Collaborative care models important for adult, child mental health

NEW YORK — Experts discussed improving access to mental health care by utilizing collaborative and integrated care models that connect primary care providers and psychiatrists to treat adults and children, according to presenters here.

In his presentation, Steve A. Epstein, MD, professor and chair, department of psychiatry, Georgetown University School of Medicine, talked about integrated and collaborative care for adults.

For adult mental health care

Integrated care, which is a broad, more general term, and collaborative care, which comes from a specific evidence-based model and is a form of telehealth, are not synonymous, Epstein said.

“Collaborative care is team-driven, focused on improving the health of a population, measurement-guided and evidence based,” Epstein said.

Offering any kind of collaborative or integrated care improves coordination of care between primary care and psychiatry. It promotes task-shifting because specialists are not needed for all patients; it’s cost-effective and convenient for patients. Prior research on collaborative care programs has demonstrated clinical improvement in depression and anxiety and patient and provider satisfaction, Epstein said. He also said provider preference and potential cost concerns play a role in why some sites offer integrated care, but not collaborative care.

“It definitely improves outcomes and it is not very expensive — and that’s very important,” Epstein said.

The collaborative care model is not always accepted by primary care groups and psychiatrists and does not address serious mental illness and severe substance use disorders for adult patients, Epstein noted.

For pediatric mental health care

Barry D. Sarvet , MD, professor and chair, department of psychiatry, University of Massachusetts Medical School, discussed the Child Psychiatry Access Program model, which uses children’s mental health consultation teams to help primary care providers meet the mental health needs of children in a defined population.

“The purpose of thinking broadly about integration — bringing mental health resources and connections into primary care services — is driven by access to care needs,” Sarvet said during his presentation. “For us in child psychiatry, we really have been interested in not just training the pediatricians how to be psychiatrists, but how to create this relationship that could be supporting the practice. We really want to broaden the scope of practice so that the primary care providers feel like they’re also personally responsible for behavioral health.”

He spoke specifically about the Massachusetts Child Psychiatry Access Program, which features three teams who operate a call center and conduct face-to-face evaluations with the families of children with mental illness. He also discussed previous research that showed primary care providers found the Massachusetts Child Psychiatry Access Program useful.

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“One of the limitations that we’re most concerned about is this notion that if the practices don’t call us, then we can’t really help them. It’s a pull kind of model rather than a push — we’re not pushing resources to the practices — we’re waiting for them to pull us,” Sarvet said. “We’re interested in [Psychiatry Access Programs] becoming more active so that we’re actually working with practices to try to stimulate their appetite for our services.”

Matthew G. Biel, MD, of Georgetown University School of Medicine and Medstar Georgetown University Hospital, talked about three programs within pediatric primary care in Washington, D.C., to support early childhood mental health care through integration of specialty care and consultation with psychiatrists.

To educate about mental health in pediatric primary care can lead to strong patient/provider trust, long-term relationships, better access to care, and less stigma, Biel said. Specifically, mental health in early childhood pediatric primary care represents an ideal setting to screen caregivers as well as young children, address emergent concerns and prevent more severe mental health challenges in the future, according to Biel.

Biel also spoke about the potential for parents experiencing depression and how these programs can help get them the treatment they need.

“We’re finding that the parents who screened positive for depression, when they are asked if they would like to come back and get some coaching and education about how to help themselves with their depression, they say yes and that they would like to come back here and will come back tomorrow.” Biel said. Building on a relationship that they have with their pediatric site is a terrific way in to reduce barriers to getting perinatal depression support.” – by Savannah Demko

Reference:

Biel, MG; Epstein, SA; Sarvet, BD. Improving Access to Mental Health Care: Models for Working Collaboratively with Our Primary Care Colleagues in Pediatrics and Adult Medicine. Presented at: American Psychiatric Association Annual Meeting; May 5-9, 20178; New York.

Disclosures: Biel, Epstein and Sarvet report no relevant financial disclosures.