Behavioral Health Integration
One quarter of all American adults suffer from a diagnosable mental health disorder every year and it is estimated that primary care physicians manage 40% to 80% of these patients. Further, rates of detection and adequate treatment of mental health disorders in primary care settings are currently suboptimal. In addition to issues with access to services, mental health disorders can lead to poor management of physical health conditions and excess use of services leading to an increase in healthcare costs.
To address these issues, Partners developed a Behavioral Health Integration program that provides tools and resources for primary care providers to help manage patients with depression. We employ a team-based collaborative care model, which includes input from psychiatrists, social workers and non-clinical behavioral health care coordinators. The BHI program was launched in 2014 and we are implementing our efforts in a phased approach.
Core components of our Behavioral Health Integration program include:
- Screening: Universal screening program in primary care for mental health disorders (i.e. depression, anxiety and substance use) using brief well validated tools
- Clinical support: Consulting psychiatrists and mid-level health providers, functioning as mental health specialists virtually or physically integrated into our primary care teams
- Education: Educational programs to train primary care personnel in brief interventions for improved disease management such as motivational interviewing, behavioral activation, problem-solving therapy, and other first-line interventions suitable for primary care
- Workflows: Standard workflows in primary care for the identification and treatment of mental health illnesses, starting with depression
- Technology: Telehealth technologies to improve access to specialty care and provide care in the most effective cost-setting
Data: Registries to track mental health outcomes and provide prompts to ensure that follow-up screening tests are administered at periodic intervals and treatment plans can be modified if needed
Below are descriptions of two active programs within the Behavioral Health Integration Program.
Depression–Consultation, Assistance with Resources and Education (D-CARE)
D-CARE is a Partners-wide program available to all adult primary care practices in the network that need assistance with managing patients with depression. We provide primary care practices with a dedicated team of behavioral health professionals who can answer questions regarding diagnosis and treatment as well as provide education and resource information that will benefit patients. The behavioral health team includes Resource Specialists, Social Workers, Psychiatrists and Psychologists. This integration of services means that primary care patients are able to receive care for depression that is appropriate and timely.
Our Collaborative Care program uses a specific evidence-based approach (based on the IMPACT model) to manage patients with depression. This treatment model has been shown to improve depression symptoms and decrease overall healthcare costs. Through this program, patients with depression are connected with a behavioral health care manager who will help the primary care team monitor the patient’s response to treatment and can work on behavioral interventions with the patient. A consulting psychiatrist provides guidance to the team on treatment recommendations. We are currently piloting this program in a number of practices across the network with the goal of making it available to all primary care practices at Partners over the next few years.