ACHE 2017: Carolinas Health integrates behavioral health, primary care to improve diagnosis, treatment

Doctor patient
Carolinas HealthCare System is integrating behavioral health services into primary care.

CHICAGO—For many primary care physicians, asking patients about their mental health is like opening Pandora’s Box.

They're afraid of what might come flying at them and worry they won’t be able to offer those patients any help for their depression, anxiety or other mental health condition. So Carolinas HealthCare System has set up a program to integrate behavioral health services into primary care offices, Martha J. Whitecotton, R.N., senior vice president of behavioral health, said in a presentation Wednesday at the American College of Healthcare Executives’ 2017 Congress in Chicago.

With one in four adults suffering from a diagnosable mental disorder, the healthcare system wanted to make sure patients were diagnosed and treated long before they might end up in a crisis situation. With proper diagnosis and effective treatment, the recovery rate for patients with mental illness is 60% to 80%, but the sad news is that rate is typically only 5% to 10% because of limited resources and infrastructure, Whitecotton said.

“We know integration of behavioral health services into primary care works,” she said. What’s different about the Carolinas Healthcare program is that they deliver mental healthcare to those patients using telehealth.

It works like this. Patients waiting to see their primary care physician fill out a questionnaire that screens for depression and other mental health issues. A medical office assistant enters the results into the electronic health record and the primary care physician has the results when he or she sees the patient. With an issued flagged by the screening tool, doctors can ask questions to assess the patient.

Patients are more likely to talk to their primary care physician, whom they trust, about what can be sensitive issues that can still carry a stigma, Whitecotton said. 

If the patient needs immediate attention, the doctor can connect them via a video hookup with a behavioral health professional. Otherwise, they can go home and then reach out to the program. After the initial contact, mental health coaches follow-up with patients by telephone to make sure they filled prescriptions, are taking medications and that they are feeling better.

For physicians it solves a big problem: They do an assessment and then have no services to provide patients. It can take three to six months to get a patient an appointment with a psychiatrist, Whitecotton said. And patients get clinically effective treatment. The number-one drug prescribed by primary care doctors is Abilify, a drug that should never be used for frontline depression, she said.

Carolinas put together four-member teams in each region, comprised of a behavioral health provider, a nurse care manager, a health advocate and a pharmacist, said Kathleen A. Kaney, Dr.Ph., the operational chief of staff, who has developed the system’s virtual care programs.