Between the high prevalence of mental health diagnoses among primary care patients, compounded by the high prevalence of mental health diagnoses among the low-income and uninsured, Clinica providers were finding themselves spending huge amounts of time diagnosing and trying to manage mental and behavioral health conditions. They were seeing people suffering from depression, people with complicated needs, people who wanted to talk. But having clinicians spend 45 minutes with these patients to give them the care they needed was an ineffective use of resources since it reduced the amount of health care the clinicians provided to other patients.
Over the last 18 months, Clinica has built a collaboration with the Mental Health Center Serving Boulder and Broomfield Counties (MHCBBC) and Foothills Behavioral Health (FBH) to create a new model of providing behavioral health care at our Boulder and Lafayette clinics. The Integrated Services Project aims to provide immediate access to behavioral health care in the primary care clinic. In our two Boulder County clinics, we have added a full-time licensed social worker to each pod (for more information about the pod model, see "Our Facilities"). This person functions as our behavioral health professional (BHP).
When a clinician suspects that a patient might benefit from counseling, he/she can walk out the exam room door and walk back in a minute later with the BHP and the beginning of mental health treatment. The clinician can make introductions, make a comfortable hand-off, move on to the next patient and let the BHP bring in her/his expertise. The patient doesn't have to make another appointment, travel to another location, make another co-payment and get to know yet another health care system. All of their care - for body and mind - can occur within Clinica's facility.
Most of our patients with depression need short-term (6-12 months) treatment, but on-going surveillance for symptom recurrence. Many benefit from antidepressants. Short-term treatment includes adequate follow-up, including medication adjustments, telephone check-ins and basic self-management skills to assist recovery and maintain health. Some require long-term (more than 12 months) use of antidepressants. A small number need ongoing access to mental health professionals (therapists and psychiatrists), which is also available at Clinica. The Integrated Services Project also brings a psychiatrist in to the clinic for 10 hours each week to see patients and provide consultation to clinicians.
The BHP takes the time-consuming part of treating a patient with mental illness off the hands of the clinician. In keeping with the IHI's Idealized Design of the Clinical Office Practice, Clinica's care teams are "co-located," with all service providers on a given team or "pod" within line of site of each other and patient care rooms. The clinician, BHP and psychiatrist all share the same patient file, available through Clinica's electronic health record system. Having one file that all providers can access means they all have a full picture of the patient's needs and treatment modalities. They have a complete list of medication that isn't cleaved by "psychiatric" and "physical." They can all participate in one treatment plan, and the patient benefits by receiving coordinated care.