It’s Past Time To Include Mental Health Into The Doctor’s Office Visit

We’ve seen vast changes in the health care landscape, and more are on their way. Largely ignored in this reform is how we address and treat mental health issues. Smart changes could have a big payoff in helping people live the healthiest lives possible.

Treating mental illness is expensive. But the cost of not treating it is enormous. It affects our population’s health in ways that range from obesity to homelessness and addiction.

Treating mental illness has traditionally been separate from treating physical illnesses. But that doesn’t really make sense, given what we know about both today.

Beginning in 2000, Intermountain Healthcare, where I work, began delivering integrated mental and physical health care in team-based clinic settings. Team-based care is just that: a team of health care providers from diverse disciplines — physicians, advanced-practice clinicians, nurses, mental health providers, and other staff members — who work together with patients, families, and communities to provide coordinated holistic health care services.

Here’s how it works. When a patient visits a primary care clinic, she or he is asked to complete a screening questionnaire. If it suggests mental health concerns, the doctor discusses that with the patient. Mental health professionals are embedded in the clinic and can immediately interact and provide treatment, under the doctor’s guidance. There are no referrals needed or long waits to get help.

A landmark 10-year study that my Intermountain colleagues published in JAMA shows that this approach pays off in several ways: better clinical outcomes for patients; more appropriate utilization of health care services (getting the right care at the right time); and lower costs, about $667 per patient each year for those with newly diagnosed depression. Based on Intermountain Healthcare’s experience and our findings, we project that the U.S. would save at least $4 billion a year in health care costs if our model was used nationally.

The program was honored with the prestigious Hearst Health Prize, which recognizes outstanding achievement in managing or improving health in the U.S.

Some people find it counterintuitive that better care can result in lower costs, but that’s often the way it works in health care. For patients, the bottom line is that getting care in a team-based setting where medical providers work hand in hand with mental health professionals results in higher screening rates, proactive treatment for both mental and physical ailments, and better clinical outcomes for complex chronic diseases.

At Intermountain, 80 percent of mental health care services are provided by primary care physicians supported by an integrated team that includes mental health professionals. This model helps primary care and mental health providers collaborate to meet a patient’s physical and mental health needs during each patient visit. They do that by focusing on prevention and early diagnosis, integrating care processes, using computerized health records, and partnering with community resources, such as government agencies and other not-for-profit entities.

With this team-based coordination, we screen 46 percent of patients for depression, a rate more than 10 times higher than in traditional physician practices nationally. Earlier detection of depression allows caregivers to provide medical and behavioral interventions earlier.

A team-based approach that includes mental health services also improves overall health. More patients in team-based practices stick with their diabetes care protocols and have documented self-care plans. Among individuals receiving care through our integrated program, emergency room visits declined 23 percent, hospital admissions declined 10 percent, and primary care doctor visits declined by 7 percent.

The results of team-based care are conclusive — better mental and physical health, lower costs, more appropriate use of health care services, and a healthier population.

We can’t stay the course with the way most doctor visits occur today, which provide fragmented care for physical and mental illnesses. It’s time to fully incorporate mental health into the doctor’s office visit.

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