Transcript Mental Health Services Offered by a Primary Care Provider

Working with the County of San Diego
to Provide Mental Health Services
Family Health Centers of San Diego
October 31, 2007
Family Health Centers of San Diego
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10 Primary Care clinic sites
3 Mobile Medical Units
3 Dental Clinics
3 Mental Health clinics
 Children’s mental health services in numerous school sites
 Mental Health Services offered at 4 additional primary
care clinic sites
 One of the largest community health center systems
in the country; FHCSD assisted 106,691 patients in
2006 with over 368,800 patient visits
Mental Health Services
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Individually contracted with San Diego County since 1998 for
adult mental health services (Logan Heights Family Counseling
Center)
Individually contracted since 2000 for children’s mental health
services (Logan Heights Family Counseling Center, East County
Family Counseling Center, numerous schools and homes)
Joined Federal Health Disparities Collaborative movement for the
treatment of depression in 2004; genesis of FHCSD’s integrated
primary care services (North Park Family Health Center)
Subcontracted with San Diego’s Council of Community Clinics in
early 2007 to expand the integrated model (City Heights Family
Health Center, North Park Family Health Center, Grossmont
Spring Valley Family Health Center)
In CY 2006 29,765 mental health visits, of which
1,093 were integrated visits in the primary care
setting.
The Case for Providing Mental Health Care in the
Primary Care Setting
 28% of Americans have a diagnosable mental health and/or
addictive disorder; less than one third ever seek
treatment .
 Some 60-70% of primary care visits have a psychosocial
basis.
 Majority of Americans receive their care for behavioral
health conditions from a primary care physician.
 People who report persistent depression have annual
adjusted medical costs that are 70% higher than those who
do not report having depression.
 THE MEDICAL UNDERSERVED ARE AT HIGHER
RISK FOR POOR HEALTH STATUS; HAVE MORE
UNMET MENTAL HEALTH NEEDS THAN THE
POPULATION AT LARGE.
PREVALENCE OF PSYCHIATRIC DISORDERS
IN LOW-INCOME PRIMARY CARE PATIENTS
Psychiatric Disorder
Low-Income
Patients
General PC
Population
At least one psychiatric Dx
Mood Disorder
Anxiety Disorder
Alcohol Abuse
Eating Disorder
51%
33%
36%
17%
10%
28%
16%
11%
7%
7%
- 35% of low-income patients with a psychiatric diagnosis saw their PCP in the
past 3 months
-90% of patients preferred integrated care
Source: Mauksch LB, et. Al. Mental Illness, Functional Impairment, and Patient Preferences for
Collaborative Care in an Uninsured, Primary Care Population. The Journal of Family Practice, 50(1):
41-47, 2001.
Unmet Mental Health needs in our
Populations
 Percentage of African-Americans receiving needed care is only
half that of non-Hispanic whites.
 Nearly one out of two Asian-Americans/Pacific Islanders
experience trouble getting mental health treatment due to language
barriers (only some 17% seek treatment).
 Among Hispanic/Latino Americans with a mental disorder, fewer
than one in eleven contact a mental health specialist (fewer than
one in five contact their general health care provider regarding
mental health concerns). For immigrants, the numbers are fewer
than one in twenty for a specialist, one in ten for primary care
provider.
 Additional factors are poverty, lack of insurance coverage, stigma,
etc.
- United States Public Health Service Office of the Surgeon General (2001). Mental Health Culture,
Race and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville,
MD. Dept. of Health and Human Services, U.S. Public Health Service.
Integrated Service Process
Screening
- PHQ-9 directed by primary care provider (PCP)
Treatment
- Offered by PCP if PHQ-9 score is 10 or higher
- “Warm hand-off” to therapist/care coordinator for
brief therapy and/or care management services
- Referral to FHCSD’s on site psychiatrist if needed
(consultation available on all cases, referred or not)
Frequent re-screening with PHQ-9 is done; medications
are adjusted as necessary.
Why is the Integrated Model a Good
‘Fit”?
- Patients like it
- Potential for early identification and treatment of
illness especially depression
- Stigma reduction (acceptance of treatment)
- Impact on treatment compliance for other health
conditions
- Leveraging of scarce psychiatry resources
- Comfort level of the population
- Co-location of treatment staff; team approach
- Better compliance with psychotropics
- Working as part of a team
- New funding streams allow more people to be served
Patient Point of View (focus group)
“It is a great relief to have my doctor care about how I feel”
“Having a doctor talk to me about mental health tells me that this is as
important as my physical health”
“For many years, I wasn’t aware that I suffered from depression until
my doctor helped me to identify it and treat it”
“Receiving treatment for my depression through my doctor has helped
me to move forward in life”
“I think that having my doctor ask me about my feelings is an excellent
idea; most of the time that’s what I want them to ask me about”
“If it wasn’t for my doctor asking me about my emotional state I would
have never understood that feeling depressed needs treatment”
“Discussing my emotional needs with my doctor has provided a sense
of relief and makes me believe that he cares about my well being”
Challenges
- Chaos that comes with new monies and the
strings that come with them
- Service number expectations for partial year
contract
- Changing documentation requirements
- Complex and protracted contract negotiations;
followed by very short start-up period
inadequate for full implementation
- Burden of audit details
- Short term nature of contracted services
- Documentation issue
How to reach me:
Nora Cole, MEd, MFT
Assistant Director, Family Counseling Services
Family Health Centers of San Diego
823 Gateway Center Way
San Diego, CA 92102
(619) 515-2318
[email protected]