Reducing Stigma with Integrated Care
Integrating mental health services into primary and specialty healthcare practices is normalizing the need for behavioral health care. In cardiovascular care, where mental health disorders such as anxiety and depression have been associated with increased risk of heart disease and stroke, inoffice assessments offer streamlined access to treatment.
Cardiovascular providers discuss how integrated care has improved the quality of care while helping to reduce the stigma of mental illness.
Matthew Sackett, MD Director, Cardiac Electrophysiology Services Centra Medical Group Stroobants Cardiovascular Center
We see a lot of patients who are anxious and depressed about heart disease, heart attacks, and congestive heart failure. Some people describe conditions that can be considered symptomatic of cardiac disease such arrhythmia or psychogenic spells, but they do not necessarily have heart problems. We thought our patients could benefit from an in-office mental health practitioner, so we began offering this service last fall.
Heart attacks and congestive heart failure have life-changing consequences. Depression is a significant issue and can impact a patient’s quality of life, outcomes, and medication compliance. Patients who talk to their physician about how they feel have an improved sense of well-being.
Since a licensed clinical social worker has been embedded in our practice, we have seen a variety of benefits. Patients’ emotions and feelings are being validated. Compliance has improved. Patients, particularly the elderly, are more comfortable receiving behavioral health care in a familiar setting. Having this service built into our practice reduces stigma because they don’t have to go to a psychiatrist’s office. Convenience and accessibility are major benefits.
I, too, have benefited by learning that the reason I may not be able to make a cardiac diagnosis is because a patient has a mental health issue. I have been able to walk away from searching for a cardiac cause when there was none. The service enables us to address mental health as part of a patient’s overall care.
Chelsea St. Clair, LCSW Clinical Social Worker Centra Medical Group Stroobants Cardiovascular Center
All cardiovascular patients are asked to fill out a multiplechoice Patient Health Questionnaire (PHQ- GAD-7), a screening and diagnostic tool for mental health disorders, including depression and anxiety. If a patient scores high for a mental health disorder, the cardiologist offers the patient access to outpatient therapy, which I provide on-site. Immediate access means we can collaboratively determine the appropriate follow-up treatment. I also provide support to caregivers by educating family members as well as patients about mental health options.
Having access to a mental health provider (sometimes immediately) results in improved quality of care. It also helps patients think more holistically in terms of organizing their lives to benefit their body and mind.
One of my patients told me, “I came in for my heart, and I left with a therapist. I already feel better.”
Robbie Price, FNP Managing Director of Operations Centra Medical Group Stroobants Cardiovascular Center
Our cardiovascular providers are among the few nationwide that offer integrated care to patients. By serving the behavioral health needs of our patients, we have identified and offered therapeutic services to numerous patients who are anxious and/or depressed. Since the program’s initiation last fall, approximately 2,300 patients, or 18 percent, screened positive for anxiety and depression. Of those 2300, 356 of our patients also screened positive for considering injuring themselves. Without the screening tool, we would have been unable to help these patients.
Benefits to both patients and providers are significant. A lot of people who are suffering are just waiting for someone to ask the first question. Patients respect their cardiologist and welcome their provider’s concern about their mental well-being. Our providers are more educated about mental health and have an immediate resource to provide assistance. By taking care of the whole person, we also have seen improvement in medication compliance.
Although we are not yet measuring outcomes, patients report being pleased after meeting with our licensed clinical social worker. In the near future, we will begin comparing hospital readmission rates before and after we began offering integrated care.
Mark Townsend, MD, Cardiologist Centra Medical Group Stroobants Cardiovascular Center
The embedding of mental health services in our cardiovascular practice was approached from clinical and quality perspectives.
• Anxiety and depression are risk factors for heart disease. The electrophysiology patient population, in particular, has demonstrated significant anxiety, depression, and post traumatic stress.
• The national Merit-Based Incentive Payment System (MIPS) incentivizes clinicians to perform based on quality metrics, one of which is linked to the management of anxiety and depression.
Historically, referrals for mental illness often have meant long wait times across the country. Having a mental health practitioner embedded in our practice gives us access to mental health services quickly. Rather than wait a month or more, patients can be seen within a week or even on the same day.
Prior to screening, we were not consistently asking about anxiety and depression. Integrated care takes anxiety and depression and moves it up on our list of priorities. We are having conversations with patients that are more holistic. We explain to our patients that many people have mental health issues, and we now have a full-time coach who works only with our patients, further validating that other heart patients feel the same way. Our patients are thanking us for providing convenient access to mental health care.