graduate Institute for Behavioral Health Studies (referred to as CGI), we know the solution is Integrated Care. Integrated Care is the collaboration of behavioral and medical professionals to provide complete treatment to patients while improving overall well-being of the patients. CGI’s mission is to educate integrated care professionals to best deliver whole-person healthcare to diverse communities and to improve access to quality healthcare for all people.
At CGI, behavioral health providers are trained in medical literacy, integrated behavioral health interventions, and in entrepreneurship. This specialized training in medical literacy and the culture of primary care medicine ensures that our most vulnerable patients receive care from behavioral health providers in the primary care office. Our charge as integrated care providers is to advocate for the marriage of behavioral health and medical teams, and to strive for a harmonious union of healthcare services; to holistically serve our vulnerable patient populations.
We prepare healthcare professionals to integrate the assessment and treatment of social, emotional, and behavioral health within emergency departments, hospitals, and other specialty clinics nationally and internationally.
Here at CGI, we know there are many gaps in care. For each gap there is a patient that slips through. We aim to disrupt healthcare delivery systems by filling those gaps with innovative treatment – changes that matter to people.
Over the past several decades, each discipline of health care providers has yearned for the opportunity to make an impact and to improve healthcare for their patient population. Nurse practitioners started a training program in the mid 1960’s and have utilized every opportunity since then to innovate healthcare delivery. In the early 1990’s, the Doctor of Physical Therapy (DPT) program was created to give DPT’s power of independence and to meet the current needs of healthcare. Finally, physicians started the Physician Owned Hospitals (POH) movement because they wanted to make changes that would impact health care by improving care of the patient.
Now it is time for DBH’s to make the same impact that many other professionals have made in healthcare in the past. We as DBH’s must make our mark in a health care system that has been fractured for decades. CGI’s DBH program trains providers in how to successfully develop their own company that will not only survive, but will thrive by being prepared to face the rapid changes in healthcare. This is truly a unique and enriching opportunity for behavioral health professionals to make their mark in health care and capitalize on the opportunity to be part of the solution to the healthcare crisis.
CGI trains pioneers that will disrupt the mundane health care system. We will ensure our patients receive the highest level of healthcare. Join us in our efforts to disrupt healthcare and make changes that matter to people!
For more information on the statistics cited in this article or additional examples of how CGI students are prepared to disrupt healthcare with innovative, effective solutions, contact Dr. Larry Ford, Faculty Associate, DBH Program, at firstname.lastname@example.org.