Treating body and mind
Two worlds converge when doctors and mental health providers work together.
Several Philadelphia health clinics now provide one-stop care for patients with both physical and mental health concerns.
When patients come to the Maria de los Santos Health Center to see a doctor, sometimes they end up spending time with Marsha Johnson. She’s a social worker, but says she rarely gets introduced that way.
Johnson: So they’ll say: ‘Look, there’s someone I work with that you can talk to, they work on things like making changes, or stress reduction.’ A lot of times they’ll pitch it as stress reduction, because it is less stigmatized.
When the doctor pinpoints a problem that doesn’t seem to have a physical cause, Johnson’s available for an on-the-spot behavioral health consultation.
Johnson: Or it just could be ‘I’ve known this person for 10 years. They are completely different than the last time I saw, them. They’re sad. They’re tearful. They’ve lost 20 pounds.
While the doctor moves down the hall to the next patient — Johnson heads into the exam room. She works with patients struggling with mental health issues like depression and anxiety. She also coaches clients in healthier habits. In the past, patients would have gotten a referral to an outside mental health specialist.
Johnson: But what our concern is that many people don’t make that connection to seeking services outside of our health center. So if we can get them in that moment that they’re in the health center, and at least do a piece of work with them, that is something valuable to us.
For a year now the north Philadelphia health center has been trying to integrate primary and behavioral health care which includes psychological services.
Johnson: These worlds are traditionally divided, you have the behavioral health world and you have the other world that deals with physical health issues. Most people think of physical health and mental health as completely different issues, and they’re divided even in terms of billing.
Administrators say staff here already shuttle easily between two cultures to serve the largely Puerto Rican community surrounding the clinic. Now they say providers are becoming fluent in delivering mental health care in the way that’s comfortable for their patients.
Behavioral health consultants are on-call and in the same building. Marsha Johnson used to see four or five patients a day, now she consults with eight or 10, and says it’s satisfying that she’s reaching many more people throughout the year.
Johnson: Primary care providers know how to sit with someone and get a piece of work done in 20 minutes. Behavioral health providers, we’re used to having not only one 50 minute visit, but we’re used to having 50 minute visit, after 50 minute visit.
Some say that way of working has created a system where half of the Americans who need mental health services don’t get it. The stigma attached to mental health care is one barrier, but Johnson says some people shy away from traditional therapy because they’re not ready to wrestle with their emotional problems week in and week out. That was the case with one recent patient.
Johnson: What I come to find out is that the person is in a situation of domestic violence, has been in that situation for five years, is not able to frequently leave the house, but the person has never brought this up with the provider before.
Johnson gave the woman safety information, then shared stress management techniques to buffer the patient’s emotional health while she chose to remain in her home.
Johnson: She had been getting a lot of feed back in her life of: ‘Well, just leave. Just leave the situation.’ She did finally after about a year make contact with a domestic violence agency and started working with them. But in the meantime for that year she knew she had a place to come, and she could talk about it at her own pace, when she was ready.
President of the Philadelphia Psychiatric Society Dr. Jeffrey Naser says primary care behavioral health could be an excellent door to in-depth mental health care. But he’s concerned that advanced practitioners like psychiatrists aren’t more involved.
Naser: I think that if we are talking about more intensive services, I would have concerns about, frankly, the level of expertise and the ability of the people providing those services.
But psychologist Neftali Serrano says there aren’t enough advance practitioners, especially at centers like Maria de los Santos.
Serrano: There’s a population that just is not getting care, period, and its really costing us and costing the health care system quite a bit.
Dr. Greta Stewart who directs Philadelphia’s Fairmount Primary Care Center — says she and other family care physicians have become de facto mental health care providers.
When one of Stewart’s patients — a woman in her late 60s complained that her chronic pain was disrupting her sleep, it was a behavioral health consultant who figured out that the sleep issue had begun to gnaw into the woman’s quality of life.
Something that I was aware of, but because of all the other issues going on with her and the things that we always address, her blood pressure, cholesterol, diabetes, sometimes the fact that she’s not sleeping kind of gets pushed to the back of the list.
Stewart says primary care behavioral health brings mental health issues back to the center of patient care.
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