Health care systems seek to close gap between primary care, behavioral health

WASHINGTON — In 2009, Robin Henderson, PsyD, chief behavioral health officer and vice president of strategic integration for St. Charles Health System, had a novel idea.

“I said, ‘What would happen if we put a psychologist in the sleep lab?’” Henderson said, recalling efforts at integrating behavioral health care into the hospital, which is the state’s largest health care system east of the Cascade mountain range. “I figured the sleep issues might be related to other things — anxiety, depression. So we put a psychologist in the sleep lab, and the next thing you know, we’re doing a lot more mental health evaluations and fewer sleep exams.”

Robin Henderson

The intersection of behavioral health and primary care, according to Henderson, represents a unique opportunity for identifying these conditions, treating them successfully, and integrating the treatment of these conditions into primary care and hospital settings.

Henderson’s next step was to place a psychologist in a rural critical access hospital. While there was some hesitancy at first, within 6 months the hospital was asking for a second psychologist.

“Eighty percent of people who present with mental health conditions present in primary care, and most of those are going to present to pediatricians,” Henderson said.

She said she believes that the pediatric primary care is the future of behavioral health integration.

“Pediatricians see more behaviorally disturbed kids than anybody,” Henderson said. “We don’t look at our child who is age 6 or 7 who is having issues and say, ‘I’m going to take you to the mental health center.’ We take them to the pediatrician.”

She said by incorporating behavioral health into pediatric practices, health care systems will be setting the stage for an evolving and long-term integration.

“What we want to do is put those behavioral health resources into pediatrics, and support our pediatricians, so that 15 years from now, people will be comfortable getting behavioral health services in pediatric care. Then we can transition them into adult care.”

Breaking down physician barriers to treating mental illness is also crucial, according to John Santopietro, MD, chief clinical officer for behavioral health at Carolinas HealthCare System. Santopietro discussed a conversation he had with an ED neurologist.

“He said, ‘If somebody comes in with a tumor on their arm, it’s not in my wheelhouse, but I’m not put off by it, but if someone comes in and they’re hallucinating, it kind of jars me.’”

To address this issue, Santopietro said Carolinas HealthCare has sought to reverse the culture of stigma, both in the community and among providers.

“I think it’s very common for a cultural change to happen by osmosis when you build good operational systems that help people.”

One system Santopietro and his colleagues have undertaken is a Mental Health First Aid course, which has trained 2,000 people to-date.

“It’s not rocket science, but what is rocket science is how powerful it is for cultural change,” Santopietro said. “CPR was born out of this kind of moment, when a human being falls down suffering in front of you, and you don’t know what to do, you don’t know how to cross that divide. Mental health CPR has arisen from the same kind of divide.”

He cited that even in cases where there is no stigma or bias, a mental health episode is still distinctly different from a physical emergency.

“If someone on a bus falls over and has a heart attack, I’m mostly going to be worried about him,” Santopietro said, “But if someone on the bus starts shouting psychotic insults at me, I may be worried about them, but I am worried about me as well. It’s a little bit different.”

He said for this reason, incorporating these initiatives has not been as easy as might be expected.

“There is that watershed moment that happens when a person really gets it,” he said. — by Jennifer Byrne

For more information:

Henderson R. Population health: A focus on mental wellbeing. Presented at: U.S. News & World Report’s Hospital of Tomorrow Forum; Oct. 6-8, 2014; Washington, D.C.